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Comment by pwned1 | Hacker News Reader

I just went through this with my grandmother. She decided she didn't want any more care in the hospital, so they morphined her up to the point that she never woke up again and she essentially starved and dehydrated to death, over about a five day period. The whole thing was disturbing to me.

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If that treatment plan disturbs you, have you made your advanced directive plan so that the same thing doesn't happen to you? You could be hit by a bus tomorrow and unable to talk / write your desires down. What would you want if you found yourself in a hospital bed without a decent shot of getting out of it?

This is a very important point, whichever choice you make in advance. My father was in a similar situation after a large stroke, a decline into pneumonia, and was clearly not going to survive. He'd made his wishes clear in advance so we felt untroubled by this course of action. The fact that he essentially starved and dehydrated to death was what we knew he wanted given the other options. He was under constant medical supervision to make sure it was as painless as possible, rather than struggling on through what he would have thought was a pointlessly drawn-out and painful death. Make sure the people close to you know what you want. You may not get a chance to express your wishes at the time, and taking the burden of that choice off the people you leave behind will be greatly appreciated, however awkward and difficult the initial conversation is.

> If that treatment plan disturbs you, have you made your advanced directive plan so that the same thing doesn't happen to you?

OPs statement as I read it, their grandmother fully chose the best option she thought she had at the time and it disturbed OP, so not sure of the point about pre-choosing.

I guess perhaps to say, they would prefer not to be killed just because there isn't a decent shot? I'd prefer a hospital system that didn't do that, but I guess until we get one maybe it might be needed.

And as always, rather than planing for death, what about planning for life.

Work on the thing in your life that might cause the issue in the first place. Planning for death is giving up in some regard.

> Planning for death is giving up in some regard.

I'm in my 40s and have a full estate plan including a will & trust, technical recovery how-to's, and my advanced care directives documented. If I get hit by a bus tomorrow, I don't want a) my estate drained for bullshit care that won't fix me, b) or the people caring for me and executing my post-death instructions burdened unnecessarily. If I am a vegetable and the spark that makes me, me is gone, pull the plug. If I don't have the mental ability to ask for food or water, pull the plug. If I am in so much pain I am out of my mind, bring on the opiates and large doses please.

I haven't given up and I have no plans to die any time soon. I just realized I had too much money to die without a will and I don't want to live like a vegetable. It's all my choice, not a hospital system. You don't like these decisions, you do you and document your own plan.

Death happens to us all. If you don't like how somebody else did their death, document your own preferences. If you want to live unable to lift a spoon to mouth, unable to walk, confined to a bed, not knowing what year it is, that's okay. Just hope you don't marry somebody like me without an advanced care plan! I would pull your plug under those circumstances. I'd cry, but I would do it if I didn't know what you wanted. Sounds like you wouldn't want that...

Ignoring a 100% guaranteed thing in your future because it's uncomfortable to think and talk about is irresponsible in some regard.

My mom went through the same in hospice. She refused any food or water. Given that she was in the later stages of Alzheimer’s I thought it was a pretty impressive feat, euthanasia would have been so much more humane.

Humane to who? Ending one person’s life kills you a little on the inside, too. I have had to put three dogs to “sleep” and the fourth will come sooner than I want. I am not a better person because of it.

Having been legally required to make the decision of when to withdraw care for three different relatives, I think this is nonsense.

When someone is going to die, there is no good way, no good time. But there are worse ways and times. As technology gives us more power to extend life of body, we are forced to considered what that means, and how to use that power wisely.

Three times I have had to decide when somebody's life ended. I think their are practical differences between deciding to withdraw care and choosing more active measures. But I think there is no moral difference. Either way, somebody vulnerable has placed their life in your hands. Either way, your only real choice is when to give up hope, and how much suffering they endure between that point and death.

I honestly don't give a fuck whether you're a better person for it. Or whether I am. It's not about us. The important question is whether you have done the best you can for the person. And "best" here, I think means something like "in accordance with their informed preferences, or as best as we can guess".

To that end, I strongly encourage everybody to get their families together and have real discussions about this. The Five Wishes framework is one good option. [1] The best thing my mom ever did for me was to have a frank conversation with me and my brother about her end-of-life preferences well before she was sick. Don't make your loved ones guess. And don't put yourself in the position of having to guess for them.

Personally, if I end up with something gruesome and terminal, I aim to die well before things get awful. Like Brittany Maynard, [2] I'd much rather go out on my terms than suffer pointlessly until my body fails, consuming absurd amounts of medical effort. Others can do differently, of course, but there's no way I'd want a doctor who frets they're going to die "a little on the inside" by following my advance care directive.

[1] https://fivewishes.org/five-wishes/advance-care-planning

[2] https://www.kqed.org/perspectives/201410280735/its-brittany-...

Can't upvote this enough. I haven't been in this position as often as you have, but enough to say that all of your comments and advice are spot on.

I have gone through exactly this with my dad, where he was in an unbelivable amounts of pain and eventually was being given so much morphine he wasn't conscious at all in his final 4 days. So we just kept vigil next to his bed at the hospital 24/7, and there was absolutely nothing dignified about it, we were literally sitting next to my dad who was slowly starving do death. It was so disturbing I still have issues because of it. My dad might have chosen euthanasia, or he might not have done - but not giving him that choice in the first place(euthanasia is illegal here) and instead going towards sedating someone to a point where there is no dignity to speak about is horrendous to me.

I don’t expect it to be somehow advantageous to me, it is about lessening the suffering of another being. Plus my mom had stated for years that she wanted euthanasia if it got to that point, but it was not a legal option.

Will repeat myself for a third time. You feel that way after tending to end of life for your 4 dogs. Imagine how it must feel for your carer when it comes time for your end of life. Get an advanced directive documented, make it legal, and take the burden off other people to guess what your preferences would be. In a way, it is a kindness to your future carer. That way if your carer disagrees with your preferences or finds it a hard burden, they can point to something you wrote and be able to comfort themselves with "that's the way he wanted it."

As wpietri said, it isn't about you. It's about them.

It's actually harder in some ways with pets because they can't talk and tell you detailed preferences for how they want to go when it's their time. All you have is the general guideline that, if their condition can't be treated and they are going to have to die, you want to minimize their suffering. I've had to do it with four cats, and we have two dogs now whose time will come eventually. It's not easy, but it's not like you have a choice; you made the choice when you took them into your life in the first place.

And don't forget that making the choice to let them into your life adds a lot more to your life than whatever the pain of having to put them to sleep takes away. Our two dogs are both rescues; we have given them many years of happy life (and many more to come) that they would otherwise not have had at all. And they have given us a lot of happiness in return. That will always be there whatever comes.

> Ending one person’s life kills you a little on the inside, too.

Are you saying this in a metaphysical sense?

Secondly, if you don't want to put your dogs to sleep, no one is forcing you to do so, just refuse it and allow them to live in pain till they die of old age. It's not the choice I would make, but then I don't have your views on euthanasia.

I'm not looking forward to when I have to do it with my own dogs but making sure their death is the least awful is our own act of love towards them.

I went through the same a few years ago with hospice. She had emphysema and real trouble breathing. She was mentally checked out after a few days in the hospital and opted for hospice. They started morphine and for a couple of hours she was able to breathe and felt great. She even said maybe she could get out of there - she fully expected to die.

Well after that she passed out, didn't wake up again, and died. Bothers me greatly to this day and I wish I had been there for the whole thing to challenge some of the decisions made that my parents didn't contest.

Gotta respect their decision. I mean, I see my father falling apart and if he made the decision idk if I'd contest it. He's not able to really go out, has trouble breathing, etc. Staring at the same 4 walls all day until you die naturally isn't the best way to go out. A little bit of you dies mentally every day going through that until you're just old, depressed, and unable to function. Why put them through that misery if they don't want to essentially rot in a bed or chair.

Don't feel guilty about this, or as if you and your brothers should have done something differently. It wasn't your choice to make-- it was hers and your parents'. They may have understood her condition and wishes differently, and had conversations you weren't a part of. In the moment, you guys didn't challenge the hard decisions your parents were making, and instead showed support. Which is doing something in its own right. Moreover, morphine can give a pleasant high, and combined with patient's own adrenaline surge around the times they're the sickest-- can make very sick people look much better. Consciousness/lucidity waxes and wanes a lot in sick people.

Will repeat myself. If you disagree with your parents' decisions, have you documented your own advanced directive plan? If you don't agree with what they decided for your grandparent, highly likely you would not agree with their decisions if they had to make them for you. You could be hit by a bus tomorrow and unable to talk / write your desires down. What would you want if you found yourself in a hospital bed without a decent shot of getting out of it?

Get it documented, make it legal, and if you don't trust your parents, then declare somebody else able to make medical decisions for you.

That's different from what I've heard from friends, they had to wait for their parent's hearts to stop. One sat with his father until three in the morning before it finally happened. I've not heard it's taken as many as five days though.

This was in the Netherlands by the way, before euthanasia was legalized.

My experience mirrors yours. I've had relatives receive doses in the scale of things stop working within 24 hours. But at that point, they didn't have very long left anyway, so maybe it's different practises, and maybe it's about how healthy the body is when the process is initiated.

Same here, in Belgium where euthanasia is legal. I have no idea why they made it last the 5 days that it took.

>>The whole thing was disturbing to me.

But that was her life and frankly, I'd want that too. IMO, when your time has come--and it does come at some point--there's no reason to suffer. A few extra days of horrible pain is not life, it's torture. Why would you want your family to see you in that position?

I went through the same, except there was no morphine until the very end when it made her pass away.

> she essentially starved and dehydrated to death

That's horrible.

From what I've read, starvation isn't actually that terrible.

For example: [1], quoting:

> Instead of feeling pain, the patient experienced the characteristic sense of euphoria that accompanies a complete lack of food and water. She was cogent for weeks, chatting with her caregivers in the nursing home and writing letters to family and friends. As her organs finally failed, she slipped painlessly into a coma and died.

> “What my patients have told me over the last 25 years is that when they stop eating and drinking, there’s nothing unpleasant about it — in fact it can be quite blissful and euphoric,” said Dr. Perry G. Fine, vice president of medical affairs at the National Hospice and Palliative Care Organization in Arlington, Va. “It’s a very smooth, graceful and elegant way to go.”

[1] https://www.redorbit.com/news/health/138158/starvation_is_no...

Patients under sedation don’t feel pain from starving or dehydration. If they were conscious the pain from their own illness would be considerably worse.

Patients under general anesthesia don’t, sedation is less certain. For obvious reasons, there’s no corpus or research into the issue, so it’s left to supposition. Remember that “sedation” and “unconscious” are not necessarily the same.

The article addresses that.

>Whether palliative sedation truly ends suffering is not knowable, although doctors perceive indications that it does. “You might be able to tell if their blood pressure goes up. Same with their pulse,” said Nancy Crumpacker, a retired oncologist in Oregon. “And you read their faces. If they are still bothered somehow, it will show in their facial expression.”

Even under general anesthesia some patients feel the pain

https://en.wikipedia.org/wiki/Anesthesia_awareness#Backgroun...

That’s a matter of insufficient drugs being used, not a feature of the drugs themselves.

Why?

If she wasn't conscious and didn't feel any pain I don't see how it's "worse" than any other method of death. The whole purpose is to make the patient not suffer.

Just to be clear, the morphine was her request, or was it some sort of vengeance on the part of the hospital?

I don't think she specifically requested morphine, just that she no longer be treated. I'm honestly not sure how the decision-making process worked. It was kinda odd to me because no one said that she was going to be completely knocked out for the rest of her few days. If I had known exactly how it was going to work, I would have asked to talk to her more before they initiated the process. But I got there the day after she requested the cessation of care and she was out, never to be conscious again. She was then moved to hospice with a locked-up morphine machine and we all sat there for several days, watching her die.

To call it vengeance would be inaccurate.

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