This is anecdotal evidence from a small (2) sample. But not all doctors die without treatment at home. Some (many?) are aware of the drugs they need to hasten their demise in a way that minimises their suffering. One doctor I discussed this with said that assisted suicide, in a very limited and measured way, isn't uncommon, if you know what to look for.
As someone with a degenerative incurable condition, I'd like the option of being able to make informed decisions about the end of my life, beyond just refusing treatment. Because spending years dying of starvation (as MS campaigner Debbie Purdy recently did, because she was unable to cope with her symptoms, and there was no other legal recourse to help her die), doesn't fill me with excitement.
We have an insane attitude to death in our culture at the moment. We seem to want to find any way to avoid the fact that being alive has a 100% mortality rate. I think our collective attitude needs to change. And the more articles like this the better.
It's really hard to change perceptions about death when it requires considering one's own mortality. It is in this only that I understand the desperate quest for religion. The idea of going dark forever is terrifying to me, and considering I'm pretty much an atheist, I don't have much hope of anything else. When people ask me if I'm religious, I usually tell them I'm hopeful that I'm proven wrong.
I know we all die. I know our lives on a cosmic scale are infinitesimal. But even I - as rational as I am, am extremely scared of facing that reality head on.
So convincing the entire nation/world to do so... Well, good luck with that.
My mom suffered from MS here entire life, and a few years ago left us on her own terms (with the help of some pills) before the age of 60. I don't blame her of course. I also have no idea if she had any help from a doctor or not.
While that certainly is an intimidating set of links you have there, only two of those have any discussion -- one over two years ago, the other nearly four years ago.
When facing terminal illness, doctors probably differ little from comparably educated subsets of the population. I don't know of studies specific to physicians, but my guess is quality of life is a priority that shapes decisions about treatment for life-threatening conditions.
After decades in practice, doctors have faced death of patients many times. It's not an experience one ever really gets used to. As a result, doctors tend to be realists about illness and its likely outcome.
It's no surprise that doctors might choose "death with dignity". Oregon, where I live, was the first state in the US to pass a law legalizing physician assisted suicide. The Death with Dignity Act went into effect in 1997. Studies have consistently shown that the leading motivations among those requesting lethal prescriptions are the desire to maintain independence and minimize reduction of QOL.
I'm a little frustrated with this article, but not for the reasons in the article. The doctors were angry at their patients' family members for putting them through the suffering; but, ... that form of suffering is just where medicine is right now.
Medicine is evolving, and growing; and, it's that desire to keep living and to keep those around you living, and to improve their well-being that has, in part, grown our medical abilities to the point they are now.
It feels like some of those improvements that, right now only provide a '15% chance of survival, and include pain', will be the stepping stones for 20, 30, 80 or 90% chance of survival, with varying levels of pain, including 0.
The article seemed to suggest that the doctors didn't approve of those intermediate steps, but ... those are the steps medicine takes, aren't they?
I dunno. I respected the rest of the article. That part of it bothered me.
It isn't the doctor's job to improve medicine, it is a researcher's job.
Doctors can only prescribe to you the 15% chance of survival, knowing that there's no greater benefit to medicine. They're too busy seeing patients to improve medicine.
Atul Gawande, who's written extensively on end of life issues, had an excellent one hour Frontline special that covered the same topic. I highly recommend watching it if you're interested at all in how terminal illness and dying are handled in the United States today: http://www.pbs.org/wgbh/pages/frontline/being-mortal/
A few years ago, I heard an NPR interview with a doctor who's friend was
terminally ill. Rather than opt for treatment, the friend spent his remaining
time living with his doctor friend. He died a few months later. The doctor
said that this is how she wanted to die, too. I've tried a
number of times to find the story, but I haven't been able to. Does it ring a
bell for anyone? I'd love to listen to it again.
This reminded me of an article I've read a long time ago which had a really strong impact on me. I've just found it by googling a couple of words that were still in my head after all these years.
I thought this was thoughtful and well written but all I see is anecdote...there is no data presented that MDs choose different options than non-MD patients.
Adding to the anecdote, I'm a paramedic who has also opted for 'no heroic measures'. Even with CPR survival rates in this county being amongst the highest in the country.
It isn't just how they die. Similar articles could be written on "How doctors loose weight", "How doctors pick their doctors" or "What do doctors do when their kids are sick". Insider knowledge and the education to effectively employ that knowledge always has advantages.
I do take issue with the concept that these docs are dieing "without treatment". They get treatment. They are diagnosed (a big deal) and have ready access to a host of pain management drugs. Having a full understanding of your condition, along with the knowledge that any pain can and will be managed very quickly, is a massive stress reduction. That's a form of treatment imho.
Can't speak for other people, but the fascination for me is
a combination of decisions that are difficult and universal and then watching to see how subject matter experts (who view this stuff on a day to day basis) choose for themselves.
I think this invariably results in deeply moving meditations on mortality and dignity from both sides of the table (care provider and patient). Or maybe I'm just suffering a recency bias from this: http://med.stanford.edu/news/all-news/2015/03/stanford-neuro...
I had a conversation about this with a friend yesterday.
What I would like to understand, is what the difference is between one incurable terminal condition and the next is, and why we're culturally stuck on trying to divide things up into "approved" and "not-approved" categories.
Death happens for everyone. Most everyone, if they make it to very old age, will have degenerated physically and mentally from where they once were. I wonder, if our sympathies are telling us to consider whether a person with X condition should be allowed to end their life, whether that same thought process shouldn't consider all end-of-life conditions to be equal, given their shared terminality and expectation of degeneration.
Or, on the flip side, should we think terminality and expectation of degeneration in these cases is not enough, whether it is appropriate to accept it in this subset of cases.
There's one thing they left out of the article. Yes, we are all going to get sick, and eventually die. Doctors--know the expected survival rates. Doctors do seem to end up with the right medications to really make those last days comfortable, or take the right amout and overdose properly?
Now, their patients, especially the poor, stereotyped, etc. are sent home, and when a doctor feels like they need Hospice, they give their approval.
I had a poor friend die. It was obvious he only had a few months left, but the doctor wouldn't o.k. Hospice? We went to two clinics, and a pain clinic and neither would give him
the medications (Opioids and Benzodiazepines) he needed. One pain clinic(noted one of the better ones--in San Francisco) offered to cut some nerves?(I still don't know what these Blow Hards wanted to cut.)
Why didn't he get the right medications; well in the states we assume everyone is going to abuse drugs. It's just getting worse. Doctors are not taking away pain.
O.K., but once you have Hospice, everything is fine these fine? Doctors are trained in Pallitive care--if you get lucky. My experience watching my father die of liver cancer was a week of Hell. Hs last words to me before he went onto one of his last comas was "Son--when will this end?" Yea--no shit!
The nurse finally came around. She then let my sister manipulate
his medications which made his discomfort even worse.(my sister thought he should spend more time with his grand kids, and she wanted him to give her more things?) There I said it. Yea, she's a piece of work.
I know this. When I am given that diagnosis of death. I used to think I would go to the bad part of town and buy smack, crack, whatnot, but as I've gotten older and I don't
have the fight in me like I did in my 30's; I will probally
just suffer through the agony of death like my father endured? Or, I might do what Robin Williams felt he had to do?
Robin's wife said she was glad he picked up his ipad when he walked by her. She said, Robin hadn't watched tv, nor went on the Internet for the last six months.
Robin was found in his stepson's bedroom with a belt
around his neck. A towel was wrapped around the belt. I'm assuming to make the suicide more comfortable? Crude knife marks on his wrists--from a pocket knife. An ipad was found
near the body with websites open to the the various side effects of the drugs he was given. I don't know all the drugs he was given, but they found a bottles of Seroquil? and a drug used to help with the neurological disorder he had.
Why did I repeat this story. Because this is how we are forced to die in the United States. I don't know why Robin committed suicide. He sounded like he was suffering for a long time, on many levels? I don't know if the prescription drugs he was taking made things worse? Either way, he shouldn't have had to die like this. I'll pass this along too. Don't think suicide is easy. I knew a guy who tried to blow his head off with a shot gun. He blew his frontal cortex off, and spent the next 30 years paralized in a rest home. He died of a lung infection.
I didn't know him personally. I worked for the Cororners office at the time, and picked up hs body.
Enough, I feel sick from even writing about this gruesome stuff, but nothing changes. Doctors should treat the pain of their patients, and the government shoud not harass them.
And we need a "right to die with dignity" law like Oregon passed. They passed it a few years ago, and very few decided
to use the kit. Most decided to go naturally, but it must be reassuring knowing you have an alternative? I yacked on, but it's something I think about often.
Engineers have a peculiar relationship with doctors. When they have need of one, and the doctor decides on a treatment plan for them, they think about the complexity of the problem space the doctor had to navigate to reach that decision. They wish the doctor would chart the parameter space for them, so they can agree or disagree with the choice in an informed manner, and have more of a clue about the competence of the doctor. This is usually not what happens, not to their satisfaction anyway, and it's deeply unsettling having to trust rather than know when it comes to something that appears so much like engineering on the surface.
An alternative title for this article might be "what doctors really think", and thus strikes to the heart of this issue.
It has nothing to do with a fascination with doctors and everything to do with a fascination with death. Death today in first world countries is so far removed from what death ought to be, that it's almost unrecognizable. Dying in a sterile white room, in a building that houses thousands of sick people, with bad food, busy nurses, and often alone, is what I'd imagine a dystopian future from a Hollywood movie like Soylent Green would look like, but instead it's what Death looks like today. There is no need for this, and if most of us were asked in advance, few would choose it as the outcome. Yet very few people have living wills created, nor plans communicated with close family for these circumstances.
You can't avoid Death, it happens to everyone. So it's bizarre why so few people plan for the only truly predictable event in their entire life.
[+] [-] sago|11 years ago|reply
As someone with a degenerative incurable condition, I'd like the option of being able to make informed decisions about the end of my life, beyond just refusing treatment. Because spending years dying of starvation (as MS campaigner Debbie Purdy recently did, because she was unable to cope with her symptoms, and there was no other legal recourse to help her die), doesn't fill me with excitement.
We have an insane attitude to death in our culture at the moment. We seem to want to find any way to avoid the fact that being alive has a 100% mortality rate. I think our collective attitude needs to change. And the more articles like this the better.
[+] [-] themartorana|11 years ago|reply
I know we all die. I know our lives on a cosmic scale are infinitesimal. But even I - as rational as I am, am extremely scared of facing that reality head on.
So convincing the entire nation/world to do so... Well, good luck with that.
[+] [-] letstryagain|11 years ago|reply
Well we assume it does but so far only about 95%
[+] [-] seanmcdirmid|11 years ago|reply
[+] [-] shiggerino|11 years ago|reply
This is an interesting and entertaining YouTube channel that seeks to address the perceived anxiety and denial of mortality of today's society.
[+] [-] epicureanideal|11 years ago|reply
[+] [-] ColinWright|11 years ago|reply
For those interested in the collective wisdom of the HN community, here are some previous discussions:
https://news.ycombinator.com/item?id=3313570 : 1206 days ago | 177 comments
https://news.ycombinator.com/item?id=4865742 : 841 days ago | no comments
https://news.ycombinator.com/item?id=5017104 : 807 days ago | no comments
https://news.ycombinator.com/item?id=5104430 : 790 days ago | 94 comments
https://news.ycombinator.com/item?id=6040804 : 618 days ago | 1 comment
https://news.ycombinator.com/item?id=6767385 : 489 days ago | no comments
https://news.ycombinator.com/item?id=7446014 : 368 days ago | 2 comments
[+] [-] arfliw|11 years ago|reply
[+] [-] jrapdx3|11 years ago|reply
After decades in practice, doctors have faced death of patients many times. It's not an experience one ever really gets used to. As a result, doctors tend to be realists about illness and its likely outcome.
It's no surprise that doctors might choose "death with dignity". Oregon, where I live, was the first state in the US to pass a law legalizing physician assisted suicide. The Death with Dignity Act went into effect in 1997. Studies have consistently shown that the leading motivations among those requesting lethal prescriptions are the desire to maintain independence and minimize reduction of QOL.
Comprehensive data/stats related to DWDA can be downloaded--the most recent report (2014) is here-- http://public.health.oregon.gov/ProviderPartnerResources/Eva...
Additional info is available-- http://public.health.oregon.gov/ProviderPartnerResources/Eva...
[+] [-] mytochar|11 years ago|reply
Medicine is evolving, and growing; and, it's that desire to keep living and to keep those around you living, and to improve their well-being that has, in part, grown our medical abilities to the point they are now.
It feels like some of those improvements that, right now only provide a '15% chance of survival, and include pain', will be the stepping stones for 20, 30, 80 or 90% chance of survival, with varying levels of pain, including 0.
The article seemed to suggest that the doctors didn't approve of those intermediate steps, but ... those are the steps medicine takes, aren't they?
I dunno. I respected the rest of the article. That part of it bothered me.
[+] [-] dragontamer|11 years ago|reply
Doctors can only prescribe to you the 15% chance of survival, knowing that there's no greater benefit to medicine. They're too busy seeing patients to improve medicine.
[+] [-] shazad|11 years ago|reply
[+] [-] quickpost|11 years ago|reply
Being Mortal.
http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/...
[+] [-] mct|11 years ago|reply
Thanks!
[+] [-] berberous|11 years ago|reply
http://www.radiolab.org/story/262588-bitter-end/
[+] [-] hippiefahrzeug|11 years ago|reply
Here it is (probably not where I originally read it): http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what...
[+] [-] rckrd|11 years ago|reply
This was surprisingly well written for an NBC or Men's Health article for those who are skeptical.
[+] [-] jimt67|11 years ago|reply
[+] [-] dataminer|11 years ago|reply
[+] [-] FireBeyond|11 years ago|reply
[+] [-] arfliw|11 years ago|reply
[+] [-] sandworm|11 years ago|reply
I do take issue with the concept that these docs are dieing "without treatment". They get treatment. They are diagnosed (a big deal) and have ready access to a host of pain management drugs. Having a full understanding of your condition, along with the knowledge that any pain can and will be managed very quickly, is a massive stress reduction. That's a form of treatment imho.
[+] [-] screature2|11 years ago|reply
I think this invariably results in deeply moving meditations on mortality and dignity from both sides of the table (care provider and patient). Or maybe I'm just suffering a recency bias from this: http://med.stanford.edu/news/all-news/2015/03/stanford-neuro...
[+] [-] hkmurakami|11 years ago|reply
[+] [-] unknown|11 years ago|reply
[deleted]
[+] [-] mattlutze|11 years ago|reply
What I would like to understand, is what the difference is between one incurable terminal condition and the next is, and why we're culturally stuck on trying to divide things up into "approved" and "not-approved" categories.
Death happens for everyone. Most everyone, if they make it to very old age, will have degenerated physically and mentally from where they once were. I wonder, if our sympathies are telling us to consider whether a person with X condition should be allowed to end their life, whether that same thought process shouldn't consider all end-of-life conditions to be equal, given their shared terminality and expectation of degeneration.
Or, on the flip side, should we think terminality and expectation of degeneration in these cases is not enough, whether it is appropriate to accept it in this subset of cases.
[+] [-] unknown|11 years ago|reply
[deleted]
[+] [-] unknown|11 years ago|reply
[deleted]
[+] [-] marincounty|11 years ago|reply
Now, their patients, especially the poor, stereotyped, etc. are sent home, and when a doctor feels like they need Hospice, they give their approval.
I had a poor friend die. It was obvious he only had a few months left, but the doctor wouldn't o.k. Hospice? We went to two clinics, and a pain clinic and neither would give him the medications (Opioids and Benzodiazepines) he needed. One pain clinic(noted one of the better ones--in San Francisco) offered to cut some nerves?(I still don't know what these Blow Hards wanted to cut.)
Why didn't he get the right medications; well in the states we assume everyone is going to abuse drugs. It's just getting worse. Doctors are not taking away pain.
O.K., but once you have Hospice, everything is fine these fine? Doctors are trained in Pallitive care--if you get lucky. My experience watching my father die of liver cancer was a week of Hell. Hs last words to me before he went onto one of his last comas was "Son--when will this end?" Yea--no shit!
The nurse finally came around. She then let my sister manipulate his medications which made his discomfort even worse.(my sister thought he should spend more time with his grand kids, and she wanted him to give her more things?) There I said it. Yea, she's a piece of work.
I know this. When I am given that diagnosis of death. I used to think I would go to the bad part of town and buy smack, crack, whatnot, but as I've gotten older and I don't have the fight in me like I did in my 30's; I will probally just suffer through the agony of death like my father endured? Or, I might do what Robin Williams felt he had to do?
Robin's wife said she was glad he picked up his ipad when he walked by her. She said, Robin hadn't watched tv, nor went on the Internet for the last six months.
Robin was found in his stepson's bedroom with a belt around his neck. A towel was wrapped around the belt. I'm assuming to make the suicide more comfortable? Crude knife marks on his wrists--from a pocket knife. An ipad was found near the body with websites open to the the various side effects of the drugs he was given. I don't know all the drugs he was given, but they found a bottles of Seroquil? and a drug used to help with the neurological disorder he had.
Why did I repeat this story. Because this is how we are forced to die in the United States. I don't know why Robin committed suicide. He sounded like he was suffering for a long time, on many levels? I don't know if the prescription drugs he was taking made things worse? Either way, he shouldn't have had to die like this. I'll pass this along too. Don't think suicide is easy. I knew a guy who tried to blow his head off with a shot gun. He blew his frontal cortex off, and spent the next 30 years paralized in a rest home. He died of a lung infection. I didn't know him personally. I worked for the Cororners office at the time, and picked up hs body.
Enough, I feel sick from even writing about this gruesome stuff, but nothing changes. Doctors should treat the pain of their patients, and the government shoud not harass them.
And we need a "right to die with dignity" law like Oregon passed. They passed it a few years ago, and very few decided to use the kit. Most decided to go naturally, but it must be reassuring knowing you have an alternative? I yacked on, but it's something I think about often.
[+] [-] cup|11 years ago|reply
[+] [-] sho_hn|11 years ago|reply
An alternative title for this article might be "what doctors really think", and thus strikes to the heart of this issue.
[+] [-] Afforess|11 years ago|reply
You can't avoid Death, it happens to everyone. So it's bizarre why so few people plan for the only truly predictable event in their entire life.
[+] [-] arfliw|11 years ago|reply
I thought it would be of interest to hackers. That's what these doctors are doing...hacking the end of life.