Letting Go

The author did a good job of laying out the complexities of end of life care decisions. She did talk about how important it is to have these discussions in advance, but I don't think she emphasized enough how important it is to have the whole family involved in discussions.

A child who has discussed these issues with her parents, and makes the right decisions in accordance with her parents' wishes, still faces guilt and indecision when the end comes and it's time to let go. If you combine that with unsupportive and accusatory siblings, that guilt and second-guessing can continue for years after the parent dies.

It's important to make sure that all children are involved in the discussion, especially if they don't agree with each other and the parent, and are hostile to any decision to forego care. Communication is hard, and distances are long, and it's far too easy not to have these discussions with the dying relative far away. It takes effort and will to make these discussions happen, but they are necessary.

Thinking about death always puts the triviality of my seemingly dire day-to-day problems into proper perspective.

For those who aren't familiar with the author, he's the brilliant Dr. Atul Gawande (http://en.wikipedia.org/wiki/Atul_Gawande), whose most recent book is the best-selling The Checklist Manifesto.

This is a good, well-written article, painting a good picture of the issues involved.

My grand-father is in a similar situation. After years of dementia, he was diagnosed today with pneumonia after he stopped swallowing last week and reacting to people some weeks earlier. He'll die soon, but he'll die at home, where he was nursed by his loved ones until the end.

I'm glad he won't die in a hospital like my other grand-father, who died from cancer after many chemotherapies. My grandmother never gave up hope and it hit her hard when he finally died. I wished he could have died at home, even if that meant his life was some months shorter.

Remarkable quote by Stephen Jay Gould:

“It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity,” he wrote in his 1985 essay. “Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die—and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light.” (“The Median Isn’t the Message”)

A personal hero of mine, Philip Berrigan refused most treatment on his liver cancer and died within a year of diagnosis. My mother 'got martial' in Gould's terms and fought doctors and death until she got her lung cancer taken care of. She is on the 'long tail' of the curve.

Impossible to know how one would react. I can see the reasons in both cases and respect both decisions.

How does one know that one's "skein has run out"? (what a nice turn of phrase)

Oh, brother, that first anecdote really got to me. How the hell are you supposed to let go of life when you just brought a child into the world?

Having had to watch my mother succumb to lung cancer (not related to smoking) very recently, I had to hold back the tears whilst reading. Wonderful article.

Gandhi wife died without receiving antibiotic treatment, perhaps this is something to think about.

For those who aren't familiar with the author he's Atul Gawande who worked on Gore's 1998 presidential campaign and was Bill Clinton's senior adviser in the Department of Health and Human Services. Another words this is a political piece and has no business IMHO on hacker news.

Heh, looking at the title, my first thought was this was about the Go language.

It wasn't, so I closed the tab.