Hacker News Reader

Comment by cameronh90 | Hacker News Reader

I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic.

It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway).

The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.

View on HN

> The lack of any legal route to assisted dying is also a problem.

Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.

I think there needs to be an acceptable palliative care option rather than attempting to extend the life of someone in their 80s. That's not really euthanasia. Accepting death is inevitable and making the last days of life comfortable seems like a better use of money than an operation that will give the patient a few more years of frailty at best.

I would want to live another few years even being frail in fact most people would.

most people would

You're wrong. There are many factors in play (family, friends, isolation, stress, money, pain, etc) around the individual's choice, but studies often find that the majority of older people would prefer a palliative approach to end of life. For example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ Sadly there aren't many studies around this topic. It's important, especially when so many people assume that older people just want to 'not die' rather than listen to what they actually want.

I personally knew a guy who was diagnosed with cancer and instead of treatment chose to spend his last few months with his family and then just die. This was in Germany, so all healthcare would have been payed for. A major reason was minimizing suffering for his family, having a good conclusion instead of prolonged suffering with unclear end date.

My uncle got diagnosed with cancer at 93 and his initial choice was similiar (I have to die of something in the end). But the family convinced him to try the therapy and it worked. He is still after two years alive and relatively well.

Different types of cancers are entirely different diseases with different outcomes. Your uncle was part of the lucky ones.

I would rather the resources to keep me alive in a frail state go to benefit the younger and future generations. At least the option for me to do that comfortably should exist.

Have you experienced frailty before? I have had a chronic illness that intermittently puts me out of commission as a relatively young person. Imagining living that way as an already aged senior sounds like torture.

I have had grandparents live into their late 90s with a decent quality of life. I think they appreciated life extension pas their early 80s.

That's where it gets tricky. I don't think anyone here has said patients in their 80s shouldn't get any life prolonging treatment.

I think patients should be able to choose this if they'd like... or choose euthanasia. Or choose life-saving options that are available.

I'd personally rather live so long as I know better. Death might be inevitable now, but that isn't necessarily a set thing. Folks are working on having different sorts of existence and working on extending life and things like that. Sure, some of it seems like a pipe dream now, but who knows when some weird breakthrough will happen. I'll take my few years, and resent anyone trying to take them away - but your few years aren't mine to decide what to do with.

Besides, not everyone in their 80's is necessarily frail. Some are frail sooner, some later.

1. Most people like to live.

2. Most people at the bitter end are past the ability to make decisions.

> but your few years aren't mine to decide what to do with

Depends who is paying for them. Voters certainly can take Medicare away, or implement a triaging criteria.

I do not think that matters. Of course, I'm probably not of the same political views as you and fully support taxpayer-funded health care. All of it, including end-of life. Voters shouldn't be the ones deciding that care: Doctors should.

I'm generally against doing procedures that won't really add life to folks - especially weeks. Years, though? That's years. Folks can be frail yet able-minded and so on. It doesn't really matter to me if someone needs to have some assistance to live, regardless of age.

Triaging criteria already exist. It is really a shame that insurance companies and businessmen have their hands in it instead of doctors. But I don't mind these criteria: They are, in general, for emergency situations instead of, say, routine gall bladder surgery.

I also support taxpayer funded healthcare, but I realize that taking care of each and every old person in nursing homes and keeping them alive as long as possible would consume a disproportionate fraction of the nation's resources, especially in a population with fewer and fewer children.

And the people triaging at insurance companies are doctors and pharmacists themselves. A doctor not employed by insurance companies is also a "businessman", considering they get paid more the more they treat. No one is exempt from conflicts of interest, but since US voters didn't want "death panels", they get to deal with prior authorizations.

It's the same function done by the NHS or government in any other country.

If someone wants to die, let them fucking die. The fact that people consider this "contentious" is utterly ridiculous. How can you possibly justify telling other people to go on living if they don't desire to do so? Seriously, mind your own fucking business.

This is why I consider it “contentious”:

«On February 13, 2014, Belgium legalized euthanasia by lethal injection for children,» from [1].

«Even the controversial head of Belgium’s euthanasia commission is concerned that a well-known Belgian psychiatrist is allowing too many of her psychiatric patients to be euthananised,» from [2].

1: http://www.patientsrightscouncil.org/site/belgium/

2: https://www.bioedge.org/mobile/view/belgium-euthanasia-docto...

'The law states a child would have to be terminally ill, face "unbearable physical suffering" and make repeated requests to die - before euthanasia is considered. '

https://www.bbc.com/news/world-europe-26181615

Perhaps the law is not being applied this way, but I think the idea here is "this poor child is in agony with no hope of improvement and keeping them alive is torture in a sense" - not "let's take terminally ill children lightly"

> If someone wants to die, let them fucking die.

That is not what the assisted suicide debate is about. The debate is about the right to kill someone who cannot do so themselves.

Not to mention, it’s not exactly clear as to who is able to make that decision.

I’ve never thought of that as the debate. Not providing care is not killing someone. We already do plenty of that in the US. The debate is about giving someone a quick, painless death via the application of certain medications as opposed to letting someone waste away painfully.

Reply on news.ycombinator.com