We are in our mid-30s and several years ago she was admitted to the ER and then ICU for 7 days for an obviously life threatening situation. (She has a near blanket NO CODE, FYI). She recovered, but there was at least 48 hours where her odds were "much worse than a coin flip" as on of her colleagues told me.
So people distinguish the different situations, in that situation she and her colleagues (she was treated at her own hospital...given that it was the best hosp in the country) knew about her NO CODE and still treated her. The reason being that medical intervention was near 100% likely to produce a positive outcome and bring her back to a normal quality of life.
However, if given a terminal diagnosis such as in the story, my wife, without hesitation, said she would choose to go without treatment. She went further and wished that this type of article could make its way to the NYT or some other outlet to get normal folks to think about. She, like most doctors, has seen way too many people "try to live" only to saddle their family with huge expenses, not dramatically effect their prognosis and basically make the rest of their lives as painful as possible.
Obviously not a fun conversation to have with your SO, but I for sure know exactly what she wants and how to ask the right questions at the hospital just in case. She also knows what I would want and how to make the right decisions.
Medicine changes, and so do your life circumstances. If you're presenting an EMT with a ten-year-old, faded tattoo, you're placing them in an awkward position due to the lack of context. Is this a decision you made ten years ago and got stuck with, or are these your current wishes? They might end up disregarding your wishes just to be safe. A bracelet with a recent date will be much less ambiguous.
And remember, with all medical decisions, you want the ability to change your mind when medical advances are made or your circumstances change. Tattoo removal sucks.
"Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and the name and telephone number of declarant’s attending physician, if any OR
The EMS provider is provided with a do-not-resuscitate order from the patient. Such an order form shall be in substantially the form outlined in Annex 1 or 2 and shall be dated and signed by all parties."
Anything else and we are required to follow all the regular resuscitation efforts.
"Do we think he really meant it? Nah, he just got the tattoo - if he really meant it, he'd be wearing one of those constantly annoying bracelets"
A tattoo (or any other non-official marking) could be anyone, like a depressed person who is going to attempt suicide.
Something related to this actually happened where I live last week. A 30 year old afghanistan vet wrote "do not resuscitate" on his arm with a sharpie and then shot himself in the chest in a hospital parking lot.
(Of course, you could say that leaving the tattoo in place is a decision you make every day, but it's much easier to remove a bracelet if you change your mind, vs. a tattoo.)
You're asking someone to make a quick life-or-death decision on ambiguous data when there is a clearly known and socially agreed upon way to express the sentiment.
Having it on an annoying bracelet that is explicitly used to signal medical intent sounds pretty good to me.
As for the bracelet, I hate jewellery and anything from my elbows down catches on anything that I'm working on with my hands, and I'm not alone - and unlike the tattoo which is only 'present' at parts of the day, a bracelet is always 'present'. Not to mention that there's all sorts of medical accoutrements that infirm people are supposed to carry with them but don't because they're annoying (prime example being the 'help, I've fallen' pagers).
Also, if getting a tattoo is less annoying than wearing a bracelet you probably have some of them already and it can become even less clear.
In any case - where is the rash of young people with 'do not rescusitate' tattoos? Everyone I've seen that is supposed to have had one is a greyhair, well out of the young-and-dumb age. And even if you do 'later regret' the tatt and don't want to stump for tatt removal, just tatt a couple of lines through it or tatt something over it.
And then there's the young people who genuinely do not want to be rescusitated - what about them? Stigma enough carrying a medical bracelet amongst the young to begin with. I just don't see this supposed grey area of young people tattooing themselves with a mythical band name.
EDIT: To put it another way, this mythical youth tattooing himself errantly is such a vanishingly tiny fringe minority. Plenty of laws exist allowing for people to freely express themselves to death. The more stringent US states have a maximum blood alcohol content of .08 for drivers, which is higher than the level at which measurable cognitive effects occur on your co-ordination and attention. If we're really concerned about 'free expression' deaths, bring that number right down. There are tons of laws like it. There is no reason not to make it another social norm to say "tattoo 'do not resus' on your chest, and you won't be resuscitated". There's no need to pander to base idiots.
You can read San Francisco's EMS protocol for DNRs--it's more complicated than just saying (or wearing) "NO CODE."
http://www.sfdem.org/Modules/ShowDocument.aspx?documentid=76... (warning: pdf)
Note that the bracelet/necklace frequently has a phone # that the first responders can call to verify the DNR.
But it doesn't matter. You're sitting in a small room with dim lights and someone tells you that you have two choices:
1. You can die a certain death, within months, with very little pain, or
2. You can try some heroic measure like chemotherapy for a minuscule chance of a multi-year moderately happy, but extremely painful survival.
Humans are programmed to have hope, and, regardless of any logic, the vast majority will choose option 2. It's just like playing the lottery. Even now, as I think about those two options in good health, I am compelled by my nature to choose option 2.
You can write, read, and interact but only for a few hours each day. Pain and fatigue take over the rest of the time. There is also so many little things you take for granted you will not be able to do anymore, or will require assistance to perform. Eating can become a chore, you may have to be regularly plug to some gruesome apparatus, also loss of mobility. Think about the last time you were sick, or injured, think of the worse moment being your new normal.
I personally can`t imagine being happy in those circumstances. I choose #1.
Each person choices should be respected, and people should be better informed on the tradeoff of each choices, which I feel is not the case in our health care system.
The only case where I could see #1 being a reasonable choice is if #2 puts such hardship on those around you that their lives become much worse.
And thus with the help of the law people are made to live as long as it is possible even when they don't want to. I'm afraid that when the policy is reversed, people would be "encouraged" to quit as soon as possible (and being afraid of such reversal the society clings to the current policy).
Somehow the society just can't understand the simple thing that the decision to quit or stay is personal and not for the society to make/enforce either way.
Agree. And forget even chronic pain. Simply having a nagging pain, a bad cold, nausea, or a bad headache is certainly enough to take the joy out of many things in life. Even a drip in my throat can kill my buzz.
What I, and a lot of people like me, are doing now by not doing #1 is gambling we'll get to do it in the future. This is an easily lost gamble, but oh well.
But if the treatment allowed me to live over a decade longer I'd also choose the treatment even if there was no chance of a new cure.
If the treatment only allows you two or so extra years, unless something is already in the late stages of coming to market, there is just no way any kind of drug or therapy for humans will get through even the earliest stages of approval in that kind of time frame.
I don't agree that only by reading "studies about biases in affective forecasting" can you be good at predicting what makes you happy.
I know if I eat good food with good friends or family I'll be happy. I've never read that in a study, but it works every single time with me. I know plenty of other ways too.
People make all sorts of tradeoffs which are non-optimal:
* Extra commute to a better job with $XX,XXX more for +1 hour/day of travel (less time for good food with family/friends)
* Move away from good family/friends to pursue better job
* Pursue career X because it's more lucrative than career Y (even though Y is more enjoyable)
There are lots of biases like this, under the assumption the change will increase our net happiness.
"This is what economists call "the commuting paradox." Most people travel long distances with the idea that they'll accept the burden for something better, be it a house, salary, or school. They presume the trade-off is worth the agony. But studies show that commuters are on average much less satisfied with their lives than noncommuters. A commuter who travels one hour, one way, would have to make 40% more than his current salary to be as fully satisfied with his life as a noncommuter, say economists Bruno S. Frey and Alois Stutzer of the University of Zurich's Institute for Empirical Research in Economics. People usually overestimate the value of the things they'll obtain by commuting -- more money, more material goods, more prestige -- and underestimate the benefit of what they are losing: social connections, hobbies, and health. "Commuting is a stress that doesn't pay off," says Stutzer."
I basically echoed the principle of "know thyself" in a relevant context.
As you say, you are echoing a principle (which verges on a platitude), but not adding a lot to the discussion unless we are willing to trust your expertise without examples. Had you combined it with your more detailed followup, I wouldn't have felt this way.
I'm not really defending my vote, just explaining my thought process since you were asking. If it helps, I've evened out my actions up by upvoting this question.
No, doctors try to make you as fully aware as possible of the options available to you, so that you or your heirs don't turn around and sue them later for 'withholding information that could have saved your life' or something along those lines. Arguably, these suits are motivated in part by the need to defray the extremely high costs of care and pushing back at the physician or caregiver about the quality of clinical care is a powerful negotiating strategy because it plays well to a jury.
Structurally, our system is designed to over-treat. With co-pays, insurance, subsidized care, and contractual discounts, patients seldom are aware of the exact cost of treatment. How often do Doctors explain to patients up front both the tests to be performed and the line-item cost (both to you and to the payor) of each?
Most doctors don't, and realistically can't, know the cost for each patient under each plan. Usually, it's a binary decision for the doctor (covered or not covered).
Try it sometime. When your physician suggests a procedure, ask what the real cost is, and whether he/she thinks that the value of the results will be worth the expenditure compared to alternatives. It's simply not something that's "baked in" to the thought process of the medical profession either in medical school, residency, or thereafter.
As for Texas, you're quite right - indeed, medical costs seem to have risen since the 'reforms' were put in place: http://www.dayontorts.com/tort-reform-medical-malpractice-to... - according to a tort lawyer, but consistent with everything else I've read on the subject.
Given the choice between now and couple years of pain later, I currently see myself choosing the former. I don't want to go through the process of becoming a disease-worn shadow of myself, and neither do I want to be remembered as one. Maybe that will change with age.
Having had 2 brushes with suicide, and multiple times being reduced to destitution, I've since learned that life is not defined by happiness; it's defined by experience. And pain is just as valid an experience as any. In fact, I'd argue that a life without pain is a life wasted. There will be joy and there will be sorrow, but every second of every day, your life ebbs just a little. It's barely perceptible, until you discover to your shock that 10 years have somehow got behind you without you noticing.
And that's when you realize that it's far better to live a life of pain than to live a life of regret, or even worse, no life at all. A random chance ignited the spark of life on our planet. It's amazing you're even alive at all, let alone able to contemplate it. Life is allotted to you in limited quantity. Guard it jealously and live it fully, regardless of how it feels. There's no arbiter at the end, except for you, saying "I lived my life to its fullest."
"I lived my life to its fullest."
In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later.
I want all the tubing. I want the cracked ribs and surgeons transform me to a piece of blubber and then anlyze the hell out of it so anyone else don't have to go through the same thing.
Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.
It's not free. It's free to you, but it is placing additional costs on the Swedish medical system, which somebody is ultimately paying for. You don't have to internalize the costs of your decision.
I'm not arguing whether or not you're a making a good or bad decision, or whether or not "free" medical care is a good thing. I'm just pointing out that providing such a system skews decision making.
It's worth noting that the US health model isn't a free-market system - the state links health care to employment, which distorts the market away from individual private health ownership, and creates patterns that make it easy for costs to creep up. The US health care model is a disaster: the state doesn't supply health care, but then also prevents the free market from operating effectively.
Germany has socialized healthcare too, FWIW. Cheaper cost per capita than our system, with better results.
My understanding is that health care is linked to employment because of the adverse selection problem that occurs in a free market of individual health insurance. Can you elaborate on why you consider this to be the government's fault?
Assume you can sign up for plan A at your company that costs 200$ a month and covers everything you want. Or you can buy Plan B which costs 180$ a month for the same coverage.
Assuming your marginal tax rate is over 10% then plan A costs you less money. Now, most company's bundle healthcare so it's harder to get that money out of the equation, but for small company's it easy to negotiate if you can get heath care cheaper though your spouse etc.
> How is the state linking health care to employment?
I understand that if you live in the US it's impractical to get private health insurance on an individual basis because there's low business in the space, meaning low competition, as well as the tax structures described by other commenters.
> My understanding is that health care is linked to
> employment because of the adverse selection problem that
> occurs in a free market of individual health insurance
(Or, if your uninsured/indigent, reduces the choices you have available to make a decision between anyway)
If I am terminally ill, I will probably reject treatment and choose to go peacefully.
Your family is your business, but I have watched both friends and family die fighting hard in the ICU. It would not have been my choice to watch them, nor for them to go through that for the sake of myself.
Fighting for the sake of fighting alone has no value.
Watching a loved one suffer is agonizing.
Lots of people put themselves into debt trying alternative or experimental therapies, even in countries with universal healthcare. The sad truth is that whatever kills you will probably not be something that the doctors can learn much from. It will be some disease that is well known, with lots of data on survivability etc.
I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are perhaps incentives to go too far that aren't there when there's no profit to be made? That's pure conjecture, though.
The choice of how much pain is worth it for how much of a chance at a longer life is going to look different depending on your religion, your responsibilities, your age, your experiences with pain, your family, your culture, etc. And yes, of course the cost of treatment will factor into that decision for both the doctors and the patient.
In a world where the only available treatment is blood-letting or getting your limbed sawed off by a hacksaw, a "do not resuscitate" policy is clearly more rational than in the Star Trek/sci-fi world where treatment consists of a doctor waving a magic iPad over your head and nanobots cure you painlessly. Since we're somewhere in between those two it becomes more complicated, but evaluating the risks and benefits and making an as informed choice as possible based on the available information still seems to me to be the rational way to look at it. Making future medical decisions based on an emotional reaction to individual cases, on the other hand, seems to me to be irrational and counter-productive.
Having seen his tour of the medical system, I desperately hope that if I were ever in that position, I'd have the strength to say no: treat the pain and I'll die in peace.
I understand that some conditions cause insufferable pain with very slim chances of surviving, but there are many success stories from people who have battled through. Its often these same people who provide the courage to others to battle on and raise money to support the families of those who have had similar experiences. We shouldn't be thinking about optimising our lives for our own happiness, but for the generations yet to come.
I will always fight for my life to the bitter end. There is no way I would leave my children to come to grips with why their father gave up without a long, hard fight.
I thought Sweden had committees to decide on what standards of care would be provided or not, preventing you from making the mistakes discussed in the article?
EDIT: Also, remember that the US government spends more per capita paying for people's health care than Sweden, but manages to spend that huge amount of money on only poor and old people who don't have employer-provided health care.
I also have "fight for life at all cost" experience, though only with animals (I provided a kitty foster home, and through that assisted in a vet clinic somewhat). It's not like with humans, but enough.
I have also seen my grandfather's last days, so maybe that influences me somewhat.
If I ever get cancer, barring some incredibly lucky circumstances when it's completely resolvable, I will avoid treatment. The suffering is not worth it, and the pressure on the loved ones is not just financial.
It's not about being tough and macho. A lingering decline can be psychologically painful for everyone involved. Pretty much everyone I know that has been involved in caring for someone who suffered a slow decline - particularly alzheimers - don't want to go through that themselves.
You say now that you may want all the tubing and to be bounced around from doctor to doctor (not all of whom know what they're doing, by the way), but it's a very different beast when you're actually experiencing it. Some folks just say 'do what you gotta do'. Others say 'I don't care what you think you'll find with yet another test, the endless battery of tests is worse than the disease'.
When you die quickly, you personally don't suffer, but those around you are stunned by the sudden, often unexpected loss and life. It seems cruel and arbitrary.
You never get a choice, though. Some people, like my father, survive their first heart attack with no apparent long term damage while others, like my mother, don't. Some people get cancer. Some people even get hospitalized for things that aren't life-threatening--but when something life-threatening does happen, those medical problems become obstacles to effective treatment.
I don't have the link handy, but there was a study a while back comparing hospice care to class 3 chemo (that's the really, really poisonous bad stuff). The study found that families of those who went into hospice coped better with the loss. Furthermore, almost counterintuitively, those in hospice care actually lived longer on average. Sometimes, taking stress off the body gives it just enough room to keep fighting on its own a bit longer...
I've lost friends to sudden deaths -- usually accidents. It's a bolt out of the blue, but it's over quickly and there's rarely much suffering.
I've lost family "after a long illness" as the news reports say, and the roller-coaster of misdiagnoses, initial treatments, exploratory surgeries, continued uncertainty of diagnostic monitoring and procedures, hope for treatment advances, false hope from charlatans and quacks, relapses, remissions, and the final, inevitable, unstoppable, and increasingly debilitating decline, tears people, families, and communities to pieces.
I've also seen cases where the end was known, but treatment brought, at a relatively low cost and with little dread or pain, an extra six months of a life that was happy and full of love. In that case, not so bad.
The one thing that absolutely shocked me is how they thought about aging and death. I kept reminding them their goal should be to find cures for everything, no matter how hard it seems. I approach every engineering problem as solvable. Maybe I can't solve it right now with the tools I have. Maybe I can't figure out a way to solve it and will have to leave it for the next generations. To absolve yourself because something is inevitable is a coward solution.
So, no, thank you. If that's what it takes to survive, I want to be cut open, sliced, probed, and, when everything else fails and I finally die, I want doctors to learn something from my death. I want them not to give up and, if they can't treat some condition, go out and invent a way to do it. You don't give up solving a problem just because it's hard.
It's their job and it's reasonable for us to expect them to do it.
The number of operations and suffering he had to endure still lives with me to this day and I could see why any doctor would choose not to go through this if they had to see such futile attempts at extending life end the same way. They flew in special equipment from the USA that was deemed highly experimental and would cut him open and try it out, only to have to cut him back open a few weeks later to remove what they put in. They tried surgery after surgery in the hopes something would be successful. They did not save his life but I like to think they at least learnt something about a cancer they simply don't see that often, that gave the next person a better shot. When they finally told him there was nothing more they could do, he asked them to stop all further treatment and to let him die on his terms.
The outlook for patients with breast, stomach, lung, testicular, skin or any other form of "common" cancer used to be as bad as pancreatic or bile duct cancer, but these days it's not a death sentence and a lot of people had to lose hard fought battles to get to this point.
You don't say in your post if your relatives were practitioners or research doctors, but if you're putting it on a practitioner to think they can beat the (studied) odds every day it is unfair in the least.
We are greatly indebted to the people who choose careers this stressful that benefit everyone else. You don't need to blame them for the current state of medical science. Trust me, they do it to themselves more than enough.
That's certainly a medical scientist's goal. It's not all the same as what I expect from a regular doctor, whose job it is to look after me - making a best effort to find or suggest cures where that is practical, or to minimize my suffering where it is not.
The leader of the breakaway Republic of Biafra died this week. He was less than a vegetable for 8months until his death.
Here was a man who was larger than life reduced to helplessness. At the age of 78, I am wondering why he was tortured for these 8 months so he would be 'alive'.
I am certain if he had the choice, he would have preferred to go with dignity. Unfortunately, people never want to prepare for such things. When it happens, their end is determined by others.
My President Yaradua, also had the most undignified of ends possible. In theory Ariel Sharon is still alive. http://en.wikipedia.org/wiki/Ariel_Sharon
I want my end to be dignified. If God forbid, I have a terminal illness, it will not be a hard decision to make. Quality NOT Quantity.
The one who lives halfway across the country was 97. He woke up at his lake cabin the morning before he died complaining of chest pain and shrugged it off but was soon being transported unconscious to the hospital accompanied by his paramedic neighbor. He slipped into a coma and the next day with several of his children at his side, was removed from the ventilator.
My other grandfather, who lives in the same town I do, was 93 and had struggled for the past several years with a progressively debilitating illness which increasingly kept him from being able to do the things he wanted to do. A couple weeks before his death his health took a turn for the worse and he quickly began losing connection with the world. He did go to the hospital and tests were done and drugs given, but we soon understood that he wouldn't recover and we brought him home. The hospice nurses and caregivers were wonderful. All his children came as did many old friends. He died in his sleep in his bedroom with his wife and children there.
Both had advanced directives requesting minimal effort to prolong their lives. My grandfather here wanted no heroic efforts and "no machines". Even so, a lot of intense discussion among his children was involved in coming to peace and/or acceptance of what exactly that meant, what the moral and ethical implications of different interpretations were, and how best to carry out his wishes.
This is what I'm now doing and what I strongly encourage you to do now:
* Create an advanced health care directive for yourself. You can get forms and examples online.
* Consider the various situations one might end up in and lay out as explicitly as you can what you'd like to be done or not done to you. The more specific you are, the more likely your intentions will be followed and the less your family/loved ones may have to struggle with the interpretation.
* Talk to your your family and loved ones about your desires. It's a hard and awkward discussion to have but do it. Be clear and frank.
Takeaway: Have an advanced directive. Be as clear, specific, and explicit as you can about your desires. Share your desires with your family, loved ones, and care providers. It is helpful not only you but form them as well.
How many times have we all heard: "The doctors gave him 6 months to live and that was 5 years ago". So if I knew I could go through 3-6 months of severe pain and get another 5-10 years of high quality life with my family, I'd probably do it. The problem is you may go through 3-6 months of severe pain and then die in month 7.
Right now being in my mid-30s and with a young daughter I enjoy, I'd take on the fight. If I was in my 80s, probably not.
As for "The doctors gave him 6 months to live and that was 5 years ago," keep in mind that you get a horribly biased sample. People don't generally go around saying "The doctors gave him 6 months to live and he died 6 months later," even if that may happen far more often.
Yes, it's just an anecdote, but a useful one to balance against those in the OP. Obviously the situation differs if you have a terminal illness, or other serious health issues, but I think a blanket NO CODE rule is a little extreme.
That's because it's something of your own invention. No one is advocating this, especially not the health professionals involved.
...except when they wear bracelets and tatoos stating "NO CODE".
I strongly disagree with this part. Before patients become patients, the vast majority of us have no interaction with the health care industry and certainly no significant capability to influence it. Doctors, on the other hand, spend their adult lives working as professionals in the industry. To say that they, as a group, are anything but complicit is wrong.
Consider the "Fuck passwords" article that's on the HN front page now. As a programmer who has dealt with passwords, the sad state of authentication is, in part, my fault. I could make the same excuse, "Well, the users don't want long passwords, and Facebook and G+ are part of the problem, and blah blah. I'm a victim of a larger system" That would be lame.
Like the doctors, I'm one of the professionals in the field, so it's my responsibility.
The whole thing reminds me of the average mid-90s movie Phenomenon. I could always understand Travolta's character's reasoning, but I still thought it was selfish.
To get meaningful results you need a large sample size, with a control group, with patients not knowing whether they're getting the new medicine or the old medicine and with doctors not knowing either. Then you need to write that up and analyse it.
Many patients are happy to take part in such trials, but it's hard to get ethics panel approval.
 you tend to test against current best treatment, not placebo, because almost anything works better than nothing and by the time you test the treatment in humans you need to know if this is better than what you're already doing.
Ethics panels have some weird effects -
And you can't get a "large sample size" of patients with rare cancers or diseases by definition. Sometimes, the best you can do is a case study of ten patients who agreed to try your treatment because the other option was death. Quite a few medical advances have been made that way, actually.
Try and tell the medical fraternity that case studies should be eliminated because they hold no meaningful result and you'll be laughed out of the room.
See also knee arthroscopy for patients with osteo arthritis - many of these surgeries were performed before a trial with a control group was possible. That trial found that people who got the sham surgery did as well as the people who got the real surgery. Case studies are lousy, often harmful, medicine.
That said, there will always be enough patients who want to fight for their life no matter the cost (see other comments on this page for evidence) that if you'd prefer to die in peace, you certainly shouldn't feel obliged to play the guinea pig for science.
But in the end, it is an individual choice. There will always be some who choose to fight no matter what (and they should be aware of their chances) and there will be others who prefer to let go.
He had seen enough "therapies" to know enough when to forgo them.
As a coder, I worry every time I drive that the computer could accidentally fire the airbags because of a bug in a poorly coded sensor (this happens far less frequently now but when airbags were first introduced people were killed/injured periodically http://news.google.com/search?q=airbag+recall+deaths ).
Not the best example but things like this do affect choicemaking and corner-cutting. It's like the fable of the plumber's plumbing, never being in good shape despite his expertise.
Hence doctors probably don't always make the best decisions about their own healthcare because they are either over-reacting, or under-reacting.
I'm not debating whether people should attempt to prolong their lives with aggressive chemo, just picking a nit.
If you're 80 and in poor health, recovery from broken ribs is likely to be extremely difficult and painful.
This seems to be a rant ie. the author has a strongly held notion that he has disguised as an argument devoid of any nuance. The support for his argument is that doctors secretly run a mile away from hospital whenever they get sick. This is not true and a gross generalisation.
Cause guess what, not everyone has a loving family or a house in the hills or a cousin with a big screen TV to go to when they are dying from a terminal illness. Some people want to try and fight their disease, and they are tenacious and brave and admirable and that's dignifying to them and to those that try and help them.
This article is an attempted justification from someone who has lost faith in what they do, nothing more.
I read it as giving people a different perspective on end of life care. The system is heavily biased toward all out medical care. This article show the other side, using as examples people who have a better understanding of the tradeoff.
This decision will always be a personal one, there is not right or wrong answer, just different possibilities.
1. A Pacemaker Wrecks a Family's Life - http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.htm...
2. A Tale of Two Hearts - http://thestory.org/archive/the_story_111811_full_show.mp3/v...
The second is an audio program.
1. Cryonics is the sci-fi version of Pascal's Wager. If cryonics is rational, than by the same reasoning so is Christianity.
2. Cryonics doesn't guarantee quality of life. If the brain is poorly preserved, you might be woken up in the far future with profound and irreparable dementia. And I mean "irreparable" not in relation to the limitations of medical science at a given future date, but in a purely information-theoretic sense. There might not be enough information left in your flash-frozen brain.
3. Cultures don't evolve because people change their minds, they evolve because people die and become outnumbered. If there's one thing the future doesn't need, it's us. And likewise, I think we would be shocked by the future.
4. Even if cryonics is theoretically feasible, I would need pretty good assurance that the cryonics company weren't charlatans. The news so far on that front isn't promising.
2. This concern is legitimate. There are going to be people that do not have good quality of life, or even a good brain, after being brought back from cryonics. It's a price.
3. You're arguing for the status Q, not because it's the best, but because it's all we've ever known.
I think everyone who is cryonically frozen is ready to be shocked by the future. They understand moral relativity and how it varies with cultures, and they're ready to see what cool stuff our descendants will come up! After centuries of being frozen, I think that it will be legitimately interesting to meet someone from our age, and we may still be able to find a place in that world. I also think that we should be looking at what's best for the individual being frozen, not what's best for a hypothetical culture in the future. If I am reawakened in the far-flung future, I don't have any grand plans of reverting their culture.
4. I met a former employee of Alcor at a conference. She was also signed up with Alcor, and was currently working on cryonically freezing other tissues. She knew her shit, wasn't just locked into cultish thinking, and believed that there is a decent chance of some cryonically frozen people coming back.
2. It's not a guarantee, has anyone ever said it is? Hence my own estimate of at least 5%. (I believe I originally got that figure in my head back from http://www.overcomingbias.com/2009/03/break-cryonics-down.ht... -- I don't think it's an unreasonable one.) It's still a better shot than being buried or cremated and worth it given the low prices available today.
3. I look forward to being shocked. I'm not going to touch your horrid comment that death is somehow necessary for progress.
4. Cryonics is a pretty poor business to be in if you're a charlatan. Where are you getting that vibe from?
While remembering that old post I linked I also found this comment I thought I'd share from a "Luke" ( http://www.overcomingbias.com/2010/07/cryonics-as-charity.ht... ):
Cryophobia is pure evil. It makes people choose death instead of cryonics. It makes cryonics more of a struggle for those who are not wealthy; it deprives the poor of the scaling effects that would make it affordable. It deprives those who are courageous enough to try it of their dignity and attacks their character unjustly and without evidence. It splits up families. It diminishes the chance of the technology working to 5% of its potential. It is unfair to AIDS and cancer victims who must die an early death permanently because of this. It misrepresents facts, repeatedly, while masquarading as skepticism. It has no shame, no decency, and no honor.
Please provide them.
> Hence my own estimate of at least 5%. (I believe I originally got that figure in my head back from http://www.overcomingbias.com/2009/03/break-cryonics-down.ht.... -- I don't think it's an unreasonable one.)
I guess if you invent a few data figures and then do math on them, you can get an aggregate of your own opinion. It's like the Drake equation, except at least with the Drake equation there are some terms we actually know.
> It's still a better shot than being buried or cremated and worth it given the low prices available today.
Every dollar you pay for cryonics is a dollar that you're depriving your actual living children or family members, or it's a dollar you're depriving yourself of in the past modulo time value of money.
> Cryonics is a pretty poor business to be in if you're a charlatan. Where are you getting that vibe from?
It's the perfect business to be in if you're a charlatan! There's no way to tell if you're doing a good job or a bad job, you never have to provide any results (because those happen in the distant and undefined future), and your customers are already dead.
> I'm not going to touch your horrid comment that death is somehow necessary for progress.... Cryophobia is pure evil. It makes people choose death instead of cryonics.
Maybe it is horrid, but is it true? Ah, you don't even bother addressing that. Because as we all know, the most rational response to an argument is to accuse your opponent of "evil". It seems to me that even if you dress it up in science fiction and call it "rationality", religion is still religion.
We're dealing with subjective probabilities representing confidence in prediction, so yes, we can do math on them and say "If you believe this, you must believe that if you want to be consistent." Even if all cryonics estimates are ultimately that person's prior (suggesting there is no additional information currently to update a person's estimate of cryonics working given their background information, something I think is false), we can still reason about different values.
If you think cryonics has epsilon chance of working, fine, it's not for you, and under the assumption that it doesn't work I'd agree no one should do it, but I don't think cryonics has epsilon chance of working, and I don't think it's just my prior. A secondary assumption we might make is that the future world would become horrible with us introduced to it. If we knew it would, then we know we'll never be revived, and I'd agree no one should bother with cryonics. Since we don't know that, you can factor it in as a part of your uncertainty about being revived, which is a part of your uncertainty about "cryonics working".
> Every dollar you pay for cryonics is a dollar that you're depriving your actual living children or family members, or it's a dollar you're depriving yourself of in the past modulo time value of money.
Yes... and? Every dollar you pay for "X" fits that. Do you think "This $10 could go to my friend" every time you spend $10? So what to do? The linked post, at the end, suggests a dollar-value you can assign if you only think "cryonics working" has a 5% chance:
"If you make 50K$/yr now, and value life-years at twice your income, and discount future years at 2% from the moment you are revived for a long life, but only discount that future life based on the chance it will happen, times a factor of 1/2 because you only half identify with this future creature, then the present value of a 5% chance of revival is $125,000, which is about the most expensive cryonics price now."
(And cryonics can be had for as little as $40k, more or less.) This isn't quite mathsturbation, since it's legitimate if in fact you match the stated assumptions.
> There's no way to tell if you're doing a good job or a bad job
Not true. You can rate cryonics businesses by how effective their vitrification methods are, how quick they are about it, how many patients they've lost due to any cause, whether they do any research into improving their methods as well as the currently unsolved problem of reversing it, how long they've been around, how well their facilities can resist natural disasters like earthquakes, and probably a bunch of other ways. Furthermore the market for cryonics is still very small; you stand to make a lot more money more easily doing other things, whether you're a charlatan or not. (For example releasing yet another homeopathic sleep inducer.)
Regarding your horrid comment, I'll explicitly say it's horrid and most likely untrue (but feel free to factor it into your uncertainty about "cryonics working"). If you're not going to bother defending that one, I'm not going to bother arguing against that one.
I thought the "evil" comment was interesting since the author noted it's not meant as a useful argument, it's meant as a response to useless ones. Which is what this has been. In your original comment "2" was the closest thing to an actually useful discussion point--how likely is it that enough brain information is there after vitrification? If you want to think of yourself as evil, go ahead, I wouldn't go that far but it's an interesting thought. Especially considering it from the perspective of living to 2070 (when I'll be 80), imagining that it turns out to be the year we successfully revive and fix whatever would have killed the first cryonics patient suspended in, say, 2000.
Don't conflate religion with religious thinking, and religious thinking with magical thinking, and magical thinking with bad thinking. While religious and magical thinking are both subsets of bad thinking, there are other forms, and they're all distinct from religion itself. (As an example of another issue where this "You're just a religion too!" criticism has been misused in relation to the idea of a technological singularity, see http://web.archive.org/web/20101227190553/http://www.acceler... )
Not only is it analogous, but by your own reckoning it is in many ways weaker. I don't think there's any useful meaning or distinction in describing the Christian afterlife as "supernatural", incidentally--either it's the case or it isn't. In any case, the decision matrix for Pascal's Wager is something like:
Christianity Heaven Hell
True (+ inf.) (- inf.)
Christianity No sinning 0
False (- fin. net loss)
Get Frozen Don't Get Frozen
Can Be Get Resurrected 0
Resurrected (+ fin. net gain)
Cannot Be Waste Money 0
Resurrected (- fin. net loss)
> Yes... and? Every dollar you pay for "X" fits that.
Well, it rather puts the lie to the claim that you have nothing to lose by having your corpse frozen in liquid nitrogen rather than buried or cremated. You do have something to lose. $40k-$125k is a lot of money that might actually be needed by your survivors. If you are ridiculously wealthy or have no children it might be different.
> Regarding your horrid comment, I'll explicitly say it's horrid and most likely untrue (but feel free to factor it into your uncertainty about "cryonics working"). If you're not going to bother defending that one, I'm not going to bother arguing against that one.
I would be glad to defend that statement: for one small example, you can just refer to demographic polling on the subject of gay marriage. Support for gay marriage is dependent upon age more than any other variable, which suggests that the passing of older generations will push the question into almost universal consensus within our lifetimes.
Now, let's be clear: this argument is against the wholesale cryonic preservation of large numbers of dead people. As long as cryonics remains restricted to a small number of eccentrics, there's no gain or loss either way; Ted Williams' severed head will not revert the far future back to 20th century social norms all by itself. If there are only a few frozen people, they will probably serve more as figures of curiosity and academic study. In fact, cryogenic preservation might provide useful information to people of the far future even in the absence of effective resurrection--by analogy, we would probably be very interested, today, to examine a well-preserved physical specimen of centuries past, just as we've been interested in dissecting mummies and ice men. But if we take the pro-cryonics viewpoint to its natural conclusion, there are probably going to be millions of contemporary people resurrected possibly centuries from now. At that point, we will have either a very large politically disenfranchised population of 21st century people or a severe shock of regressive ultraconservatism. It would be the moral equivalent of colonialism, except in time rather than in space.
From what I've seen from cryonics proponents, yourself and "Luke" included, your basic method of argument is to make wild, largely unsubstantiated claims about life after death and then condemn all disagreement as "horrid" or "evil". If that's not religion, what is?
(If you want to continue this, feel free to email me. My address is in my profile.)
2. You can set the terms and conditions under which you want to be woken up
3. Setting aside the lack of evidence for this claim, I want live for selfish reasons
4. This is part of the risk. But there are numerous incentives for cryonic service providers to keep their contracts
But from a cost-benefit perspective, it still is pretty flimsy. Definitively one of my worst cases of akrasia.
It's at least 3 orders of magnitude lower than that: no one was recovered from that frozen state alive so far.
That complex technology is freezing human bodies in attempt to preserve it for the future.
Even if in the future recovering technologies work - non-working first step (freezing) which is done today - will kill overall process.
I also qualified my original statement by saying that I'd do it if the technology improves. Extrapolating from past life expectancies, there is nearly a hundred years for the technology to develop until I need it. Saying the technology won't be there in a hundred years is a very strong statement.
2) You are extremely optimistic. Life expectancy improves for about 1 year in every 5 years (I'm quite optimistic with that estimate too).
So if you are 30 now, then by the time you are 80 life expectancy would change from 78 years (today) to 88 years(50 years from now).
So basically you have about 60 more years to live if you are lucky.
No way that freezing technology would improve into something meaningful by then.
It is true the writer writes from the point of view of his own choice, but on a topic such as this, that is really the only way to do it authoritatively.
The point of the article, I thought, was to make us think - what would I do when/if the time comes?
The salient point:
> For the six patient populations
combined, the mean survival was 29 days longer for hospice patients than for nonhospice
She (and I) would never go through this by choice. I can't stress that enough. This is not about money, this is about leaving life in the best possible way, on your own terms, with your family and as comfortable as possible.
If it weren't for the kind advice of my mother's doctor, who instructed all of her caregivers NOT to allow her to be taken to the hospital or be picked up by an ambulance, she might have ended up in a vegetative state in a hospital as well. He explained how it's a hospital's duty to do everything in their power to resuscitate someone, regardless of whether it's really humane or not.
It was awful watching them both die, but sitting with your family while you're given liquid morphine is much better than going through a frightening, painful, lonely death in a hospital.
Quality of life is something to achieve with the inclusion that these basic needs are met. If not, the quality of life is a personal opinion and can be interpreted in any way, from conservative, to ridiculous.
Tell them. I would recommend going through scenarios with them. Everyone thinks of the persistent vegetative state, but it's very unlikely you'll end up in one. It's more likely you'll be days away from death and passed out in a haze of exhaustion and morphine, with a ventilator doing little more than prolonging this scenario. Do you want the ventilator removed? Do you want CPR if you're hospitalized for a terminal condition? What if you're hospitalized for a non-terminal condition?
> Is it sufficient enough to have a living will, for example?
It sure helps, so do that. But also make sure to designate one of your loved ones in particular as your power of attorney. Make sure it's someone who understands and is capable of carrying out your wishes. That person will stay in close contact with health care professionals and has the legal right to make any and all decisions should you be incapacitated. In my limited experience, no one even looks at the living will if there's someone with clear power of attorney telling them what to do.
This person has an even more important job, at least in the American health care system: they're often the only one who talks to all the doctors and has the big picture. If you're seeing five different specialists, and they're all talking about their own specialties, no one is necessarily in charge of the big picture. In the outpatient world you have a primary care doctor, but when you're hospitalized, this guy's out of the picture. There is probably a hospitalist in charge of your care, but just like the nurses, the hospitalists rotate on shifts, and don't really coordinate with specialists so much as just trying to keep you alive. You need someone to be power of attorney, and to take the job seriously. One of the striking things, to me, about Steve Jobs' biography was that even for him, this was true--his wife was the one coordinating the doctors and keeping in charge of the big picture.
> Are there documents out there that I should be carrying in my wallet, and do paramedics seek these documents out in an emergency?
No. I've had paramedics at my house for my dad twice, and they never looked in his wallet. On the other hand, I was there both times.
The job of a paramedic is to stabilize you, gather whatever information they can, and take you to the ER. They probably don't give a shit about your wallet or your cell phone. Whatever procedure there is for identifying someone's next of kin and finding their advance directives, it's done in the hospital. Most of the time they just ask you, if you're conscious, and they ask whoever is physically with you at the time. They would only resort to searching you and your effects if you were completely alone, or if no one around you knew anything or anyone. So designate your power of attorney and designate that person as your emergency contact at work. If you don't live with that person, make sure a neighbor or roommate or someone else you live with or close to has that person's number programmed into their phone and knows to contact them. You want a person you trust, not just a tattoo or bracelet or document, in charge here.
This looks like an excellent research question for the guys at freakonomics (http://www.freakonomics.com/blog/) to me.
In most cases, EMS in the field is operating under a fairly tightly defined set of protocols. Those protocols define what is or isn't a valid "Advanced Directive"
The site is down for me.