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Comment by diminoten | Hacker News Reader

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide.

Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause?

At the very least, we could be honest about it and say what the real reason is: we don't have the resources to try everything for everyone, and normalizing a set of not-quite-everything standards is the best way to keep the average level of care up for everyone.

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>Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause?

Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future.

We're not talking about saving lives, we're talking about briefly delaying an inevitable death. How much suffering would you be willing to endure for the possibility of another few days or weeks in a hospital bed?

Doctors know what these deaths look like. They know what it feels like to effectively torture someone for no good reason. Doctors overwhelmingly choose palliative care for themselves, because they know that extraordinary medical efforts for very sick patients are invariably brutal, miserable and futile.

>Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future.

One significant problem, at least in my experience, is when doctors take that approach with someone, based primarily on their age and on inaccurate diagnoses, who has multiple serious health problems and does not die in the very immediate future.

The common view seems like an inversion of Blackstone's ratio (better to prematurely end the life of one individual than to let however many other individuals suffer). To be fair, as a personal point of view this is fine, but it may also merge with socio-economic constraints in a really ugly way. In addition, no one I've spoken to has made any effort to even consider and explore differences in how other people experience pain or view death.

When all is said and done, it can be a real shit show.

You seem to be thinking of a case where an otherwise healthy person is dying of an incurable disease, and risky treatments might bring their health completely back.

I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in sight but death. An 80-year-old with Alzheimers, diabetes, and cardiac problems doesn't have a "root cause" that you can just fix with an experimental treatment. They're old. We all get old. In that kind of case, I hope the doctors' perspective makes more sense...

No, it makes zero sense.

My grandfather had advanced Parkinson's, but had zero intention of dying to it or its cornucopia of related symptoms/effects. So what if he has a major disease that made life many orders of magnitude worse for him? Life is still life, and death is still infinitely worse.

Giving up and accepting death may seem reasonable to some, but not for me or my grandfather. There's always a root cause, and there's always a way to keep going.

Giving up is suicide.

>Life is still life, and death is still infinitely worse.

I assure you that this is untrue. There's a reason why people on the upper floors of the World Trade Center jumped from the windows, and it's not because they expected a soft landing. There are many, many things in this world worse than a peaceful death.

I assure you it is not untrue.

People failing to realize a truth doesn't make it less true.

Peaceful death is suicide, if chosen. Period.

> Peaceful death is suicide, if chosen. Period.

Then suicide is preferable.

Stop using the word suicide as if it was an insult.

I feel like that is a crappy example to shove in people's faces. I guarantee you there is a nonzero amount of people who did that on 9/11 who could have made it down safely and enjoyed the rest of their lives.

Actually it's a perfect example of the other kind of suicide, not due to permanent illness so much as temporary circumstances that could be resolved and lead to the person not wanting to do that. That is something for which friends, family, and medical professionals ought to intervene.

If you down voted this please explain your position to enlighten others. Otherwise I am just going to assume you did so out of poor life experience. Suicidal people often need and can use help, after which they can return to not being suicidal. Gp's 9/11 reference was also kind of nonsensical, and I say that as someone who was in the DC area at that time.

The North Tower of the World Trade Center was engulfed in flames above the 93rd floor and suffered severe structural damage, cutting off all possible routes of escape. At least 1,300 people were trapped above this point; none of them survived. Even if the towers had not collapsed, these people would almost certainly have died from smoke inhalation due to the difficulty of firefighting and the impossibility of rescue.

The South Tower was struck more obliquely leaving one intact stairwell, but this was difficult to locate and descend due to the huge quantities of thick, black, choking smoke. At least 600 people were unable to find an escape route before the tower collapsed. Most of these people would have likely died of smoke inhalation if the tower had not collapsed.

My reference to 9/11 was, in my opinion, entirely apposite. On that day, nearly 2,000 people were faced with no choice other than the manner of their death. Around 200 people chose to jump.

https://usatoday30.usatoday.com/news/sept11/2002-09-02-jumpe...

This is much more detailed than your original statement. Thank you.

I still think the number is likely nonzero (a word I chose to indicate it may not be a high number but it is not zero) and my earlier point is reenforced: they were forced into it by circumstance, and would have taken another path had it been on offer.

It was most certainly not a "peaceful death".

Edit: I will be honest, some of my reaction came emotionally from offense at the implication that theirs was somehow a "peaceful death" (your words). The USA Today piece you cited says it was officially called "homicide". That is accurate. Assisted suicide is a totally different thing.

My grandma had cancer. A doctor had ignored her complaining of throat pain for too long, and it didn't look good. The doctor who told us chemo was an option was pushing my grandma really hard to just go ahead and die instead of trying chemo. It was horrible, and I hate the attitude that people shouldn't try so hard to stay alive.

My grandma tried the chemo. She did die anyway, which I'm sure some folks will see as a reason that she never should have tried.

Would it be OK if your gradma had decided against chemo and the doctor was pushing her really hard to take it?

Doctors bullying patients seems like a problem regardless of the direction they're pushing them.

>Life is still life, and death is still infinitely worse.

And if that's truly your choice, you can choose it. In fact, as the article makes clear, your choice is the default one as things are now.

But you should understand that other people's choice might be different from yours, and you don't have to right to insist that they get your preferred treatment if they don't want it.

> there's always a way to keep going.

Did your grandfather die? I'm assuming he did, since you don't refer to him in the present tense. If so, doesn't that falsify this statement?

I think one reason is because they see people with terminal diagnosis take a beating from heavy medication like chemo and being unable to spend time with their family instead of just taking pain killers and spending their last months with family and friends.

> I want to go out as a result of a series of violent mistakes trying to save my life.

The problem is that excruciating pain is only obviously better than death if there’s something positive at the end of it.

Otherwise it’s comparable to being tortured 24 hours a day for the rest of your life.

Sorry, but excruciating pain is always better than death, because death is eternal nothingness. At least excruciating pain is something.

Have you seen someone in excruciating pain for a long time without hope for improvement or experienced it yourself? It's really easy to talk tough while you are healthy but your opinion may change once you are in that situation.

From what I have seen I would prefer to go out in dignity at my own will instead of being an experiment of the medical machine. Others may feel different and I think both paths should be available.

Yes. And no, my opinion hasn't changed.

What does dignity buy you if you're dead? Nothing. You can have yours, I'll spend mine to stay alive as long as possible.

That's your choice. As I said both options should be available.

In the end you will only know how you will really feel once you are in such a situation.

such absolutist statements make me think you are relatively young and likely have not experienced any form of chronic pain, mind you not momentary pain that you 'rise above' but constant, unwavering, always-on pain. that changes perspectives, especially when you are old and don't have much to look forward to.

These kind of ageist arguments are pretty annoying. Some people have chronic pain and still want to live as long as they possibly can.

There’s a significant difference between chronic pain and crippling state of existence that requires your ribs to be broken to sustain life.

From my understanding: any CPR done properly has a risk of breaking people's ribs. You've got to push quite strongly to resuscitate the heart.

If you're not coming back, the doctor performing CPR will push harder and harder to try to get you to breath again. And yes, that means broken ribs.

Medicine is ugly. We rip out veins in the legs and attach them to the heart to "cure" blocked arteries and prevent heart attacks. We pull tendons out of corpses, drill screws into bones, and re-attach the knee bones... to provide additional support to torn tendons.

And in some cases: doctors tell the patient to live with the condition (ex: some peculiar shoulder bone breaks), because the treatment is sometimes worse than the ailment.

---------

I don't know all treatments or all ailments... and even doctors won't know all the possibilities. But, the overwhelming expert opinion of the health care industry seems to be against full code. (and btw: they make money when they drag lives out... they have a financial incentive against this recommendation. The longer they drag out your life, the more money that they make.)

I suppose I might choose the excruciating pain if I were alone on a desert island with nobody watching. But if my wife and children were sitting round my death bed I think I'd prefer, for their benefit, to die in a dignified way. And in a timely manner so as not to keep them waiting. Death is not eternal nothingness. Life goes on.

Death absolutely is an eternal nothingness, don't fool yourself. Your kids, your wife, none of that matters after you're dead. It's literally irrelevant at that point.

My kids and my wife absolutely matter after I'm dead. I'm not so self-centered as to believe that they exist solely to give me pleasure.

To you? Nope. Nothing does, you're dead.

You don't feel the same way about the """nothingness""" before you were born as you do after you die. You're just weirdly flexing your ego in the most pompous way possible in this thread.

That's a crazy argument, of course I don't feel the same about something now that I have it...

Mark Twain was quipping, not building a life philosophy.

You dont seem to understand. There will be no you to have lost it. There was no you to gain it.

What you don't understand is there is a me now, currently, so this comment/argument is completely pointless and generally wrong.

> there is a me now

Like I said, your ego-- the sense of self-- is doing a weird flex. But ok.

Not weird, and not a flex, I'm simply acknowledging it's existence, unlike apparently everyone else here.

Is there?

Death is not eternal nothingness. Eternal implies that something "is". Death "IS NOT".

Seems unlikely.

Pretty much every healthcare worker I know, religious or non-religious, leans towards DNR over "Full Code" on themselves. To the people who have watched others die on the operating table, they do not believe that the final moments in a hospital is worth it.

Death is inevitable. You can either have it with dignity, perhaps a week or month earlier than usual. Or, you can drag it out for weeks or months in a hospital (possibly bankrupting your family). Regardless, you'll die eventually.

There are plenty of stories about brain-dead patients staying in a hospital for years (!!) while their bodies atrophy and inevitable brain damage prevents any hope for a reasonable life afterwards. Modern science can keep someone technically alive, but at an unfortunate cost.

Its far luckier to die peacefully (and suddenly) in your sleep... without dragging out your life. Doctors for the most part know this, but they don't want to change American culture or trample on people's right to choose how they die. But its pretty clear what option is preferable.

It's not only likely, it's certain. Death is nothingness, not peace, and pretending like it's preferable is basically acquiescing that infinite nothingness is preferable to nothingness, which is definitionally false.

There is literally no such thing as a peaceful death. It may sound poetic, and it may be comforting, but it's not true or real in any sense to the people actually dying.

The reality is, it's peaceful to the living, and so we falsely optimize for that.

> Death is nothingness, not peace, and pretending like it's preferable is basically acquiescing that infinite nothingness is preferable to nothingness, which is definitionally false.

This seems to be in the realm of philosophy, meta-science and religion. I don't really want to bring the discussion there, but I simply need to point out that many, many religions (and atheists) have different opinions on this matter. For example, a dignified death may bring you closer to the creator (emphasis on "dignified", because suicide doesn't count for some religions).

And I don't believe there's any way to properly gather evidence about what happens to someone after they die. And without establishing our religious ideals as ground rules, I don't think we can really have a good discussion on the matter.

Yeah. No. Let me cut your crusade against the medical profession short by telling you that doctors are putting their money where their mouth is [1].

They see the kind of suffering that prolonging people's lives with certain conditions can inflict and choose to have none of it.

Other than that your comment is incredibly rude towards people who will do everything in their ability to keep you alive anyways - if you/family so insist - and also borders on being a conspiracy theory.

[1]: https://www.zocalopublicsquare.org/2011/11/30/how-doctors-di...

This article only talks about useless symptomatic treatments, not about effort at treating root cause.

If you’ve just been diagnosed with something terminal you’d want to try every experimental treatment no matter how violent or dangerous. But if you’ve already established that nothing is working and your body has begun the shutdown process I don’t see why you’d want your last feelings to be shocks to your heart, your ribs broken or your throat being cut and plastic tubes shoved in.

Emergency reactive procedures (codes) for a 20 year old who had an accident on the way to the gym and a 80 year old in the last stages of terminal cancer are the same, the article is arguing that they shouldn’t be.

In many cases, there are no mistakes made. Imagine a doctor saying: "You're going out but if we inflict pain you will stay longer." What would you choose? Peace or pain? What would you want your relatives to choose for you? In case you can't decide anymore?

If the rest of my life will be nothing but pain, I don't think I'll want it.

Death is not peace, stop perpetuating that lie.

Stop trying to pass off your own personal opinions as facts.

Stop trying to interpret my opinions as facts. Are you seriously fooled into thinking what I'm saying here is even arguably fact? Of course it's my opinion...

If you call something someone else says a lie, that's not a statement of opinion. You're saying they said something false. That's a factual matter.

An opinion can be false/wrong/a lie.

Something can't be an opinion and a lie by definition.

Lying is consciously uttering something you belive to be untrue. It can't be your opinion at the same time.

So unless you're planning to insult the people you are talking to by calling them dishonest, you should cease this way of discussing the topic.

It's obvious you care greatly about this matter and tempers can understandably get heated, but people calling each other liars rarely have productive discussions that leave all parties wiser.

Something can be an opinion and a lie by definition.

Also, I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie." Getting upset about a fact is yelling at a cloud.

And why is it obvious I care greatly about this matter? Because I've written less than a page's worth of content on the topic? Seems like a weirdly low bar...

> I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie."

You can't know their opinion is wrong, because you've already admitted that's just your opinion. It's not a fact. Your opinions are not facts.

That's not how opinions work at all. An opinion can be true or false, justified or not. I'm not countering anyone's opinion with my own opinion, I'm pointing out facts that disprove those opinions, and then offering my own alternative opinion that isn't proven wrong.

> I'm pointing out facts that disprove those opinions

You have pointed out no fact that justifies your accusation of lying.

Ah so now you rope back around to the actual conversation. Nope, you've poisoned this well too much with your semantic nonsense, you don't deserve to benefit from anything I have to say about death.

> you don't deserve to benefit from anything I have to say about death

You've already said what you have to say about death pretty clearly, so if I were going to derive any benefit from it, I would have already done so. But if it will set your mind at rest, no, I haven't derived any benefit from what you have to say about death.

All you're doing is being petty and generally terrible. Why?

I've been watching this thread in amazement. If this is how you communicate with people you'll often have your style described as petty and terrible. Are you just repeating what you hear yourself a lot?

> Something can be an opinion and a lie by definition.

Where opinion means "belief held", that's an obvious oxymoron.

> Also, I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie." Getting upset about a fact is yelling at a cloud.

Let me quote yourself at you:

> Stop trying to interpret my opinions as facts. Are you seriously fooled into thinking what I'm saying here is even arguably fact? Of course it's my opinion...

As another commenter already said, you can't have it both ways. Right now you're directly contradicting yourself.

> And why is it obvious I care greatly about this matter? Because I've written less than a page's worth of content on the topic? Seems like a weirdly low bar...

I said so because that would excuse your uncompromisingly hardheaded and rude conduct towards virtually everyone in this discussion. I often try to think the best of people.

I have a hunch this will go nowhere and I am not going to reply to whatever comes next.

Epistemologically, there can be false beliefs, so no it is not an oxymoron, obvious or otherwise. Basic philosophy.

You're right, this will go nowhere because you're trying to have a semantics argument while also being wrong about the semantics you're trying to correct.

And again, I don't care if you find me to be rude. Bringing it up is distracting from the larger conversation, about how we're being sold a bill of goods by doctors about "peaceful death" because it makes their lives easier to think about, at the cost of giving up earlier on patients.

> we're being sold a bill of goods by doctors about "peaceful death" because it makes their lives easier to think about, at the cost of giving up earlier on patients

At last, an actual substantive statement. But unfortunately, it's still your opinion.

I have no problem at all with you choosing to fight to the last and continuing to seek treatments right to the end even if you are diagnosed with a terminal illness where all known treatments have slim to no chance of success. But that's your choice, and other people might choose differently. And the problem with accusing people of lying simply because they don't share your opinion and would make a different choice from yours isn't that it's rude (though it is); it's that it's not justified.

So to be clear, you can obviously see when I'm expressing my opinion, but due to semantics of English, you demand I express it in a way that doesn't offend you?

Jesus dude, why the fuck would anyone listen to that level of hubris? What the hell kind of incentives are you giving me here, because right now my only incentive is to laugh at the person who can't actually have a conversation because they're too busy derailing it with semantic arguments about things they did understand, but didn't like how it was presented.

> So to be clear, you can obviously see when I'm expressing my opinion, but due to semantics of English, you demand I express it in a way that doesn't offend you?

It has nothing to do with offending anyone. (Note that I explicitly said that rudeness was not the issue). It has nothing to do with how you presented what you said. It has to do with the substance of what you said--your accusation of lying--being unjustified.

It's not unjustified, and even if it was, a belief can still be true or false.

Again, I urge you to read about epistemological knowledge. Basic philosophy concept that will educate you.

> you can obviously see when I'm expressing my opinion

Yes, exactly, which is why I keep objecting when you express your opinion but then treat it as if it were fact.

I don't care if you object, I'm not going to stop.

> You're right, this will go nowhere because you're trying to have a semantics argument while also being wrong about the semantics you're trying to correct.

Yikes. Okay. You goaded me into replying.

About lies and opinions: If you said something factually incorrect that you nevertheless believed to be true at the time, you were not lying.

That is why it can't be a lie when you say something that you honestly believe (i.e. your opinion).

Now it might be that "Lie" means something different in your culture, but in the English language it means "[..] an assertion that is believed to be false, typically used with the purpose of deceiving someone". (https://en.wikipedia.org/wiki/Lie).

Here's a good article on the matter: https://philosophynow.org/issues/27/The_Truth_about_Lying

Now whether I lied when I said I would not reply is for you to figure out.

Sorry, you can't have it both ways. Opinions are opinions: nobody knows for sure which ones are right or wrong. IMO you should retract your accusation of "lie" since you have admitted you were just stating your opinion. Your opinion might not agree with someone else's opinion, but that doesn't justify you accusing them of lying.

Not all peace is welcome, mind you.

I 100% agree with you. Though everyone should be able to make their own decision and because people are diffrent they will come to diffrent conclusions about what the right path for them is. We should not be trying to impose our path on other people.

That said I'm going to speculate that as a doctor being asked to do long series of futile actions while watching a person die has to be traumatic. So I can understand why many doctors like the idea of palliative care.

The fact that doctors overwhelmingly choose non-intervention and palliative care for themselves at their end strongly implies that they're not merely traumatized as doctors, but also that they feel it's terrible for the patient.

Everyone has a threshold regarding the amount of suffering they are willing to endure rather than dying. Yours (and your grandfather's, per your other comment) may be high, but so isn't everyone else's.

Suicide and euthanasia are valid options in some situations, which are up to each individual to evaluate for themselves.

The doctor in the article has been confronted to the selfish side of love too many times. People want their family members to be kept alive because losing them would make them sad. Somehow more sad than seeing them suffer and slowly die anyways.

I wonder whether you would have such strongly held opinions if you had more experience of medicine, disease, and end of life.

though I agree with you mostly I feel you are ignoring a couple of things

1) Pain, often pain management becomes a much bigger issue than going all out fighting vehemently to prolong your life by a few more days/weeks/months. Its hard to understand what chronic pain does to you and your mind unless you or a close loved one goes through it. Often pain management also aligns with 'slipping gently into the night'.

2) Incentives, hospitals are in the business of making money and they's gladly run marginally useful tests and medicines until they max out whatever coffers they can. as I see its not long before the ethical/common sense minded providers get overpowered by the money making machine and give in. as it is perhaps you are not aware there was a study that concluded most (IIRC 75%) of a persons healthcare expenses happen in last 18months of their lifes. just ask yourselves this, would you rather give your inheritance to your kids & grandkids or some hospital trying to maximize profits by promising you random treatment that increases you life by a few months? ultimately this should be your decision to make but there should be strong protections around the options providers can present to you.

edit:formatting

2) brings to mind all too common scenario of patient being discharged from a psychiatric unit on day 22 because insurance only covers three weeks.

Adding a study to back up yours. "Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older."

https://www.kff.org/medicare/issue-brief/medicare-spending-a...

The Norse of old would agree with you, where if you die a "straw death" outside of battle you don't get to go to Valhalla. But apparently if you stabbed yourself on your deathbed you still got to go to Valhalla?

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