Comment by caprese | Hacker News Reader

Comment by caprese | Hacker News Reader

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> The families often are in almost some sort of denial

It was like pulling teeth to try to get doctors to tell me anything realistic.

I don't get the impression that anyone in the medical community is trying to change this.

Unlike my other family members, I had seen this person once a month obviously deteriorating in line with what every prognosis and statistic would say. My other family members were there every day and couldn't or weren't willing to see the progression. This isn't a movie with a pleasant ending. The only hope is for the suffering to end, from my perspective, and in hindsight, yes, it was a spot on analysis.

With regard to the doctors, now that part was just like in the movies. They hemmed and hawed and made sad empathic expressions, but didn't explain the possibilities at all. They just assume everyone is in a state of stupor, they probably assumed my rapid conclusions were some desensitized state of shock, just as they assumed my other family members clinging to hope was an equally dismissible state of denial.

I know some parents who had a child with an extremely rare degenerative disorder that attacks the nervous system. They were wealthy enough to afford extremely good care and as such, kept their poor suffering child "alive" for 12 years longer than anyone else who had ever had the same disease. Life expectancy of newborns with this disorder is about 1-3 years.

At every turn, the doctors and nurses charged with the child's care encouraged the parents to end the kid's suffering. The parents were absolutely invested in using all of their resources to give the child "the best care". The last few years of the kid's life were basically vegetative, with frequent interruptions of how a human with an obliterated nervous system manifests pain.

I'm sorry if this reads all tragic and horrible, but that's what it is. There should be laws preventing family members from prolonging the suffering of their loved ones.

It would already a great step if we would stop criminalizing assisted suicide. My grandmother recently passed away from cancer and she luckily suffered only a relative short while after switching from treatment to palliative care. She said from the first day that she only wanted to die quickly and asked the doctors repeatedly to give her something to end her suffering. Her health deteriorated to the point where she couldnt get up anymore and my parents had to find a palliative care facility. Only there was she given proper pain medication, which is horrible in itself, but still had to die slowly.

Its cruel and nothing more. I have little sympathy for the religiously driven pro-torture faction.

>There should be laws preventing family members from prolonging the suffering of their loved ones.

I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems. Just imagine the misery associated with doctors deciding to "kill people's children," which in fact in some cases would be unjustified. (Nobody can always get it right, not even doctors.)

Assisted suicide has been legal in Canada for a few years now, and there haven’t been many major issues (other than Catholic hospitals refusing to comply with the law). Doctors aren't fools, and won't do it in cases that aren't blatantly acceptable. Most of the scenarios where it is desirable are cut and dry, and we have ethics boards/courts to handle the other circumstances.

Assisted suicide is a completely different thing than "laws preventing family members from prolonging the suffering of their loved ones."

The first gives patients and families more options in how to deal with end of life care, the other takes options away.

> the other takes options away

Yes, it takes it out of the hands of the family and actually respects the patients final wishes, that they made for themselves while still lucid.

What are you referring to? No one is talking about invalidating advance directives, or taking away medical power of attorney, etc., in cases where, as you put it, "the patients final wishes, that they made for themselves while still lucid" are known.

Of course (unfortunately) most people still don't take these steps to make their wishes known. But the original comment was about "laws preventing family members from prolonging the suffering of their loved ones," specifically about an example of a young child, whose wishes were not known (and of course not really relevant for a toddler). The fact is in the absence of any advanced directive I would much rather have the family make decisions about the type of care desired by the patient than the state.

"Refusing to comply with the law" sounds like assisted suicide is mandated, when it's really a voluntary thing. As it is, where are there even still private, religious hospitals in the country? At least here in Ontario hospitals are all public institutions.

Ah, welcome to Alberta :)

A lot of small towns in Alberta only have Catholic hospitals (which are publicly funded, but run by Covenant Health [0], a Catholic institution). They refuse to provide, among other things, assisted suicide or abortion services despite being publicly funded. 4/9 of Edmonton's hospitals are run by Covenant Health.

[0]: https://en.wikipedia.org/wiki/Covenant_Health_(Alberta)

That doesn’t mean we can’t explore the idea.

In Australia, and I believe most places with well developed legal systems, you can get in quite a bit of trouble for mistreating an animal.

No so much if you mistreat someone under the auspice of medical or aged care.

Our culture has institutionalised the mistreatment of the terminally ill and frail-aged.

There are good arguments to be made that this should be seen as a problem that should be addressed.

Brutal but I remember reading an excerpt from an army doctor during the Napoleonic wars. He had two soldiers in his care who had been burned in a gunpowder explosion. A one point a solder came in saw them and then bluntly asked if they would live and was told that it was hopeless. The guy then went and cut both of their necks. The doctor in shock screamed at the man you monster to which them man screamed back I'm not the monster you are.

Reminds me of another account of a runway crash that left pilots trapped beneath burning wreckage and the understanding that any extraction and fire fighting would take hours when even minutes of a firey agonizing death, the local commanding officer on the ground grimly shot them both with his service pistol to shorten it to seconds and there was no disciplinary action even considered.

Another story a friends 93 year old grandfather was found unresponsive in his apartment. Rushed to the hospital and they saved his life.

And when he woke up he was utterly pissed because they cheated him out of an easy death. And as a devout Mormon he was done with this world.

My born in Greece high school history teacher said the Greeks didn't care how a man died. It's was how you lived that was important. I've tried to keep that in mind.

>I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems.

Existing child protection laws are for the most part perfectly satisfactory, if they're actually used. The courts routinely decide on whether a parent is fit to make decisions about their child, or whether a particular decision is in the best interests of that child. Many of these cases will individually present very difficult decisions, but the legal principles are relatively straightforward.

The impediment to actually using those laws is largely that of pro-life activism - few hospitals are willing to legally advocate on behalf of a suffering child because of the fear of becoming the centre of a media circus.

Yeah, the Terri Schiavo case is a great example of how pro-life activism unnecessarily prolonged someone's suffering: https://en.wikipedia.org/wiki/Terri_Schiavo_case

That is what I was referring to earlier in the thread. I think that case had far reaching effects, even to this day.

In some US states the doctors propose a plan, and if the parents of the child disagree with that plan they can go to court to get an injunction to prevent the doctors carrying it out.

Compare that with England. The doctors propose a plan, and if the parents disagree with it the doctors go to court to get an order. The court has to look at the child's best interests and the paramountcy principle means that while everyone's (parents and childs) rights are looked at it's the rights of the child that take priority.

> associated with doctors deciding to "kill people's children,"

They can already do this in most of the US.

My entire family is in medicine and I am well aware of this.

However, cases like the one I mentioned are fairly clear cut, in my opinion.

The current situation is already fraught with horrible problems! We torture innocent children to death! Would the problems you’re imagining really be worse?

When my dad was in ICU, an elderly woman coded repeatedly for the last probably ten days of her life. My mother spoke about it with disgust. She felt the family wasn't prolonging the woman's life. They were merely torturously dragging out her death because they were not emotionally ready to accept the reality that she was dying and would not be going home again.

(Given that my dad was in his late sixties, I think "elderly woman" as a descriptor from my mother means eighties.)

>There should be laws

Philosophical problems aren't solved by legislation, it is important that people stop looking towards lawmakers to push their morals.

Telling good stories – tragedies – well enters them into the popular mythos effects better choices.

>Philosophical problems aren't solved by legislation, it is important that people stop looking towards lawmakers to push their morals.

Murder, rape and theft are all philosophical questions, why are they easier to resolve through legislation?

What isn't philosophical question? You could say "nothing" and defend it well but that transforms my point from "some things are better off solved with other than laws" to "laws are pointless". Obviously I'm not trying to say the latter.

The issues you mention aren't philosophical questions in the way I am trying to express because there really isn't much of an open question. How many people are openly advocating that murder is generally acceptable? There are corner cases, specific instances, etc. that are up for debate but on the whole there is little question, murder is wrong and there need to be legal remedies when it happens.

That is wholly different from the end-of-life issues we are talking about. People's opinions and behaviors are all over the map and there is generally no consensus about anything. It is not a problem that is obvious and it is not a problem which has existed for much time. Murder has existed forever, the ethical question about when and how to use medicine to extend life is very new and has had only a little public discourse.

I mean, we have laws about murder, rape, and theft, but are the questions actually resolved? did george zimmerman murder trayvon martin or did he justifiably kill him in self defense? if you pick a young woman and an old man at random, will they agree on the definition of "rape"? will either of their definitions be reflected by the law in their jurisdiction?

we do our best (most of us at least) to create laws that are just and fair, but ultimately law is a pragmatic measure taken to prevent societal collapse. murder is illegal because you can't have a viable society where anyone can kill anyone else at any time without penalty. whether or not you treat dying patients humanely doesn't really threaten the stability of a nation in the same way.

And what's to prevent insurance companies from exploiting those laws to reduce costs and increase profits?

As strange as it sounds that's not really how it works.

It's a competitive industry. So, an insurance company's profit is based on total healthcare costs. The only way for the industry to make more money is to cover more people, or for healthcare costs to rise.

Put another way, if total healthcare spending was 0$, their total profits would be 0$. They can cut internal costs somewhat, but that's about it.

As opposed to the doctors, nurses, hospitals, medical supply and pharmaceutical companies who profited for over a decade from the child's care?

What prevents it now?

> laws preventing family members from prolonging the suffering

This would be inconsistent with the profit motive, which incentivizes patient treatments not cures.

You do know that most hospitals in the US today are run by Non-profits right?

This tired old, inaccurate, and moronic belief that evil capitalism only wants to make people suffer, where good moral socialism would solve all of our medical problems fails even a elementary glace at history and reality

Is wasn't long ago that homosexuality or intersexuality was a terrible condition that "any loving parent" would kill their child to prevent.

When my father was dying a few years ago, the doctors and nurses were very pragmatic and rather blunt in their prognosis and the options. They carefully did not make recommendations, but laid out the results of the various options.

I appreciated that.

Sorry you had a rough time getting information from your doctors.

> I don't get the impression that anyone in the medical community is trying to change this.

This is, in my experience, completely wrong.

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