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Comment by vundercind | Hacker News Reader

Recently watched someone close die over a couple days, after a long decline.

The last 24 hours were monstrous to inflict on anyone. Torture. Evil.

Hours and hours of faltering breathing, often restarting with what was plainly a panicked adrenaline-pumping response. It looked like they felt like they were about to drown every few minutes, hour, after hour, no relief. No IV fluids (terminal anyway, so no trying to keep them alive with techniques like that) and unable to drink, so certainly terribly thirsty the whole time. Unable to communicate or really engage with surroundings, and quite high on pain meds anyway (the closest thing to a mercy in all this). It’s fucked up that that’s a fairly normal way for dying people to make their exit. I’m sure there are all kinds of problems with trying to provide a way out when someone can’t make the choice for themselves, without opening it up to abuse, but damn, I hope this isn’t the best we can do because it’s terrible.

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> and unable to drink, so certainly terribly thirsty the whole time.

I know people that work in hospice, and they say this is a big misconception (the article hints at it too). they patients don't die from lack of water, they don't want water because they are dying, and their body can't process it. In fact, as you kind of touched on at the start, giving them IV fluids can cause them to drown since their body can't process the water.

Death is pretty ugly thing, that comes for us all. I got to learn the fun way that in the state of Oregon, it is illegal to disable a pacemaker. Even when the person has a DNR, and it is really the only thing keeping them alive. The best the doctors can do is turn the pacemaker down as low as possible, and hope its not enough to keep the person artificially alive. Which seems kind of really weird, when its also the first and one of the only states that allows medically assisted suicide..

The best thing they can do is shoot me with a nice does of heroin and after the high.just ending it.

We know how to end life's.

It's probably ironic that it's never been easier to buy that drug (and others) and decide your own fate compared with trying for a dignified and hopefully pain-free death the "legal" way.

Doubly so given the epidemic of fentanyl contamination.

We haven't had that (yet) on this side of The Pond but I'm sure it'll happen.

Brexit benefits! It's the one thing Tories got right in 14 years. *laughs maniacally*

I suspect it's the only Europe-UK supply chain that hasn't been affected by Brexit :) Maybe the Tories need to persuade a few drug dealers to go straight and fix the whole supply chain problem.

> Maybe the Tories need to persuade a few drug dealers to go straight and fix the whole supply chain problem.

They'll get Michael Gove right on that!

He's the right man for the job! https://www.bbc.co.uk/news/uk-politics-48572982

Granted death penalty opponents are biased, but it's often said that barbituate overdose is a very unpleasant way to die. I've also heard opiod overdose is unpleasant.

I was once helping take down a 10-foot weather balloon full of helium, and took in two breaths in a row of pure helium. I started to get tunnel vision, said "whoah", sat down when I realized I was about to lose consciousness, fell down, and twitched just long enough for my friend to realize I wasn't joking around before I woke up. From my experience, hypoxia from pure helium is slightly pleasant all the way to loss of consciousness. I presume pure nitrogen would be nearly the same.

Let my last words be something witty in a high-pitched helium voice.

(Side note: pure nitrogen hypoxia would not be a particularly humane form of execution because the condemned would likely fight it by holding on to their last breath.)

Yup, AFIAK hypoxia is the best way to go. Survivors who are rescued in time (or, like you, self-rescue) don't have a bad experience. The MAiD protocol used in Canada likewise appears to not be a bad experience as the only thing the patient experiences is anesthesia.

I'm also coming to the conclusion that inert gas hypoxia is going to be my way out. My end has to be, as far as I can make it, painless and polite, meaning a happy exit with minimal inconveniencing of as few as possible other people. Any suitable substance for this seems to be taken off the market, even basic stuff like metal nitrites (as used in curing meat. Try getting hold of a nontrivial amount of this in the UK). I don't have the inclination to follow up Project Peanut; I don't have the background for this.

I fully understand why this has been done, to stop people who only intermittently get the urge, but for someone like me it's a major bloody inconvenience, so inert gas it most likely is.

(The above is not an opener for a discussion, it's an FYI for a different perspective. Please don't respond).

Any thoughts on how to inhale it without risking others finding you in a oxygen deprived setup?

Like a warning sign or some fan kicking in later?

You don't set up such an environment in the first place. Tank to flow limiter to hose to bag.

Maybe it could be done outside with a nasal cannula?

i considered diving equipment, but I never investigated them properly.

I had general anaesthesia for a surgery, and I can remember the falling asleep was only very slightly uncomfortable. so I think it can be done - once I'm under, just cut out something important and throw everything in the furnace.

Oregon pioneered death with dignity so this is a huge surprise.

Does the pacemaker law predate the death with dignity law?

I'm wondering if it only anticipated pacemakers being disabled for malice or out of negligence.

All the US death with dignity laws are lethal prescriptions only, the patient must self-administer. Turning off a pacemaker would be the doctor doing it, not the patient.

give them a switch.

I'm no expert myself but recently had a relative in hospice,[0] which prompted me to look into this issue a bit. There are a few papers (for a recent example, Kingdon et al. (2020))[1] that say that the data is actually extremely low-quality on both sides of the issue. Personally, this makes me wonder if "fluids are bad" might just be received wisdom and/or anecdata... hopefully someone will do a better study(ies) at some point in order to get actually reliable data.

[0] We did end up following the hospice's recommendations not to administer IV fluids, for what it's worth.

[1] https://spcare.bmj.com/content/bmjspcare/11/1/68.full.pdf

Here they would ask you (unless dementia and not arranged, which is an ongoing issue) if you want more morphine and you can keep saying yes until you don’t wake up. Or click the button yourself; there is no limit (also; very hackable these limiting machines). Probably many people in a long decline would just hold the button until not waking up; that is the way it should be. Some people worry about the gov making us wear masks; I worry about govs preventing me from getting out when I want to. Not your fucking business mate.

You know that government doesn’t care about you.

They care about your relatives who are burdened not “accidentally” holding that button for you when somehow you would still like to live.

In the US, the big reason is religious groups that want to force their religion onto others.

There are anti-euthanasia atheists (E.g. Kevin Yuell).

There are pro assisted suicide religions too.

Neither of those matter because they don’t hold massive, disproportional influence over a huge part of the US political establishment.

In general in the US only White Evangelical Protestants and Black Protestants have less than a majority who believe assisted suicide / euthanasia should be available for "great pain and no hope of improvement", and those two groups still have over 40% who believe it should be available.

And that's as of 2015, so the trend may be higher by now. https://www.pewresearch.org/short-reads/2015/10/05/californi...

My bad, it's Yuill.

There’s an interesting case right now in Vancouver against the largest hospital downtown which is affiliated with Catholics (I think, St Paul’s is the facility in any case).

Several in-patients that opted for medical assistance in dying were refused that treatment by administrators of the hospital on religious grounds, and their families are sueing based on the additional suffering inflicted by having to transfer to other facilities.

Catholic hospitals are a big problem in the US too.

If your job duties might go against your religious beliefs, you are responsible for finding other work. Not doing so should be grounds for termination.

That has nothing to do with it. Society in general is just uncomfortable with the idea of euthanasia and politicians don’t want to be labeled as promoting “suicide”

It’s just not a great hill to die on since most people that actually care strongly about the issue are the ones bed ridden in the hospital.

> who are burdened not “accidentally” holding that button

That’s almost always a financial incentive though; if you remove that you can see who really cares. I have an open will for my friends and family; everything goes to charity with the taxes and tangible assets worked out so they don’t have issues; they get a net amount of a few million. Everyone else knows they don’t get 1 cent; helps with the accidental button holding.

Yes, this has been my experience with a family friend who died of a brain tumor. Basically, once you're in hospice (in this case it was home hospice) and it's clear you're going to die, they just hook you up to the morphine drip that you can press yourself.

Obviously for many people it's still very scary - it is death after all. But the self-administered morphine drip has been around for ages and is relatively uncontroversial.

> very scary - it is death after all.

Is it? As an atheist I welcome the nothing; no more worrying about filling out taxes and such. Being religious you really should be jumping for joy (although you cannot kill yourself probably), but how is death scary if you believe in something after?

Because it's hard to fully comprehend or feel complete certainty of what is going to happen.

It’s not the death that is scary, it’s the Judgement Day that’ll come after. Because you don’t know whether you did enough good stuff to go straight to heaven, or first have to suffer in hell to account for your sins. Not all of us believe in a religion that says you are already forgiven and you’ll go to heaven, because God sent himself down to Earth to become His own son to sacrifice Himself to Himself to convince Himself to forgive you.

I was raised with a particularly idiotic strain where you cannot repent or be forgiven; one mistake (however tiny) will be hell and that’s it. It is what made me an atheist at a young age (I think I was not even 10 when I decided it’s a bag of bull): it particularly exposes how weird religion is.

That's really a fringe belief indeed. Luckily there's no such thing in my religion.

Only on HN do we have to explain why death may be scary to some people. Sometimes I wonder if this place is populated by actual humans.

as an atheist who has been suicidal from around age 12, I'm not afraid of being dead, but actually causing my own death has been very difficult - it's not so much a logical fear as a mental block, it's like you're moving through very thick syrup trying to get the thing done, you're fighting a mental force that's holding you back, and eventually all the commitment and energy that you had invested in getting it done just seems to have dissipated and you just feel empty. I'm my case at least, the survival instinct has won every battle. unless of course we have quantum immortality, it would explain why I keep failing.

your value is what you contribute to the economy by working and consuming, or helping others work and consume. You're not getting out that easy!

My dad had cancer that had spread to the lungs.

He got pneumonia at the stage where he was having to use an oxygen machine at home. At the hospital he asked the doctors if he'd be able to go home, and they said it was highly unlikely.

So, he asked them to turn off the oxygen, which they did. He passed peacefully a few hours later.

Sure, we might have gotten a few extra months with him, but I'm so glad the doctors respected his wishes. My worst fear was him having to endure something like what you describe.

That was my mother's philosophy. The hospital is for fixing you up and sending you home. If the sending home part isn't going to happen she didn't want treatment.

The reality is there comes a point where the doctors can only prolong the dying--and in an awful lot of such cases that's a negative for the person.

I’ve witnessed similar and in a way, I think the person was kept alive too long. I personally think they would’ve died from other causes well before it got to the stage they were at. Euthanasia is probably a pretty important thing because of this. If we’re going to resuscitate people in their 80s, then maybe we shouldn’t let them go through the “long death” a few years later.

All in all it’s a tragic thing the only constellation is that I guess after 24 hours in that, one welcomes death with open arms.

I saw it with my father--to take the pain the morphine also took his memory. And in the end there was only suffering--fortunately, the problem would quickly kill making him eligible for terminal sedation.

Watched my grandfather pass in the same way. Didn’t seem right to let him pass of basically lack of food and hydration after 95 years even though also terminal. I just wanted to see him comfortable and he was far from it.

Same here, but i have been told that dying is like that unless thoroughly drugged.

In the last days when organs start failing, food and drink don’t necessarily make things more comfortable since the body can’t handle it.

Thanks for sharing. Helps a little bit

Someone I know acquired potassium cyanide for this reason. She's getting up there in age and wanted some insurance against a horrible death.

Yeah, we are so obsessed with keeping people alive that this sort of thing is prudent behavior.

So sorry to read of your loss, and the painful way it goes.

Sadly, this is just one of millions of descriptions of why the phrase "Slow as death" exists. Generally, life really does not want to give up, and the process is indeed terrible.

I watched someone die of ALS for 6 months, it was pure hell on earth. A middle aged guy who basically was vibrant and in average health struck down from out of no where, the final moments were horrific when they turned off the life support. Even his diagnoses was difficult since no doctor wanted to deliver the news and it required a trip to the MAYO Clinic to finally get an answer.

I have often wondered why he was chosen to carry such a burden, a harmless and kind person.

When I think about having a kid I think about how this is how they will end. When you give birth you also give death.

I'm sorry for your loss.

Edit: I feel a bit dumb now, I hadn't actually read the article yet, went straight for the comments. Seems like I'm just reiterating what it says.

When I'm in that shape I just wanna go in peace. Preferably at home, in my own bed, surrounded by loved ones. No tubes down my throat, no shots to keep me alive at any cost, with no end in sight.

Here's some good discussion on the topic between two doctors that I watched recently: https://youtu.be/O0YIGAUDlzQ?t=242

The problem with this perspective in my opinion is that many times, especially for an elderly person, a small emergency can very quickly escalate into a life and death situation, and the outcome is not clear until it’s too late. you may enter the hospital thinking you have a decent outcome, but you end up with a bad outcome.

for example, nobody plans to go on a ventilator. But if you need one (like severe pneumonia), you’re already pretty messed up and you’re going to have a painful death with or without the tubes.

you’re going to have a painful death with or without the tubes

But I feel that was the main point at the start of the thread: if death is certain and going to be painful, why must we drag it out? Why is that additional lifespan (measured in days) so much more important than comfort?

The point is that it's not certain. With the medical assistance you might recover fine and live another five happy years.

Is it really worth trading away that opportunity just to not accidentally die on a ventilator? I'm not sure.

There's a good article[1] on this topic that talks about how older doctors generally choose to forego lifesaving measures. I think about it a lot because it seems like when a professional who's in the best position to know the tradeoffs makes this kind of decision for themselves they probably understand the risk/reward better than you or me.

[1] https://www.saturdayeveningpost.com/2013/03/how-doctors-die/

I think that's the article that made me change my opinion on CPR. When the hospital asks me to sign the form indicating if I want to be resuscitated, I answer no without hesitation. It's harder when my vet asks before operating on my dog, but in the end I made the same call for my dog that I would make for myself - do not resuscitate.

Plenty of people who make the sausage don't want to eat it.

I never wanted to go into medicine. Thus I do not believe the preferences of a typical older doctor represent my preferences in this respect.

I read an article once of a nurse who kept CPR going on her husband for somewhere around 2 hours until they could get him to a hospital that was able to restart his heart. I believe he ended up okay. CPR obviously isn't invasive tubing, but it's still kind of hard on the body.

It depends on the situation.

If it's part of a long decay I would categorically refuse anything like that. If it's due to an abrupt and fixable thing give it a try.

https://www.sciencealert.com/study-more-patients-could-survi...

> Yet families are often asked to make the call within 72 hours of someone sustaining a severe brain injury. Unless patients make a rapid recovery in the first few days, it's thought they are unlikely to survive or recover much at all.

> The data Sanders and colleagues analyzed tentatively suggest otherwise.

> The data revealed that 31 of the 56 brain trauma patients who stayed on life support died within six months; and 45 percent survived. Of the 25 patients who survived, more than 30 percent recovered enough in that same six-month period to have at least some independence in daily activities.

> Just four patients recovered 'fully' to how they functioned before their injury.

> some independence in daily activities

"some" is doing a lot of work in this sentence. Recovering enough to have "at least some" independence after several months is not a great outcome. That very likely means lifelong daily care is required.

I know. That objection was brought up in the first article I read on this issue. Still, depending on the care required, it's pretty bad to imply that someone is better off dead.

And 7% of the study subjects recovered completely.

The idea of living long term, near death, while medical expenses slowly eat away the savings I would prefer to leave to my loved ones makes me very unhappy.

The general idea here is to wait longer than 72 hours before making the decision.

> I just wanna go in peace

I wonder what 'go in peace' means if you explain it medically. Possibly abrupt heart failure?

From the deaths of older relatives that I've (sort of) witnessed, if any other part of your body fails it's going to be slower and a lot more unpleasant.

I’m quite convinced that I live in a country where we never let people die like this.

Also, I guess prolonging treatment is in the interest of for-profit hospitals as found in other countries, thus as long as your suffering is profitable, you wil…

I made a similar comment already but I kind of agree. I’m not sure if it’s about profit it’s also about legal concerns. I think legally doctors are supposed to keep you alive until they can’t anymore?

No, truly, doctors are not legally required to keep people alive against their will. It’s just that you have to have made it clear in advance what kind of life-saving and comfort measures you want. You have to say “yeah actually I don’t want all that.” It’s hard on the doctors to watch people dying painfully with too much life support, too. They know what kind of death they want, and it’s not that. (As the article reflects.)

I would be surprised if there exists a country where people never die like this. You would have to euthanize every single person who died of a long list of natural causes.

Maybe NK will implement mandatory euthanasia at 63 or something crazy.

This is from personal experience, but there is a difference between letting someone take 2 weeks to starve or die of dehydration, and big-letters "euthanasia". Sometimes the people who work in palliative care are nuanced enough to ease you out when your final days come. Where I live, euthanasia is not legal. But when my sister was dying from cancer she directly told her palliative meds guy "I watched my uncle gasp for two weeks. I'm not going like that. You hear me?"

When it came to it, she didn't. It still wasn't petty because death-by-cancer never is. She was extremely weak and thin and tired. But on her last day she spoke to everyone in the family, gave weak hugs, said goodbyes. I guarantee you that guy took away days (at least) of suffering. We all knew that. He knew that. She knew that. Nobody said it though.

And I think that's better than someone who can't afford to deal with a disability being asked if they're prefer to die than cost the state lots of money. Horror stories both sides of the nuance.

This is mostly how it works for most people who die like this in my country where Euthanasia is legal.

> I guess prolonging treatment is in the interest of for-profit hospitals as found in other countries

France does the same but has nationalized healthcare, so it does not seem motivated by profits. It puts pressure on the healthcare system and only brings additional suffering. We could change that, but implementing assisted death needs careful consideration and defeating politically the small subset of people that think life with extreme suffering is precious.

> but implementing assisted death needs careful consideration

Yes.

> and defeating politically the small subset of people that think life with extreme suffering is precious.

You don't need to defeat us. All you need is a clear-cut agreement between the patient and the doctor, preferably in advance for those who are physically unable to decide at the end, similar to a DNI. Between the patient and the doctor, and possibly the patient's family, it's no one else's business (though I still think second-party euthanasia of non-terminal persons is disgusting, and that they should commit suicide without involving a second party). It's when government or other third parties start getting involved that everyone should have an issue with euthanasia.

You're assuming the person has enough function to commit suicide.

If you reread my comment more closely you'll see that I'm not. I list a couple of options, only one of which is suicide. I'm willing to tolerate various things that I consider repugnant, even though there is a limit.

> All you need is a clear-cut agreement between the patient and the doctor,

Then you are not part of the group of persons I was pointing out. Is was thinking of people against it regardless of the conditions. Some form of consent is needed for euthanasia. How strong this consent should be (written agreement before? Or must explicitly tell the doctor right before the injection?) needs to be decided after thinking carefully about how to keep the law being useful while avoiding abuses. But right now euthanasia is fully illegal; the best one can get is starving to death.

Euthanasia per se is illegal in all US states, but assisted suicide is legal in a number of US states. https://deathwithdignity.org/states/

I actually am probably one of the one's you are pointing out. In that I don't want a government sanctioned process for this (it leads to a slippery slope in the countries it has been enacted in[1]). At best I'm basically in favor of decriminalization, not legalization, and not a standardized process that can be altered over time.

"By establishing a social policy that keeps physician-assisted suicide and euthanasia illegal but recognizes exceptions, we would adopt the correct moral view: the onus of proving that everything had been tried and that the motivation and rationale were convincing would rest on those who wanted to end a life.

Ezekiel Emanuel"

[1] - see point 6: https://haase.org.uk/history-of-euthanasia/

Also this case in Canada of a woman with MCS who couldn't get better housing away from the chemicals. It was easier to give her medical assistance in dying than to get her to a house or apartment free from other people's smoke and cleaning chemicals: https://www.ctvnews.ca/health/woman-with-chemical-sensitivit...

She's not the only Canadian case of it being easier to grant MAID than to get functioning health and welfare services. One person was granted it because he was about to become homeless.

That breathing pattern is called the death rattle.

When my dad died last year from aggressive relapse of cancer, his death rattle was so intense my mum couldn't deal with it and had to leave the room when it was happening, it's a disturbing experience. She's still traumatised by it today.

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