While bedridden, I hallucinated wordless conversations with the Grim Reaper. One day, in the landscape of my mind, he rode up to me on a black steed, leaned down and peered into my face, then swirled around and rode off. I ran after him screaming "Don't leave me here! Take me with you!"
That was the last time the Grim Reaper came to see me. With his departure, I knew I would live.
I wasn't happy about it. I knew I faced a long, hard, torturous recovery. Death would have been kinder.
At some point in recent years, I found myself in a group chat. Someone joined. He was a physician who had had a patient die on him that day.
It was a case of 'agreeing to pull the plug.' The man didn't want heroic measures. He knew he was dying.
The physician described this man's final hour and how his breathing slowed, then stopped. It was weirdly cathartic. A lot of stress went out of me and never came back.
Thank you. Most of my earned income comes from writing. So I've had a bit of practice.
I hope you are well.
Mostly, yes. Everything but my finances seems to be in reasonable shape, all things considered.
I thought surely his brain is gone, and that he will be in some sort of vegetative state for the rest of his life, if he lives at all. I was already convinced that was it for him. If at that point doctor asked me weather to "pull the plug", I probably would have agreed.
I couldn't be more wrong. Not only did he live. No brain damage at all. 4 years later he's still around. Today he went on a bike ride.
I'm not sure what the odds were for him. The Nurse did tell us that with every hour he is alive his chances kept improving. Brain damage was still a very large risk. But they lowered his temperature, with an ice blanker, to help with this.
Just keep in mind sometimes people can have remarkable recoveries too, especially with modern technology.
That's much different from what is described in the article.
He was out for (if I recall) 27 minutes. It was 4 days of intensive care without us knowing if he would have any brain function, he made a full recovery.
He was back at work in a few weeks, and he's doing great (albeit with a pacemaker).
EDIT: As an anecdotal example, I know of at least one person who is walking around today because of a defibrillator at a stadium. 17 year old male took a lacrosse ball to the chest, instantly triggering ventricular fibrillation. The athletic trainer used an AED from the seating area and his heart was beating again before the ambulance arrived.
I mean I don't know how often people end up needing one of those in real life and I'm pretty sure it's some weird conspiracy by the manufacturer(s) of that device, but still.
From a study in the New England Journal of Medicine: "Conclusions: Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts."
Full study: https://www.nejm.org/doi/full/10.1056/NEJMoa1203366
DOI for Sci-Hub: DOI: 10.1056/NEJMoa1203366
I am thankful by the fact that I was there. But I am tormented by it too.
(1) An increasing, intentional aversion to one's own death and the death of others. Instead of living life in full awareness that you and those you care about are all dying (in some sense), our culture runs from the prospect of death through various forms of distraction, etc. This adolescent attitude weirdly breeds a callousness of heart. If death isn't something you ever think about, then does it really have meaning? If you always evade the fear instead of confronting it head-on, then there is no real loss or pain or grief. There is less joy precisely because of this evasion, but at least you've numbed yourself, right?
(2) The second irony is that even though this culture runs from the thought of death, it is also increasingly a culture of death in some regards. A culture of death is one where individual and collective actions that typically lead to the de-stabilization, weakening, or implosion of the society which celebrates them... are celebrated. This can be seen across the West, regardless of one's ideological slant. Cultural/societal death and decay remain invariant across ideological groups (that is, they have no privileged locus).
Psychedelic drugs can give you perspective on, well almost everything that nothing else in western culture comes even close to. Or might not, as said we are so unique that no blanket statement can express the truth.
As for me, doing some rather extreme sports puts me to situation with imminent fear of death (ie climbing hundreds of meters above ground, used to have strong vertigo all my life), that one becomes well-aware and content with it. Maybe not every climber, but definitely me.
If I experience my parents/life partner passing in my hands, it will be a tough moment. But I will manage it, no doubt there. Same goes for rest of close people. If you expose yourself to extremes, you become familiar with how you react to them, and also in managing them.
There are more ways.
I've only been in a life-threatening situation once in my life, but I've experienced the others a number of times.
My point was that our culture seems to discourage absorbing loss (within oneself) and transforming it from pain into maturity, resilience, increased desire to help others, increased motivation to maintain communities, etc. Instead, there seems to be a pressure to make death (and loss) something ephemeral, such that the loss never really occurs.
He had a terribly bad stroke that left him very much alive, but without the ability to speak, read, or write. He was a professional book reviewer and writer for much of his life, and continued to read, write, and think with voracity up until the minute before his stroke (he was setting up his Series 4 Apple Watch at his desk when the stroke hit ;) Not an ounce of cognitive decline into his 80s, which we were all thankful for.
He spent about 10 days in the hospital after the stroke. He was mostly lucid, glad to have the family around (thrilled to have his grandson there), but clearly frustrated that he literally could not say a word to us. At one point I handed him his iPad Pro so he could, perhaps, type a bit, but he looked at me and shrugged when the keyboard popped up. That part sucked.
He developed a heart arrhythmia and pretty severe pneumonia very quickly, and after a week or so of minimal cognitive improvement, the attending sat me, mom, and my sister in a room to discuss plans. He explained that, of course, they could and would do the "everything we can" bit if we wanted, but that dad's Living Will (*note: highly recommended for everyone to get one) was clear that if he couldn't live a comfortable life after this sort of debilitating event, he wanted only palliative care. The attending also explained that there was "a 0% chance he'll regain cognitive abilities at this age to live anything near a normal life."
It took us less than a minute to all vehemently agree that the right decision would be to move immediately to palliative care, to let things take their course, and let him spend his last hours/days in peace. The attending told us he was shocked at how easily we agreed -- that most families have a hard time letting go and that he often has a difficult job trying to balance the need to be pragmatic with the wishes of families who might not be in a rational state of mind. He actually thanked us for being so level-headed. Dad died about 2 days later in absolute peace, with family around, a warm and wonderful nursing staff taking care of him, and honestly, I wouldn't have had it any other way given the circumstances.
I share this not to gloat or preach that our family is somehow better than those who choose to request "full code", but as an anecdote to let people know that it's ok to let your loved ones go peacefully. Even in the months since this happened, none of us have even a single ounce of regret about the way things were handled.
I writing this not inject doubt in your decision, and there are many differences, but I would like to share how impossible the decision can be. I read articles like this and acknowledge the massive amount of unnecessary pain many has to go through in their last days, but if I end up having to make a similar decision I don't know what I would do or think.
My dad has ESRD and we've had some conversations about what he would want at the end. Many of the potential issues we've discussed involve getting 2nd+ opinions if necessary... but he also makes it clear (and I agree with him) that at some point the treatment and recovery process itself might not be worth it for an unknown recovery for him.
I think this communication respects that this is a difficult decision, and I've come to the conclusion that decisions can be reached that may not be the "best" objective decision (e.g surviving another 33 years) but it is a decision that the person supports, so that you as a survivor can be at peace with it too. So like, if my dad were in a situation similar to your relative - I already know that he would feel that the numerous procedures and years of recovery outweigh 33 more years of life. I would not seek full treatment. Knowing this makes me at peace with anything that can happen, more than anything else we could do.
I was inspired largely by Atul Gawande's book "Being Mortal" - where he talks about and discusses ways that we can figure out how to live our life at the end, rather than be worried about death.
Yes. Having the conversation before really helps. Not only is it said to put less stress on those close to oneself, but it put things in a bit larger perspective. A 2nd+ opinion is also critical, and who know what one would have said in our case. I strongly hope that the medical science is today better than 30 years ago so that the advice the doctors gives are today more accurate.
For myself I have thought a few times about what I would want, but have not reached a decision. The article is a strong reminder how badly it can and in many cases will happen when someone demand full treatment.
I could admire her tenacity in keeping him alive, but it's very clear she did it for herself, because she needed to get used to the idea of him dying, not for him.
This was no doubt difficult on him. It must have been tough on the rest of the family members as well. Lives and careers sometimes go for a toss while taking care of loved ones who become disabled. Because you love them, you want to take care of them.
That said... my dad had a living will I didn't know about until he had a stroke... one of the most painful weeks of my life.
The goal and ideal scenario is that when circumstances require it, your loved ones do not feel that they are the ones making a decision. They should feel that they are carrying out the decision that you already made for them, with minimal interpretation on your part.
I was in a similar situation with my mother, and without going into too much detail, it was a significant burden taken off of me that she had made it very clear (both in person over the years, and through legal documents) what her wishes were. It is honestly something that I'm very thankful that she did, and recommend to others, especially those facing eminent medical issues.
Personally, it was a mercy to see him die, it's strange to say but I was happy when he finally passed. He was a shell of a man in his final weeks, most his mind was gone after a series of strokes and he was being fed through a tube. He was alive in a technical sense, but he most certainly wasn't living.
This is a not-uncommon situation in end of life care. It's difficult for a family to accept a tragedy like this, a loved young woman dying in the prime of her life from something untreatable. The families often are in almost some sort of denial (understandably, I'm saying that without judgment) and demand that everything be tried, even when it's futile and ends up making the situation worse like in this case. Medical community has been working on trying to change this for years, but ultimately it seems to me like it's a cultural thing as well.
It was like pulling teeth to try to get doctors to tell me anything realistic.
I don't get the impression that anyone in the medical community is trying to change this.
Unlike my other family members, I had seen this person once a month obviously deteriorating in line with what every prognosis and statistic would say. My other family members were there every day and couldn't or weren't willing to see the progression. This isn't a movie with a pleasant ending. The only hope is for the suffering to end, from my perspective, and in hindsight, yes, it was a spot on analysis.
With regard to the doctors, now that part was just like in the movies. They hemmed and hawed and made sad empathic expressions, but didn't explain the possibilities at all. They just assume everyone is in a state of stupor, they probably assumed my rapid conclusions were some desensitized state of shock, just as they assumed my other family members clinging to hope was an equally dismissible state of denial.
At every turn, the doctors and nurses charged with the child's care encouraged the parents to end the kid's suffering. The parents were absolutely invested in using all of their resources to give the child "the best care". The last few years of the kid's life were basically vegetative, with frequent interruptions of how a human with an obliterated nervous system manifests pain.
I'm sorry if this reads all tragic and horrible, but that's what it is. There should be laws preventing family members from prolonging the suffering of their loved ones.
Its cruel and nothing more. I have little sympathy for the religiously driven pro-torture faction.
I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems. Just imagine the misery associated with doctors deciding to "kill people's children," which in fact in some cases would be unjustified. (Nobody can always get it right, not even doctors.)
The first gives patients and families more options in how to deal with end of life care, the other takes options away.
Yes, it takes it out of the hands of the family and actually respects the patients final wishes, that they made for themselves while still lucid.
Of course (unfortunately) most people still don't take these steps to make their wishes known. But the original comment was about "laws preventing family members from prolonging the suffering of their loved ones," specifically about an example of a young child, whose wishes were not known (and of course not really relevant for a toddler). The fact is in the absence of any advanced directive I would much rather have the family make decisions about the type of care desired by the patient than the state.
A lot of small towns in Alberta only have Catholic hospitals (which are publicly funded, but run by Covenant Health , a Catholic institution). They refuse to provide, among other things, assisted suicide or abortion services despite being publicly funded. 4/9 of Edmonton's hospitals are run by Covenant Health.
In Australia, and I believe most places with well developed legal systems, you can get in quite a bit of trouble for mistreating an animal.
No so much if you mistreat someone under the auspice of medical or aged care.
Our culture has institutionalised the mistreatment of the terminally ill and frail-aged.
There are good arguments to be made that this should be seen as a problem that should be addressed.
And when he woke up he was utterly pissed because they cheated him out of an easy death. And as a devout Mormon he was done with this world.
My born in Greece high school history teacher said the Greeks didn't care how a man died. It's was how you lived that was important. I've tried to keep that in mind.
Existing child protection laws are for the most part perfectly satisfactory, if they're actually used. The courts routinely decide on whether a parent is fit to make decisions about their child, or whether a particular decision is in the best interests of that child. Many of these cases will individually present very difficult decisions, but the legal principles are relatively straightforward.
The impediment to actually using those laws is largely that of pro-life activism - few hospitals are willing to legally advocate on behalf of a suffering child because of the fear of becoming the centre of a media circus.
Compare that with England. The doctors propose a plan, and if the parents disagree with it the doctors go to court to get an order. The court has to look at the child's best interests and the paramountcy principle means that while everyone's (parents and childs) rights are looked at it's the rights of the child that take priority.
> associated with doctors deciding to "kill people's children,"
They can already do this in most of the US.
However, cases like the one I mentioned are fairly clear cut, in my opinion.
(Given that my dad was in his late sixties, I think "elderly woman" as a descriptor from my mother means eighties.)
Philosophical problems aren't solved by legislation, it is important that people stop looking towards lawmakers to push their morals.
Telling good stories – tragedies – well enters them into the popular mythos effects better choices.
Murder, rape and theft are all philosophical questions, why are they easier to resolve through legislation?
The issues you mention aren't philosophical questions in the way I am trying to express because there really isn't much of an open question. How many people are openly advocating that murder is generally acceptable? There are corner cases, specific instances, etc. that are up for debate but on the whole there is little question, murder is wrong and there need to be legal remedies when it happens.
That is wholly different from the end-of-life issues we are talking about. People's opinions and behaviors are all over the map and there is generally no consensus about anything. It is not a problem that is obvious and it is not a problem which has existed for much time. Murder has existed forever, the ethical question about when and how to use medicine to extend life is very new and has had only a little public discourse.
we do our best (most of us at least) to create laws that are just and fair, but ultimately law is a pragmatic measure taken to prevent societal collapse. murder is illegal because you can't have a viable society where anyone can kill anyone else at any time without penalty. whether or not you treat dying patients humanely doesn't really threaten the stability of a nation in the same way.
It's a competitive industry. So, an insurance company's profit is based on total healthcare costs. The only way for the industry to make more money is to cover more people, or for healthcare costs to rise.
Put another way, if total healthcare spending was 0$, their total profits would be 0$. They can cut internal costs somewhat, but that's about it.
This would be inconsistent with the profit motive, which incentivizes patient treatments not cures.
This tired old, inaccurate, and moronic belief that evil capitalism only wants to make people suffer, where good moral socialism would solve all of our medical problems fails even a elementary glace at history and reality
I appreciated that.
> I don't get the impression that anyone in the medical community is trying to change this.
This is, in my experience, completely wrong.
This is true. I think that it's also a religious thing as well, and almost Christians. Other religions are more accepting of death, but Christianity has taught many to sincerely believe that Jesus himself would step into the room and heal their loved one, therefore every attempt must be made to save them.
This is something I've seen first hand in my years as a Paramedic. Patients with absolutely zero quality of life, yet remain a full code, in a nursing home. Family hasn't visited them in months (maybe coming 2-3 times a year tops) but there's evidence of a direct deposited social security or retirement check going somewhere. It's sad and I wish that we had a huge cultural shift regarding end of life care.
In my own experience growing up in church as a pastor's kid and attending a lot of funerals, people at Christian funerals tend to be a lot more accepting/less obviously distressed than people at non-religious memorial services.
I think what you're describing has more to do with the American scientific optimism of the 50s and 60s and it's left over impact on American culture than it does with any particularly religion.
My parents generation truly believed that cancer, heart disease, and many other common ailments would be cured by the time they were old.
Sam Altman says he “fully expects” his brain to be uploaded to the cloud someday. Is it any different this time, or do humans always delude ourselves about our mortality?
It's not fair to the person ready to die, but there's a lot of pressure put on people (through TV, movies, friends) to fight for those you love, even when they don't want you to.
As a whole, I think that Americans are woefully unprepared for end of life care. I encourage people to have an advance directive on file.
- Christians take the afterlife very seriously. One must be judged by God. Regardless of how confident you are in your final destination, the prospect of being called to account for your actions in front of an omnipotent being is not something they take lightly.
- Protestant Christianity teaches that one must be "saved", that is, accept Jesus Christ and have a profound spiritual experience and subsequent spiritual connection with God. Many Christians are honest people who may not have had such an experience and are aware of this fact, which naturally creates fear when the end of life approaches. In other words, they may have doubts about whether or not they are indeed saved. The alternative to being saved of course, is spending an eternity in hell. As you might imagine, this can be nerve-wracking.
- Christians believe that whether or not someone ought to live or die is in God's hands. They take the view that whatever humans ought to do to extend life ought to be done, since death will come when God wills it. Choosing to stop life support is tantamount to choosing to end someone's life, a power they believe only God wields righteously.
- Lastly, regardless of one's personal or religious beliefs, death is scary. I think the appropriate reaction to a Christian (or any other religious person) who is terrified that they, or their loved one, may die, is not observing that this fear may be incompatible with their professed beliefs. The appropriate reaction is compassion.
Note: I'm an atheist, so telling me that all or part of the above is irrational is...uh...preaching to the choir.
Maybe it is. Maybe it isn't.
But the qualms come from relatives not wanting to be responsible for killing grandpa.
Also, the decision to 'pull the plug or not' is agonizing for everyone, not just one specific group.
And it's definitely not 'irrational' to fear dying.
On the flip side, couldn’t life support be considered thwarting God’s will?
Psalm 139:8 ("If I ascend up into heaven, thou art there: if I make my bed in hell, behold, thou art there.") has often been discussed in the context of the fate of those who commit suicide
It's no different from somebody wanting their loved one to live, and God disagreeing and the person passes away.
So next time you hear that reinterpret it as "wow I must be doing something right if God wants the same thing I want".
Are you wrong? No. You just don't have all the info. Could be the same here, you might be totally wrong as you say, or it could be you're not wrong, you just don't (and can't) know everything involved.
What is not, is not. Omnipotence means "being able to do anything that is possible to do", not "being able to do anything that is possible to be spoken of". Re-stating your argument:
* "He could even make a square circle"
* "He could even tell a true falsehood"
* "He could even do that which contradicts itself"
Making a rock too large to lift is "He could even make something that He could not control". What you have wound up rhyming with is Anselm's argument for the existence of God  - for if your god can make a rock to heavy for him to lift, then there exists a greater omnipotence that could lift that rock. Therefore, your god is not omnipotent, and is not god.
Would you say that omnipotence includes the ability to define what omnipotence means?
My limited understanding of theology is that polytheistic religions resolved a lot of this by not having omnipotence, and by having hierarchies of gods. You had a sort of overarching force of nature thing that gave creation to everything else, and to which gods answered. And then you had gods like Zeus that were almost all powerful, but still bound by laws of the higher tier being/force/whatever. And below gods like Zeus you had another tier that obeyed even more rules, but was still more powerful than a mortal.
Dualistic religions postulated that there is god and an evil counterpart with which god is in eternal struggle. God in this sense is not omnipotent since an omnipotent god could defeat any foe just by changing the rules of the struggle.
Monotheistic religions hold that there is only god, an omnipotent being and the source of all creation. Christianity is an inconsistent mix of this and dualism where god is omnipotent, yet cannot just do away with the devil.
Same as how the concept of alphabet does not apply to a number, or how you can't divide by zero.
It's simply not a concept that can be applied.
That would imply that there are two things: God, and this creation of his "the ability to can't", but since God is just "one" this entire concept can not be attributed to him.
You can read about "Negative theology" if you are really interested in this topic.
> I think this shows that the concept of omnipotence is itself logically incoherent. It’s the theological equivalent of Russell’s set of all sets that do not contain themselves.
That's not a new idea, wikipedia has: https://en.wikipedia.org/wiki/Omnipotence_paradox
The subsection "Paradox is meaningless: the question is sophistry" covers it about as well as I could in a comment here.
That's very variable with denomination.
Nope. Everybody dies, with rare exception: the Bible is pretty unequivocal on that. I hate to drift so close to playing an SJW card and I'm not saying what you've described never happens, but please don't tar us all with the same brush and, instead, educate yourself.
Sure, even the most deluded Baptists realize death is inevitable. And they're not entirely hostile to DNR. But their approach to the sanctity of life, and the countless stories of last minute miracles, means they will take an aggressive approach. "Pulling the plug" was often considered suicide / murder, and many in my church considered it a start to mass euthanasia of the old and chronically infirm.
Perhaps your experience in Christianity is different. But you should educate yourself and realize your experience is far from universal. The brouhaha over Terri Schiavo was not an anomaly in my former faith. The evangelical approach has created much suffering for people in end of life care. I have no qualms about tarring such people for what they perpetuate.
Sure people prayed for sick family members, but the focus was always more on repenting and being reunited in heaven than it was on staying alive via miracles. If anything, in my experience, devoutly religious Southern Baptists tend to be more accepting of death than less religious people.
>"Pulling the plug" was often considered suicide / murder, and many in my church considered it a start to mass euthanasia of the old and chronically infirm.
I agree that evangelicals tend to be very strongly against assisted suicide. Part of that is that anti-abortion activists groups are also anti-euthanasia and part of their tactics include scaring old people by convincing them that assisted suicide will eventually lead to forced euthanasia.
I don’t however believe that most or even very many evangelicals believe that removing someone from a ventilator is equivalent to suicide/murder.
Once the death happened, they were accepting of it. But they fought like hell until that moment.
This was my experience. There is (or used to be) some variance between SBC churches, so I don't doubt your experience was different.
I didn't mean the focus of prayers. I meant the overall focus--sermons, Sunday school etc...
>Feeding into all of this were the half-baked stories from the pulpit of healing. Of some miraculous last minute renewal of health. Always the result of praying, fasting, etc.
I've heard thousands of hours of sermons in multiple SBC churches from dozens of pastors, and I've been to multiple conventions as a delegate. While I have heard stories about miraculous recoveries from the pulpit, they were fairly rare and not an important focus.
The focus on miraculous healing sounds more like a charismatic church than an average SBC church.
Now as you said, there is a lot of variation among SBC churches. It sounds like the churches you were involved in had a much more of a charismatic bent than was common.
And on top of all that, I sometimes conflate my "church" memories with school. I was sent to a strict Baptist Christian school. A very conservative and horrible place which often made my church look like a bunch of hippies by comparison. Sometimes the terrible theology from one bleeds into the other.
My mom went through her metastatic cancer surrounded by an amazing hospice chaplain who happened to also be her Sunday School teacher, helpful Sunday School classmates and other church members, and realistic expectations all around. She was pretty blunt but cheerful about what was happening, and insisted on a DNR when it started looking really futile, which one of her fellow Baptist friends witnessed without hesitation.
It was a great comfort to be able to begin her obituary, "she passed away at home, surrounded by her family and friends," and her church community believed that she went to meet her Lord in peace.
Think back to the Terri Schiavo case. While she was apparently Catholic, the sentiment was the same. Her family believed that she was going to be healed by God (or Jesus, either one) and would make a full recovery.
I also think that years of medical dramas on television have given many many people (again, not everyone...) unrealistic expectations of medicine.
That's a mischaracterization of what happened. They had several arguments.
1. They believed that she wasn't actually in a persistent vegetative state, but that she was still conscious and could understand what was said to her and display emotions. They even found doctors (who were probably wrong, but they still had validation) to agree with their theory.
2. They believed that her husband wanted her to die so that he could get remarried while still inheriting her estate.
3. They didn't believe her husband when he said that she wouldn’t want to be kept alive via feeding tube. They believed that since she was a devout Roman Catholic she would have seen denying nutrition as euthanasia even though she might not want to be kept alive via a ventilator. This is the main religious argument made at the time, and it’s more of an argument about her wishes than a religious argument.
4. They found doctors who told them that there was a chance of improvement through experimental procedures.
They also seem to have made money since then by taking a salary to run a foundation in her name. It seems like either they were just parents who didn't accept that their daughter was in a persistent vegetative state, they believed the doctors who told them that their was small chance of improvement, they were trying to make money, they really hated their son-in-law, or some combination of all 4.
It didn’t seem to have anything to do with them thinking that God was going miraculously heal their daughter. It’s definitely not evidence of wide scale Christian refusal to accept death.
True if you are speaking only of the events you described. However you left out the national debate(and I use that word loosely) over the matter. That was evidence of wide scale Christian refusal to accept death. It took the typical form of the extremists appealing to and living under the shield of the larger group of religious believers who didn't exactly believe the same, but presumably felt some need to side with a "believer".
And even among those groups, I don't remember it being a common argument that she should live because God would miraculously heal her.
The argument was that (they believed) she was still conscious and that her life was still worth living.
That is what I would call a distinction without a difference. The underlying motivation for those actors is still the same no matter you call it religion or politics. They appealed to the identity of the religious and largely got the response they wanted. Same thing Russia did with BLM except Russia was inciting both sides.
Christian's believe in miracles/supernatural by definition. This includes faith healing. It absolutely prevalent everywhere in the religion and its different sects. The Terri Schiavo incident was not specially exempt from this belief.
The first assertion is true. The 2nd doesn't follow from the first--many Christians don't believe that miraculous events still happen. Faith healing in particular has a very specific meaning, and many denominations outright condemn it.
As to what extent belief in the possibility of miraculous healing affects the vast majority of Christian's actions. I'd say no more than the belief that there is a tiny chance that a science might be wrong about a diagnosis affects a non-believer's actions.
>It absolutely prevalent everywhere in the religion and its different sects. The Terri Schiavo incident was not specially exempt from this belief.
People existed who believed that there was a small chance that God could choose to heal her. It doesn’t follow from that premise that these people were against removing her feeding tube because of that belief--it certainly doesn't follow that the broader Christian community was against it because of that belief. That was not the stated reasoning of the vast majority of her parent’s supporters.
This case just doesn’t provide evidence that Christians are more likely to pursue aggressive treatment or less likely to accept death because they believe God will save their family members because there was no national debate about miraculous healing.
The national debate at the time was primarily about whether or not she was conscious and was her life worth living, whether or not it’s cruel to kill someone by denying food and water, and whether or not denying food and water through a feeding tube is the same as killing someone.
We'll have to disagree on that. I did not assert there is a 100% correlation. I did mean to imply there is a high one.
> many Christians don't believe that miraculous events still happen.
I reject that assertion. I believe nearly all Christians engage in intercessory prayer at least once in a great while. Doing so shows they believe in the possibility their prayer coming true.
> It doesn’t follow from that premise that these people were against removing her feeding tube because of that belief--
You are overlooking the fact the main court challenges were by her parents on the basis she was not brain dead when in fact as a point of knowledge she was. They held the belief she might recover even after numerous experts and medical scans showed the damage was irreconcilability permanent. They then went further to cloak the case in religious themes. There were several organizations with strong ties to faith healing working with her parents. There was a large volume of innuendo and direct appeal to faith healing for the duration of the event. Some of it's even still around if you look.
This was similar to the Dover intelligent design case in that the side holding supernatural belief doesn't come straight out and say what their true beliefs are, and for good reason. Instead they attempt to sow uncertainty in court, in hopes of what they belief will come true.
> there was no national debate about miraculous healing.
You're right on that mostly, but only because it's very rare to find the open questioning of another Christian's supernatural beliefs in America. Even Mormons are generally afforded that. I won't speculate as to why that is.
It was one of many arguments for continuing care. No, it wasn't the only argument, but I remember it being a fairly common one.
I remember the dozens of websites popping up around the time and the frequent call for "prayer warriors."
there are still a few pages around, but a lot of them went away with the demise of Geocities, or just link rotted.
Yes there were people praying for her to be fully healed, but there's a difference between believing it's possible to be healed and arguing that we should keep her alive primarily because of that possibility.
The focus of the argument was that her life was already worth living because they believed she was still conscious, and other sanctity of life issues. At the end, the most common argument was that it was cruel to deny someone food and water. They were talking about how the family couldn't even give her ice chips.
The pro feeding tube people believed she should keep being fed regardless of whether God was going to heal her.
Though they held out hope, they acknowledged that she might never get better.
Their objection to withdrawing her feeding tube was not because they considered it wrong to do to a person who might recover but because they considered it wrong to do to a person.
That does not mean that they considered every life support measure to be necessary. It just means that they considered the denial of food and water to be different than something like turning off a ventilator.
This is a completely unsensitive and arrogant comment. Replace 'Christianity' with 'Muslim' or 'Jewish' and see if you still would've pressed the submit button.
Further, as a Catholic who has many friends and family of different forms of Christianity, your opinion-stated-as-fact is not accurate in the slightest.
How do you as a paramedic know what's happening to a patient's social security check?
The death of a family member can change the entire family dynamic, and greed is a powerful emotion that knows no political or religious boundaries.
It really boils down to quality over quantity. After all, I'm sure most would choose to die comfortably in their bed after a week rather than in a few months all while in excruciating pain.
I think I'd lean more towards quantity if it were a choice - my kids are very young though so right now I just want to know them for as long as I can.
But absent cost as a factor (I don't want to blow all my savings on myself - rather leave them to wife+kids), pain isn't a reason for me to go.
My early years were in the rural Third World where I had a whole bunch of near-fatal diseases as a young child and (unrelatedly) nearly committed suicide when I was a late teen, early adult.
The one thing I'd really like is a "resuscitate at all costs" marker. Imagine if there were a consent token marked upon your body, written into your bloodstream. Medical staff just test it and it says "let this man die", "put this woman through all pain so that she may have a few more days", or "kill this person actively if this happens".
There is pain so unbearable I want to quit. But I was wrong so many times in the past. Put me through it again and I'll want to quit but if I make it I'll be glad I failed to.
Force me to live. Let me say I must be forced.
Most of the comments here advocate accepting death to minimize pain, but it doesn't have to be one or the other. With the right mindset you can accept both gracefully.
A life in pain can be worth living without running towards or away from death.
Getting through each day is hard, and it's really not so easy to just 'gracefully accept' that I'll be in constant pain for the rest of my life, which will likely continue to worsen over time and possibly spread to large (motor) nerves.
Your final point is valid, but at the end of the day it should be up to the affected person to decide.
As a result the man went through a failed code attempt he did not want.
So It is pretty rough to read this article, because It describes the sad experience for the patient in such real detail.
Recently my old cat Jackie passed away. The moment I saw her not pee in the litter box but instead leave tiny droplets on the floor, I knew it was time to start planning for what the next few hours were going to be like. She was deaf, blind, failed kidney, two times underweight, and a tumor in her mouth. Her inability to eat or relieve herself had peaked. In the next four hours she was euthanized.
There's many instances throughout life that you know there's nothing you can do.
This doctor was right, your everything isn't always to spend moments with doctors. Sometimes it's to make the final moments worth it. I wasn't with Moglee. No one was. I was with Jackie, but the vet talked me out of getting antibiotics so she could eat instead of starving to death.
Click on each panel to get a larger version.
It's a very emotionally and mentally taxing job. Basically nothing that arrives under your care is good news. Often you know the potential outcomes before anyone else, including the other physicians who are sending someone in to your care. A large portion of the job is telling other specialities "No", either because they haven't done their job or because the case is "non survivable". This is necessary because you have a very limited number of beds in an ICU and if you fill one, someone else might very well die while waiting to be prioritized in. Because of all that, you are almost never the 'hero' in the story. The very best you hope for is that people acknowledge that you were able to keep someone alive long enough to get the treatment they ultimately need, or you were able to stabilize them enough to move to a step-down or palliative care department.
Then there are the families. The vast majority seem (based on my external observation) seem to grasp what is happening and make reasonable decisions. There are some amount of them however, who are completely ignorant of the pain and suffering they are imposing on their loved one. Over time it seems like a young ICU physician goes from seeing these families as ill-informed and possibly well meaning to seeing them as selfish and uncaring.
Externally I would say that it seems like groupthink is almost always a component of the decision making process. In a setting where just a single partner or other person is making a decision, they have a lot of empathy, if it is a family or group, they have empathy for eachother, but not for the patient. At least not in the way they think they do.
I'm not sure where I am going with this other than to say that as an observer to this almost every day, this article really just scratches the surface of this issue. I shared it with my partner and another ICU physician and their reaction was "that's minor leagues after a while, but your first few do always stick with you" to "I don't know why I even do this job."
Current example: 87 year old patient, already has metastatic cancer, had a stroke and is being "maintained" entirely by machinery. The family "Doctor, you have to do everything, we want her to make it to her 90th birthday"
Nothing scares me worse than death, but idea of my lungs slowly giving out over years is a pretty damned close second.
You may also want to buy a peak flow meter to quantify the obstruction when you have an attack (assuming you never had a spirometry while obstructed). Something like this will do:
I got worried about life expectancy for asthmatics recently, and it seems like, generally speaking, as long as it's well treated, the life expectancy is about the same as a non-asthmatic on average. You have to be careful when you have a severe asthma attack though, those can potentially kill you if you don't go to ER.
Here's an article from the CDC that includes a page that gives the breakdown of deaths and demographic breakdowns of it:
If you're actively wheezing at night, something is wrong and you need to get treated for it. I only have that happen to me once or twice a year, usually, and whenever that happens I'm taking medication to help combat it.
Either way, I'll have another conversation with my doctor.
My understanding was that asthma was generally a lifelong thing - my breathing was fine until I was around 30.
Allergies often get better with age, but their exact pathophysiology is not well understood.
If you have a loved one in this last stage care you can't have reasonable goals because nothing is reasonable anymore. Instead you measure success with time. The longer loved one 'lives' the better everyone did. It's irrational and harmful for everyone involved but that's how it is. That was actually what the person was asking when he ask if they did everything they could. Could she live longer?
My loved one today told me she would like to die on the operating table. She already had 4 head surgeries to remove her brain tumors. Last two last year left her physically disabled. She might need another one this year. The day after tomorrow we are doing her next MRI.
Code blue is not literally used everywhere... many places in the US use a number these days like 99 for "Blue" and then other memorable two digit numbers for more specific, less emergent needs like respiratory support or rapid response. Same thing.
There is both the PA codes, ie anything from fire (unsurprisingly often code red), active shooter, to rapid response (person still has a pulse but ain’t feeling so hot)... to full on code blue.. but most places I work these are “quick” numbers like 66 or 88.
I don’t think freaking out bystanders is a consideration.. since the non medical codes are often posted prominently in conspicuous locations, and the medical ones.. I mean who cares. But in most hospitals if you look near a nurse station you’ll find them not hidden. But who gets freaked out by a trauma alert or a code blue at of all places a hospital? there’s no saving those types.
Having worked in a number of places it is more about expediency and scale. Code Blue was fine in the 1960s.. it was basically a tack on to other colors and it’s not too confusing. Now fast forward and there are different types of teams you want to call... respiratory, rapid response, ACLS, police, psych.. colors don’t scale well for this unless you want to go off of roygbiv.. and then you’ve lost.
Edit: there have been efforts to standardize. In the US sometimes you get consistency in a region.
I'm confused by this part. It almost implies that the code also involved intentionally not saving her
What he means is that they did everything they could medically, at the cost of broken ribs and punctured lungs. But that it was probably not the right thing to do.
As an example, they intentionally didn't save her from the agony of receiving CPR.
The other thing is without an AED (a defibrillator) the success rate of CPR is quite low, one physician I know equated it to buying time for the brain, as he had never seen CPR alone bring someone back.
For the first few minutes after someone's heart stops beating, it probably hasn't actually stopped, it is just beating in a chaotic way that isn't actually moving any blood (this is known as "ventricular fibrillation, hence the "defibrillator"). The electrical discharge of the defibrillator is like someone standing up in a loud room and blowing an air horn. It shuts everyone up for a second, and hopefully the heart's normal "pacemaker" can take back over.
There are some medications that can be given to "strengthen" that pacemaker, and to make the rest of the heart a bit less "twitchy" (and therefore less likely to go back into a lethal arrhythmia).
There is a related arrhythmia known as ventricular tachycardia where the heart is beating too quickly to move any blood (and the beating is being triggered by random cells in the heart, not be the heart's intrinsic pacemaker).
If someone is unresponsive and doesn't appear to be breathing, high quality CPR and early defibrillation are what will help them. If you have an AED, put it on them and follow the prompts it gives. And AED will not do anything that would make the patient's condition worse (to hurt someone with a defibrillator, you need to be using a manually controlled one).
That's what I get for late night commenting...
> I wanted to tell him no. I wanted to tell him that if we had done everything we could she would have ...
I struggle with things like this. Its like I want to answer accurately, but then have to consciously remember the culture and consequences. Other people are so natural at this
> I had seen this person once a month obviously deteriorating in line with what every prognosis and statistic would say... it was a spot on analysis
IMHO these two are inextricably linked. Most people want to live in their own emotion-mediated reality. By not innately editing your own thoughts based on their emotional implications, you're able to arrive at more correct (but inconvenient) conclusions. But everyone else still has to take the slow road.
And yes, it's very hard to get doctors to break out of that mode when communicating. The vast majority of people they see need that mode, and it's very hard to directly convey that you are non-medical but still highly technical.
The subjects are very emotional ofcourse, which makes doing “the right thing” extra hard in the best of circumstances.
Note. I do think we could be more flexible on this matter.
However while depressing it's gloriously mind opening and motivating to do some quality stuff.
Turn the light's out
when you're leaving.
I want to
watch the car park empty.
when they're strangers.
To wave goodbye.
https://www.youtube.com/watch?v=aRUO411-vJ4 (audio of the track)
https://en.wikipedia.org/wiki/Work_and_Non_Work (album it appears on)
I can't help but wonder if there was anyone with medical training acting as a patient advocate in this and similar situations.
This is not the best explanation, but hopefully it brings you and other readers awareness of this growing specialty.
Much of our medicine feels like it's not meant for the patient, but for the people around the patient. We struggle to let the person go, regardless of their own - often voiceless - suffering.
We all feel pain. We all fear loss. Whose choice should it be to live or to die?
I feel that one rule ingrains in all citizens a notion that each of us does not have free agency over our own body. That someone else’s decision trumps our own regarding our own body.
I claim this is a perverse notion and the that feelings of the family in this article are a mere extension of this pervasive philosophy.
Arguably no: they should have stopped, reviewed, and helped her and the family decide to withdraw treatment and die with some personal dignity, but the time for that was far earlier.
Having had two in-laws die with medical staff disrespecting their end-of-life issues (in different ways) I feel quite strongly the 'do no harm' myth is being a bit over-extended. At the end, prolonging life does harm. Withdrawing anti-anxiety drugs does harm. allowing a surgeon to go ahead and risk a catastrophic stroke and loss of identity does harm.
> He had spoken with her family innumerable times explaining her dismal prognosis, the virtues of palliation and hospice care, and the harms of overtreatment. Like many families, anything other than a “full code” meant giving up on their loved one. In the midst of tragedy, changing that mindset, like the code itself, was often an exercise in futility.
I've thought a lot about death this weekend, as I knew what I was going into before I got here. The only real conclusion that I have is that I'd like to feel like I'm always doing my best to satisfy what I believe is a good life and to not be blindsided by it in life by coming to terms with it in a healthy way.
This may have been misunderstood by the author. The patient's loved one may have asked that question in a more general context, to achieve some form of closure. And the answer to this, truthfully, would have been that, yes, they did everything they could - especially in the early stages of the disease when there was still hope of minimizing the damage and/or alleviate suffering.
I understand the young doctor's judgement that the patient's loved one was partially to blame for the needless extension of the patient's suffering. It's a hard call to make, and people don't want to be the one who let a loved person go. They're afraid that they'll always be asking themselves the question whether they should really have given up on that person. That's why it's better to have the patient set the policy while they're still able to make that decision, precisely to not put relatives into that position.
After residency, they seemed to have lost an important part of their humanity - namely compassion and a desire to help people. It was replaced an air of superiority and contempt for others, tinged with cynicism and a joyless gallows humor.
I'm not sure how common this is, or how my other physician friends managed to avoid it, but it was a disturbing and obvious change that bothers me to this day.
(Though now I think about it one thing some of them had in common was wisely quitting general surgery residencies because of the massive and unprofessional mistreatment of residents as well as rampant sexism.)
My mother, over the past few years, has been going through the consequences of being a lifelong smoker. She has had cancer, aneurysms, a heart attack, and multiple breathing crises resulting in trips to the emergency room and weeks in the hospital. She has survived all of this, despite the doctors' predictions and in some cases best efforts to facilitate those predictions. They see an elderly woman with multiple terminal illnesses in pain, so they give her morphine, it depresses her breathing and causes hallucinations, and she looks and acts the picture of someone who's not going to make it to next week. That happened a year ago and my sister figured out that she was being overmedicated, and a short time after stopping the end-of-life treatment, she was able to go back home. Eventually she got enrolled in Hospice, which at first meant access to some equipment and a bit of "help", but before long they brought the morphine into the house to deal with some back pain, the amount escalated, and she ended up back in the hospital where she stopped eating, got an untreatable bowel obstruction, and rapidly lost a ton of weight. She wasn't actively being treated for anything, and all of our interactions with the doctors and hospice people were about ensuring there would be no life-saving interventions, so we questioned the point of being in the hospital. Once again, off the morphine she came back to life and went home. She didn't want to die. We have had years of decent quality time together that would not have happened if we hadn't taken an active role in preventing her from being prematurely shoved down the "old person dying" chute.
I am a huge fan of modern medical science. It saved my mother's life and the lives of many people I know. At the same time, people are human and do human things. Not everyone values the same things. My sister and I found it very upsetting to be constantly judged for wanting to do anything other than medicate my Mom to death, and as it my be obvious from my tone, I'm holding a grudge. I feel compassion for the author of this article for the trauma they had and have to experience, but I do not respect them for it is obvious they don't respect the family with the judgmental and holier-than-thou attitude.
Thanks in advance.
5 years ago, my mom was given a cancer diagnosis, and a life expectancy of 6 months. And from that day forward, there was no shortage of people lined up to tell us "there's no shame in giving up", "you don't have to fight", "die with your dignity", and "don't prolong the invevitable".
What was far more rare were the people that reminded us that anything was possible. Other survivors who had also been given months to live with an untreatable cancer, only to "still be ticking" decades later, with an active life. People that offered hope in traditional chemotherapy, clinical trials, alternative approaches like special diets and exercise.
None of these people said to fight at all costs -- to live a hellish and painful life. Instead, they offered the alternative -- that despite what the doctors were saying, the doctors didn't know how long or how well anybody would live any better than we did. They didn't tell us to ignore the doctors' prognosis, only to be open to the possibility that the prognosis would be wildly wrong, even if the diagnosis was right.
These people were the minority, but I'm so thankful we had their input.
My mom lived, without cancer growth, for over 4 years, when she was told not to expect 6 months. And while we had plenty of rough days, we had so many amazing days as well. While I can't speak for my mom, I'm as certain as I can be that she wouldn't have traded those days for anything.
This wasn't for lack of concern that she was fighting just for me. I would ask her at times whether she was just doing this for me. I'd tell her that, though it would be hard, if she decided she was done, I would support her. Her reply -- that she was grateful for the life she was still living, and didn't want that to change.
And yet still, for 4 years, I had to constantly deal with nurses she would meet, at work (as a hair stylist), online, etc. who would talk to her. Inevitably the conversation would turn toward her cancer diagnosis, and when my mom would tell the nurse or health care worker the type and stage of cancer she had, immediately the happy conversation would turn grim.
Sometimes, the nurse would say "I'm sorry" to my mom, as though (in my mom's own words) my mom had already died.
Others would come right out and say "you know that most people don't even live 6 months with that", as though somehow my mom would have made it through regular doctors appointments and treatments without a single person telling us what the prognosis was. Then came the dreaded "no shame in dying" part.
In every case, I'd find my mom depressed, defeated, and heart broken. It wasn't that she was hearing information she hadn't heard before, but rather, she was being reminded by people that presented themselves as smarter and better than us, that the prognosis was bad, that we should just accept it, and in some cases give us the impression that it was wrong to even want to fight it, as though every day that we already had together beyond that 6 month mark wasn't even deserved.
I would have to remind my mom that, at 1 year, 2 years, 3 years on, she had already proven the prognosis wrong. And again I would ask, with guilt that I was the only reason she held on, whether she was done fighting, and made sure she knew I would support her either way.
I don't relay this to try to give false hope, or encourage people to live horrible lives when they're ready to move on. I say this because I truly believe my mom would not have been happy with her life, however long, had we just accepted it from day one, and done nothing to fight it.
I say this, mostly, because the people telling us to give up or even just reminding us of how this was supposed to end, no matter how well intentioned, had NO idea the damage they did to my mom's spirit or quality of life, even as she was seeing amazing results that were not supposed to happen.
And also, the people who helped us fight, I credit to giving us the time we had, and the quality of life she had. Time that I am so grateful for.
If I have one take away to give, it's this -- if you meet someone who's dying, no matter what you believe, the best thing you can do is offer simple encouragement. Tell them, simply, "fight if you want to fight, and amazing things might happen. Don't be ashamed or pressured against accepting it when you feel like it's time. But YOU decide that, and NOT your friends, family, doctors or nurses".
Nobody is selling you anything. Doximity is a social network for health care workers. It's in everyone's interest to get this kind of information out there.
We underinvested in research. We aren't as far along as we could be, and we're moving slower than we can.
We, the voting public, are responsible for this tragedy. The US allocated just 2% of its budget to scientific research, and we elected officials who want to push it lower still.
There shouldn't have been a tradeoff between quantity and quality of life. The real tradeoff was made years earlier, between research and slightly more material comfort. We chose material comfort, and she paid the price for it.
Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause?
At the very least, we could be honest about it and say what the real reason is: we don't have the resources to try everything for everyone, and normalizing a set of not-quite-everything standards is the best way to keep the average level of care up for everyone.
Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future.
We're not talking about saving lives, we're talking about briefly delaying an inevitable death. How much suffering would you be willing to endure for the possibility of another few days or weeks in a hospital bed?
Doctors know what these deaths look like. They know what it feels like to effectively torture someone for no good reason. Doctors overwhelmingly choose palliative care for themselves, because they know that extraordinary medical efforts for very sick patients are invariably brutal, miserable and futile.
One significant problem, at least in my experience, is when doctors take that approach with someone, based primarily on their age and on inaccurate diagnoses, who has multiple serious health problems and does not die in the very immediate future.
The common view seems like an inversion of Blackstone's ratio (better to prematurely end the life of one individual than to let however many other individuals suffer). To be fair, as a personal point of view this is fine, but it may also merge with socio-economic constraints in a really ugly way. In addition, no one I've spoken to has made any effort to even consider and explore differences in how other people experience pain or view death.
When all is said and done, it can be a real shit show.
I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in sight but death. An 80-year-old with Alzheimers, diabetes, and cardiac problems doesn't have a "root cause" that you can just fix with an experimental treatment. They're old. We all get old. In that kind of case, I hope the doctors' perspective makes more sense...
My grandfather had advanced Parkinson's, but had zero intention of dying to it or its cornucopia of related symptoms/effects. So what if he has a major disease that made life many orders of magnitude worse for him? Life is still life, and death is still infinitely worse.
Giving up and accepting death may seem reasonable to some, but not for me or my grandfather. There's always a root cause, and there's always a way to keep going.
Giving up is suicide.
I assure you that this is untrue. There's a reason why people on the upper floors of the World Trade Center jumped from the windows, and it's not because they expected a soft landing. There are many, many things in this world worse than a peaceful death.
People failing to realize a truth doesn't make it less true.
Peaceful death is suicide, if chosen. Period.
Then suicide is preferable.
Stop using the word suicide as if it was an insult.
And I've seen enough suffering and death to know that not everybody shares your opinion. I've seen people who, when they were healthy, held opinions just like yours beg for death when their time had come.
Count your blessings that you've not known pain, fear, or panic like the dying do.
^^ That's an opinion, phrased as if it was a fact. It's a value judgement and nothing more. I respect that it's your opinion, but just because you fervently believe it doesn't make it objectively true.
If you wish to engage in a meaningful and productive conversation, you'll need to be more honest about separating your opinions from fact. I think that, underneath all the shouting, you have a very interesting take on the issue. I'd like to discuss it. But it's drowned out by your inability to recognize that other people can have a different -- and equally valid -- interpretation of what "quality of life" means.
(Also, no: You cannot "decide things" about excruciating pain. It takes over a person's ability to reason. Chronic, debilitating pain very much robs a person of their agency.)
The fact that you can identify what my opinion is and still not address it, preferring to have this semantic argument, is a great example of someone avoiding the conversation because they know they're in the wrong.
Actually it's a perfect example of the other kind of suicide, not due to permanent illness so much as temporary circumstances that could be resolved and lead to the person not wanting to do that. That is something for which friends, family, and medical professionals ought to intervene.
The South Tower was struck more obliquely leaving one intact stairwell, but this was difficult to locate and descend due to the huge quantities of thick, black, choking smoke. At least 600 people were unable to find an escape route before the tower collapsed. Most of these people would have likely died of smoke inhalation if the tower had not collapsed.
My reference to 9/11 was, in my opinion, entirely apposite. On that day, nearly 2,000 people were faced with no choice other than the manner of their death. Around 200 people chose to jump.
I still think the number is likely nonzero (a word I chose to indicate it may not be a high number but it is not zero) and my earlier point is reenforced: they were forced into it by circumstance, and would have taken another path had it been on offer.
It was most certainly not a "peaceful death".
Edit: I will be honest, some of my reaction came emotionally from offense at the implication that theirs was somehow a "peaceful death" (your words). The USA Today piece you cited says it was officially called "homicide". That is accurate. Assisted suicide is a totally different thing.
And if that's truly your choice, you can choose it. In fact, as the article makes clear, your choice is the default one as things are now.
But you should understand that other people's choice might be different from yours, and you don't have to right to insist that they get your preferred treatment if they don't want it.
> there's always a way to keep going.
Did your grandfather die? I'm assuming he did, since you don't refer to him in the present tense. If so, doesn't that falsify this statement?
My grandma tried the chemo. She did die anyway, which I'm sure some folks will see as a reason that she never should have tried.
Doctors bullying patients seems like a problem regardless of the direction they're pushing them.
I think one reason is because they see people with terminal diagnosis take a beating from heavy medication like chemo and being unable to spend time with their family instead of just taking pain killers and spending their last months with family and friends.
The problem is that excruciating pain is only obviously better than death if there’s something positive at the end of it.
Otherwise it’s comparable to being tortured 24 hours a day for the rest of your life.
From what I have seen I would prefer to go out in dignity at my own will instead of being an experiment of the medical machine. Others may feel different and I think both paths should be available.
What does dignity buy you if you're dead? Nothing. You can have yours, I'll spend mine to stay alive as long as possible.
In the end you will only know how you will really feel once you are in such a situation.
If you're not coming back, the doctor performing CPR will push harder and harder to try to get you to breath again. And yes, that means broken ribs.
Medicine is ugly. We rip out veins in the legs and attach them to the heart to "cure" blocked arteries and prevent heart attacks. We pull tendons out of corpses, drill screws into bones, and re-attach the knee bones... to provide additional support to torn tendons.
And in some cases: doctors tell the patient to live with the condition (ex: some peculiar shoulder bone breaks), because the treatment is sometimes worse than the ailment.
I don't know all treatments or all ailments... and even doctors won't know all the possibilities. But, the overwhelming expert opinion of the health care industry seems to be against full code. (and btw: they make money when they drag lives out... they have a financial incentive against this recommendation. The longer they drag out your life, the more money that they make.)
Mark Twain was quipping, not building a life philosophy.
Like I said, your ego-- the sense of self-- is doing a weird flex. But ok.
Pretty much every healthcare worker I know, religious or non-religious, leans towards DNR over "Full Code" on themselves. To the people who have watched others die on the operating table, they do not believe that the final moments in a hospital is worth it.
Death is inevitable. You can either have it with dignity, perhaps a week or month earlier than usual. Or, you can drag it out for weeks or months in a hospital (possibly bankrupting your family). Regardless, you'll die eventually.
There are plenty of stories about brain-dead patients staying in a hospital for years (!!) while their bodies atrophy and inevitable brain damage prevents any hope for a reasonable life afterwards. Modern science can keep someone technically alive, but at an unfortunate cost.
Its far luckier to die peacefully (and suddenly) in your sleep... without dragging out your life. Doctors for the most part know this, but they don't want to change American culture or trample on people's right to choose how they die. But its pretty clear what option is preferable.
There is literally no such thing as a peaceful death. It may sound poetic, and it may be comforting, but it's not true or real in any sense to the people actually dying.
The reality is, it's peaceful to the living, and so we falsely optimize for that.
This seems to be in the realm of philosophy, meta-science and religion. I don't really want to bring the discussion there, but I simply need to point out that many, many religions (and atheists) have different opinions on this matter. For example, a dignified death may bring you closer to the creator (emphasis on "dignified", because suicide doesn't count for some religions).
And I don't believe there's any way to properly gather evidence about what happens to someone after they die. And without establishing our religious ideals as ground rules, I don't think we can really have a good discussion on the matter.
They see the kind of suffering that prolonging people's lives with certain conditions can inflict and choose to have none of it.
Other than that your comment is incredibly rude towards people who will do everything in their ability to keep you alive anyways - if you/family so insist - and also borders on being a conspiracy theory.
I think you totally missed the point of the article. The doctor there did what you advocate, it's just that he doesn't consider that doing everything they can.
In any case, how exactly do you know what they didn't do that they could have? I don't see where you get enough information to derive any such conclusion. Considering that the doctor writing the article was just an intern, chances are he doesn't know everything they tried; how can you possibly claim to know?
I can claim to know because of all the comments in this thread, because I've had loved ones get terminally sick, because I know what every doctor says when you ask them about this, and the stark reality is it's more about the masses than it is about the individual.
We literally can't try everything on everyone because that'd lower the average level of care overall, not to mention the ethical concerns over experimental treatments that haven't been sufficiently tested.
You can interpret the text however you want, it's still entirely topical to call out the medical profession on the false notion of death as peace that they're trying to sell us for their own sakes, at our expense.
If you’ve just been diagnosed with something terminal you’d want to try every experimental treatment no matter how violent or dangerous. But if you’ve already established that nothing is working and your body has begun the shutdown process I don’t see why you’d want your last feelings to be shocks to your heart, your ribs broken or your throat being cut and plastic tubes shoved in.
Emergency reactive procedures (codes) for a 20 year old who had an accident on the way to the gym and a 80 year old in the last stages of terminal cancer are the same, the article is arguing that they shouldn’t be.
If the rest of my life will be nothing but pain, I don't think I'll want it.
Lying is consciously uttering something you belive to be untrue. It can't be your opinion at the same time.
So unless you're planning to insult the people you are talking to by calling them dishonest, you should cease this way of discussing the topic.
It's obvious you care greatly about this matter and tempers can understandably get heated, but people calling each other liars rarely have productive discussions that leave all parties wiser.
Also, I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie." Getting upset about a fact is yelling at a cloud.
And why is it obvious I care greatly about this matter? Because I've written less than a page's worth of content on the topic? Seems like a weirdly low bar...
Where opinion means "belief held", that's an obvious oxymoron.
> Also, I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie." Getting upset about a fact is yelling at a cloud.
Let me quote yourself at you:
> Stop trying to interpret my opinions as facts. Are you seriously fooled into thinking what I'm saying here is even arguably fact? Of course it's my opinion...
As another commenter already said, you can't have it both ways. Right now you're directly contradicting yourself.
> And why is it obvious I care greatly about this matter? Because I've written less than a page's worth of content on the topic? Seems like a weirdly low bar...
I said so because that would excuse your uncompromisingly hardheaded and rude conduct towards virtually everyone in this discussion. I often try to think the best of people.
I have a hunch this will go nowhere and I am not going to reply to whatever comes next.
You're right, this will go nowhere because you're trying to have a semantics argument while also being wrong about the semantics you're trying to correct.
And again, I don't care if you find me to be rude. Bringing it up is distracting from the larger conversation, about how we're being sold a bill of goods by doctors about "peaceful death" because it makes their lives easier to think about, at the cost of giving up earlier on patients.
At last, an actual substantive statement. But unfortunately, it's still your opinion.
I have no problem at all with you choosing to fight to the last and continuing to seek treatments right to the end even if you are diagnosed with a terminal illness where all known treatments have slim to no chance of success. But that's your choice, and other people might choose differently. And the problem with accusing people of lying simply because they don't share your opinion and would make a different choice from yours isn't that it's rude (though it is); it's that it's not justified.
Jesus dude, why the fuck would anyone listen to that level of hubris? What the hell kind of incentives are you giving me here, because right now my only incentive is to laugh at the person who can't actually have a conversation because they're too busy derailing it with semantic arguments about things they did understand, but didn't like how it was presented.
It has nothing to do with offending anyone. (Note that I explicitly said that rudeness was not the issue). It has nothing to do with how you presented what you said. It has to do with the substance of what you said--your accusation of lying--being unjustified.
Again, I urge you to read about epistemological knowledge. Basic philosophy concept that will educate you.
Yes, exactly, which is why I keep objecting when you express your opinion but then treat it as if it were fact.
Yikes. Okay. You goaded me into replying.
About lies and opinions: If you said something factually incorrect that you nevertheless believed to be true at the time, you were not lying.
That is why it can't be a lie when you say something that you honestly believe (i.e. your opinion).
Now it might be that "Lie" means something different in your culture, but in the English language it means "[..] an assertion that is believed to be false, typically used with the purpose of deceiving someone". (https://en.wikipedia.org/wiki/Lie).
Here's a good article on the matter: https://philosophynow.org/issues/27/The_Truth_about_Lying
Now whether I lied when I said I would not reply is for you to figure out.
You can't know their opinion is wrong, because you've already admitted that's just your opinion. It's not a fact. Your opinions are not facts.
You have pointed out no fact that justifies your accusation of lying.
You've already said what you have to say about death pretty clearly, so if I were going to derive any benefit from it, I would have already done so. But if it will set your mind at rest, no, I haven't derived any benefit from what you have to say about death.
No, it's your opinion that death is not peace. "Peace" is not a word with a single fixed meaning, so you have no basis for saying that other people are lying when they express the opinion that death is peace. All you can say is that your opinion disagrees with theirs.
> Rudimentary philosophy will help you understand this conversation, as it covers fairly extensively the truth/false of beliefs, and the very nature of what truth is. I recommend you spend some time looking into it
Sorry, not buying it. Blowing smoke won't change the fact that you're making an unjustified accusation of lying.
That's your opinion. Other people have different opinions. You don't get to declare by fiat what the meanings of words are.
That said I'm going to speculate that as a doctor being asked to do long series of futile actions while watching a person die has to be traumatic. So I can understand why many doctors like the idea of palliative care.
Suicide and euthanasia are valid options in some situations, which are up to each individual to evaluate for themselves.
The doctor in the article has been confronted to the selfish side of love too many times. People want their family members to be kept alive because losing them would make them sad. Somehow more sad than seeing them suffer and slowly die anyways.
1) Pain, often pain management becomes a much bigger issue than going all out fighting vehemently to prolong your life by a few more days/weeks/months. Its hard to understand what chronic pain does to you and your mind unless you or a close loved one goes through it. Often pain management also aligns with 'slipping gently into the night'.
2) Incentives, hospitals are in the business of making money and they's gladly run marginally useful tests and medicines until they max out whatever coffers they can. as I see its not long before the ethical/common sense minded providers get overpowered by the money making machine and give in. as it is perhaps you are not aware there was a study that concluded most (IIRC 75%) of a persons healthcare expenses happen in last 18months of their lifes. just ask yourselves this, would you rather give your inheritance to your kids & grandkids or some hospital trying to maximize profits by promising you random treatment that increases you life by a few months? ultimately this should be your decision to make but there should be strong protections around the options providers can present to you.