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Comment by dcurtis | Hacker News Reader

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare.

But it doesn't matter. You're sitting in a small room with dim lights and someone tells you that you have two choices:

1. You can die a certain death, within months, with very little pain, or

2. You can try some heroic measure like chemotherapy for a minuscule chance of a multi-year moderately happy, but extremely painful survival.

Humans are programmed to have hope, and, regardless of any logic, the vast majority will choose option 2. It's just like playing the lottery. Even now, as I think about those two options in good health, I am compelled by my nature to choose option 2.

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It is obviously a personal choice but situation #2 may be worse than you imagine.

You can write, read, and interact but only for a few hours each day. Pain and fatigue take over the rest of the time. There is also so many little things you take for granted you will not be able to do anymore, or will require assistance to perform. Eating can become a chore, you may have to be regularly plug to some gruesome apparatus, also loss of mobility. Think about the last time you were sick, or injured, think of the worse moment being your new normal. I personally can`t imagine being happy in those circumstances. I choose #1.

Each person choices should be respected, and people should be better informed on the tradeoff of each choices, which I feel is not the case in our health care system.

I can't imagine not doing #2 unless I'd also be non-functional during the extended life period. If I could read, use the Internet, write, talk to people, etc., it seems like it would be worth pain (which will end when you die, no matter what).

The only case where I could see #1 being a reasonable choice is if #2 puts such hardship on those around you that their lives become much worse.

It is easy to say that pain would be worth dealing with but in reality the majority of the healthy public has no understanding of what true chronic pain entails. Ask anyone who has worked in long term or hospice care this question and you will likely find an overwhelming majority choosing option 1. The reality is that in the US death and dying are still anathema.

>The reality is that in the US death and dying are still anathema.

And thus with the help of the law people are made to live as long as it is possible even when they don't want to. I'm afraid that when the policy is reversed, people would be "encouraged" to quit as soon as possible (and being afraid of such reversal the society clings to the current policy).

Somehow the society just can't understand the simple thing that the decision to quit or stay is personal and not for the society to make/enforce either way.

Agreed, I can think of nothing more personal than having to make that kind of decision. I do think some safeguards are probably necessary to prevent reactionary decisions such as cases where pain or disease are temporary. At the end of the day it comes down to education.

exactly, bingo! It's like saying u'll stay married forever when your hormones are raging.

"reality the majority of the healthy public has no understanding of what true chronic pain entails"

Agree. And forget even chronic pain. Simply having a nagging pain, a bad cold, nausea, or a bad headache is certainly enough to take the joy out of many things in life. Even a drip in my throat can kill my buzz.

Nobody gets out alive, so for me it's definitely a question of quality not quantity. It's all very case-by-case however; for example my dad had major surgery to remove most of one of his lungs (cancer) and recovered and had another pretty normal decade of life before the cancer returned, at which point in consultation with his doctors he decided he wanted nothing more done. He could have had more surgery, chemo, radiation, but was clearly in the zone of diminishing returns (enduring a lot of unpleasantness for maybe a bit longer life of uncertain quality).

For me #1 is easy. Screw writing and reading, instead travel around the word, jump from planes, swim with sharks and die in months. 100% better then daily visits to a hospital for a handful of years.

What I, and a lot of people like me, are doing now by not doing #1 is gambling we'll get to do it in the future. This is an easily lost gamble, but oh well.

That sounds great but dying doesn't leave you with a lot of energy to do these things for long.

I think the point is that the treatment leaves you with a ton less energy and hunger and power, etc. Otherwise there really is no point in skipping the treatment.

Then the $19.95 home stem cell kit comes along the week after you die.

I think dhughes made a point here. I would choose option 2 not only because I have a chance to live longer, but also because there might be a treatment for my illness, which will be discovered in the future.

If the treatment allowed you to live over a decade longer then you could live long enough to get another treatment option, this has been true about AIDS drugs.

But if the treatment allowed me to live over a decade longer I'd also choose the treatment even if there was no chance of a new cure.

If the treatment only allows you two or so extra years, unless something is already in the late stages of coming to market, there is just no way any kind of drug or therapy for humans will get through even the earliest stages of approval in that kind of time frame.

At that point, it's probably still too late for you.

In case of chronic diseases like cancer, #2 does put hardship on those around you and their lives will become much worse.

Humans are notoriously bad at predicting what will make them happy.

Humans who haven't thought about it aren't, but when you've thought about it you can predict very well.

A decade of research into affective forecasting says otherwise. It shows that you'll only be good at predicting what makes you happy if you read studies about biases in affective forecasting. See "If money doesn't make you happy, then you probably aren't spending it right" http://dunn.psych.ubc.ca/files/2011/04/Journal-of-consumer-p...

The abstract of that paper underscores my point that if you've thought about it you can predict better what creates happiness.

I don't agree that only by reading "studies about biases in affective forecasting" can you be good at predicting what makes you happy.

I know if I eat good food with good friends or family I'll be happy. I've never read that in a study, but it works every single time with me. I know plenty of other ways too.

I don't think reading studies is the only way either, but I don't think most of us have questioned what makes us happy outside of soceity's default settings (money/fame/toys/vacations).

People make all sorts of tradeoffs which are non-optimal:

* Extra commute to a better job with $XX,XXX more for +1 hour/day of travel (less time for good food with family/friends) * Move away from good family/friends to pursue better job * Pursue career X because it's more lucrative than career Y (even though Y is more enjoyable)

There are lots of biases like this, under the assumption the change will increase our net happiness.

In case people think kalid is making it up, the first one is the 'commuting paradox': http://ftp.iza.org/dp1278.pdf (or http://www.businessweek.com/magazine/content/05_08/b3921127.... )

Thanks for the link! I remember reading that study somewhere. A salient part of the article:

"This is what economists call "the commuting paradox." Most people travel long distances with the idea that they'll accept the burden for something better, be it a house, salary, or school. They presume the trade-off is worth the agony. But studies show that commuters are on average much less satisfied with their lives than noncommuters. A commuter who travels one hour, one way, would have to make 40% more than his current salary to be as fully satisfied with his life as a noncommuter, say economists Bruno S. Frey and Alois Stutzer of the University of Zurich's Institute for Empirical Research in Economics. People usually overestimate the value of the things they'll obtain by commuting -- more money, more material goods, more prestige -- and underestimate the benefit of what they are losing: social connections, hobbies, and health. "Commuting is a stress that doesn't pay off," says Stutzer."

That article was so good I made a separate submission for it. Thanks.

Why would this be downvoted? It commented on a defeatist statement that is only accurate for people who don't learn about what creates happiness, thinking it's only things like more money or promotions or buying products.

I basically echoed the principle of "know thyself" in a relevant context.

I voted it down because it's an "argument from authority" and I found it slightly pretentious. It was also ironic, considering your other comment today defining "argumentum ad verecundiam". I didn't really like Kalid's statement either, but left it alone.

As you say, you are echoing a principle (which verges on a platitude), but not adding a lot to the discussion unless we are willing to trust your expertise without examples. Had you combined it with your more detailed followup, I wouldn't have felt this way.

I'm not really defending my vote, just explaining my thought process since you were asking. If it helps, I've evened out my actions up by upvoting this question.

People frequently choose #1 half way through #2.

I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare.

No, doctors try to make you as fully aware as possible of the options available to you, so that you or your heirs don't turn around and sue them later for 'withholding information that could have saved your life' or something along those lines. Arguably, these suits are motivated in part by the need to defray the extremely high costs of care and pushing back at the physician or caregiver about the quality of clinical care is a powerful negotiating strategy because it plays well to a jury.

"Lawsuits" are an easy scapegoat, but it's probably not a significant driving factor. For example, Texas has very strict tort reform laws which basically make it impossible to sue a doctor for malpractice. But defensive medicine hasn't faded at all in the four years since those laws took effect.

Structurally, our system is designed to over-treat. With co-pays, insurance, subsidized care, and contractual discounts, patients seldom are aware of the exact cost of treatment. How often do Doctors explain to patients up front both the tests to be performed and the line-item cost (both to you and to the payor) of each?

Most doctors don't, and realistically can't, know the cost for each patient under each plan. Usually, it's a binary decision for the doctor (covered or not covered).

Try it sometime. When your physician suggests a procedure, ask what the real cost is, and whether he/she thinks that the value of the results will be worth the expenditure compared to alternatives. It's simply not something that's "baked in" to the thought process of the medical profession either in medical school, residency, or thereafter.

I agree lawsuits are not the primary or even a major driver of costs, but every doctor I've met worries about them, and I was responding to speculation about what motivates doctors as individuals.

As for Texas, you're quite right - indeed, medical costs seem to have risen since the 'reforms' were put in place: http://www.dayontorts.com/tort-reform-medical-malpractice-to... - according to a tort lawyer, but consistent with everything else I've read on the subject.

Probably most of us belong into "Dum spiro, spero" category, but I have known some non-doctors who have taken option no.1 (painless death) and even accelerated it.

"Dum spiro spero" => "While I breathe, I hope" - for those of us who don't remember their Latin training, myself included.

Well, when winning the lottery means living and losing equals the same thing as not playing; I'm going to play every single time.

But it does not equal the same as not playing. The end result is the same - death. Heck, the result of all three possibilities is the same. But the difference is in the length and quality of life leading up to it.

Given the choice between now and couple years of pain later, I currently see myself choosing the former. I don't want to go through the process of becoming a disease-worn shadow of myself, and neither do I want to be remembered as one. Maybe that will change with age.

That's your ego talking, worrying about what other people think of your choice. As you get older, what other people think starts to lose its importance.

Having had 2 brushes with suicide, and multiple times being reduced to destitution, I've since learned that life is not defined by happiness; it's defined by experience. And pain is just as valid an experience as any. In fact, I'd argue that a life without pain is a life wasted. There will be joy and there will be sorrow, but every second of every day, your life ebbs just a little. It's barely perceptible, until you discover to your shock that 10 years have somehow got behind you without you noticing.

And that's when you realize that it's far better to live a life of pain than to live a life of regret, or even worse, no life at all. A random chance ignited the spark of life on our planet. It's amazing you're even alive at all, let alone able to contemplate it. Life is allotted to you in limited quantity. Guard it jealously and live it fully, regardless of how it feels. There's no arbiter at the end, except for you, saying "I lived my life to its fullest."

    "I lived my life to its fullest."

That's the point he was trying to make. You can't live much when you're strapped to a bed on painkillers.

That's opinion, and opinion shapes what reality you see. Changing your opinion is hard, but it can be freeing.

Only equivalent if where you buy lottery tickets they jump over the counter and beat the crap out of you every time you buy a ticket.

Especially when someone else is paying for all of those lottery tickets.

The choices are very binary. A right choice would be option 2 with right to die if things don't turn out as planned.

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