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Comment by quetzlbazaar | Hacker News Reader

The solution in my opinion to this problem is to permit euthanasia and for assisted suicide to become culturally accepted as an alternative to a drawn out death of dementia in a care home. The quality of life for many (not all) care home residents who are on these sorts of drug regimens is dire and in reality not entirely for their benefit, as is apparent to everyone including those responsible for oversight like Medicare. This system exists (primarily in the West) due to a combination of taboos surrounding death and profit/political incentives on the part of pharmaceutical and care home companies.

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Speaking from experience, people are not nearly as enthusiastic to make the decision to kill themselves (as dementia sets in) as every likes to imagine that they will be themselves. I have seen multiple cases of people who - in healthy middle age - made bold statements ("just shoot me when I get like that"), who later went on to write documents insisting that "all measures be taken to preserve my life". So not even "just let me die peacefully when it's my time", much less "load me up on opiates and finish me off in a month when I don't know who/where I am anymore".

I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.

Unless you are proposing that others get to make this executive decision that people with dementias lives aren't worth living, this solution is not practical.

More practical would be to accept that we are far better off over-medicating with pain meds to "keep people comfortable" with the implicit idea that it will shorten their lives. Everyone can pretend we're doing it for pain. Effectively it's like what you said but with some face-saving bullshit where no-one has to admit we're killing grandpa/grandma over the course of a few months. I'd much rather a few months on opiates at the end of my life than a few years on Haldol (JFC). Ugh.

“I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.“

Is it really demented thinking to want to avoid approaching death? I am there right now with my mom, and if she wants to press on, who am I to argue?

Agreed. I think people change their minds about how bad life would be if you can't function at a high level. A good deal of this is pride.

On Monday I will be an Intel Principal engineer again - but there's some Monday where I may need someone else's help to get the shit off my bum. From the perspective of that next Monday the indignity of the latter one is astonishing and humiliating, but there will be many intermediate stages where I get used to the idea that I am not what I was and to see that life is still quite pleasant.

"More practical would be to accept that we are far better off over-medicating with pain meds to "keep people comfortable" with the implicit idea that it will shorten their lives."

If it's reasonably certain that I will die soon or there is no chance for recovery I would like to try all kinds of drugs like heroin, cocaine and others. Why stay sober?

> I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.

More likely it is that theoretical death sometime in the future is something much different then real death sometime soon. Which is much different to actually doing it and following up.

The exact same thing happens in physical danger situations. People are brave and daring and when faced with actual situation, the start making real decision differently.

Jurisdictions that allow euthanasia or assisted suicide usually require that the patient be of sound mind as confirmed by a physician. But many nursing home patients are suffering from a significant level of cognitive decline and thus no longer meet the criteria. It's kind of a Catch-22.

Yes, it's unfortunate. The taboos (cultural or otherwise) and personal hang ups that people have surrounding death and dying prevent people from acting before it's too late. Ideally very-old-age/death planning would become as normal and culturally acceptable as planning your retirement and pension. The former is absolutely certain to happen but people will give almost all their thought to the latter.

Okay, let's assume we do exactly what you outlined there. In 2031, do you not expect to read an exposé on how many "care home" residents are being pressured into signing euthanasia papers without understanding what they're doing? How do we avoid that world?

People will always need to make arrangements for their deaths well in advance before the cognitive decline prevents them from being able to do so. Such has always been the case with or without legal euthanasia.

I would definitely expect to read such an exposé and certainly there would be cases of people pressured into assisted suicide who otherwise would not want it. There is no good solution to this issue, in my mind. Some measures could be taken to prevent undue coercion like criminalizing those who did it but I'm not sure how it would work exactly.

Personally I think I would prefer euthanasia if I knew I was developing dementia and likely to end up in a care home similar to the one described in the article, or even one much better than that, so perhaps selfishly I would prefer a society where such is legal even though there would end up being abuses like you describe.

So the solution to people being mistreated is to give them the option of dying instead?

You're right, it is not really a solution specifically to this problem, 'alternative' would have been better a better choice of words. Certainly I think it would be a good thing if people had the option of dying, even if they also had the option of going to a good care home - if only on the basis that dementia in and of itself may not be something an individual wants to experience even in the case where they are receiving good care.

We can think of care homes as like suppliers in a captive market, and we are the consumers - but it is even worse that a captive market in the sense that at least in a captive market you have the option not to buy, whereas we will be forced to. The existence of assisted dying as an option may even economically incentivize the care industry to improve.

A nursing home around here for dementia runs $10,000 per month.

Same time we hardly pay that per year for k-12. Shows how messed up our priorities are.

School aged kids and teenagers also require a lot less individual care and attention

Nursing homes have some similarity to schools, the staff is mostly occupied by a few problem patients while the rest quietly shuffle along

14% aren't even graduating our watered-down standards. I think they could use a lot more individual care and attention.

This is a stupid comment. You think a child is as much work as a psychotic elderly person.

That seems cheap if you break it down into per hour of labor needed. I can only imagine how understaffed they are. I would hope I can take myself out before I end up in one of those.

These doctors can’t be trusted to treat patients with Haldol. I certainly don’t trust them to properly administer euthanasia.

If they are fabricating schizophrenia dx, then they would also likely to fabricate medical cause for euthanasia.

One option might be to not require a medical cause for assisted suicide. Instead it could be something that people have an absolute right to do for any reason or none, though I do not think most societies would be comfortable with that. Perhaps heavy due process similar to that required in many jurisdictions for a woman wanting to carry out an abortion could be required.

“euthanasia” is already available. gun, knife, bridge, rope.

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