Seems a little strange to not want to try to commit to the requirements for transplant and instead just die.
Perhaps they (arguably justifiably) fear the trauma that further interventions will bring.
The most “usable” form of this would be to allow the patient to agree or disagree to the shock (maybe defaulting to agree if no response is given in time); this would place the agency in the hands of the patient and allow them to be mentally prepared. Missing that, at least a couple seconds of warning would be better than nothing.
(Disclaimer: I don’t know much about these devices or the latency requirements between detection of an abnormal condition and treatment; these suggestions only work if the heart can tolerate a few seconds of delay. It seems plausible since the detection itself is based on monitoring of heart rhythms over some period of time, but I am not an expert.)
Now the unpleasant experiences become something that I'm doing to myself, and that my animal brain in the moment has the power to prevent. Every intervention becomes a test of my willpower: I know that I need this, I know I don't want to do it in the moment... What's the harm in rolling the dice this one time, in exchange for avoiding just this one painful episode? The parallel that immediately comes to mind is "well, just this one cigarette won't kill me..."
I'd much, much rather pre-commit than have to face that aversive decision time after time and day after day. Knowing that my life is on the line if I'm caught in a moment of weakness. That calculus is much too important to me to leave to the whims of my reactive brain.
You just have different values than the OP. I have values different from yours as well that would have me turn down a transplant... and it's not that I wouldn't want to live longer. There are just some measures I'm unwilling to take.
Let me be clear: I understand the difference and I agree with you. The reality is that a transplant would probably be a lot of work and suffering and I can definitely understand opting out of it. All three of the grandparents I actually got to meet ended up doing this same math and getting the same result: sometimes life-extending care isn't worth what you have to go through to get the extension of life. I guess what I'm interested in playing with here is the language we use to abstract the reality, and how it doesn't really hold up once death is accepted. Treatment is a commitment. So is dying. Treatment will go on for the rest of his life. Without treatment, dying will go on for the rest of his life. A lot of the things we do and ways we look at things assume that dying is
1) very far off 2) to be avoided at all costs
If either of these things becomes untrue the calculus we do to determine reasonable courses of action goes flying out the window. Neither of these things is true for this person, but it's true for all (for a given value of all) of us trying to talk about it and I see throughout the thread this interesting disconnect that basically boils down to people saying "You can't kill yourself! You'll die!"
It's very difficult for someone who hasn't experienced this (like me and, I guess, you) to put themselves in the other person's shoes. I think I can understand the decision he's making, and it doesn't seem to me to have been taken lightly.
I have no idea how I'd react in that situation - but I can understand people who'd rather not. Especially considering that you might not want to take one of the few organs from a person who might be willing to fully commit to that.
Getting a heart transplant doesn't necessarily mean buying yourself 40 more years. Could be 5, 10, 15. If I recall correctly, the average is around 10-15 years.
You also have to be on immunosuppressants for the rest of your life, with all the added risks that come with that (infections, cancer, organ damage, etc.).
When you’re ready, you’re ready, but people should have the option of continuing if they want.
But if my health made me feel like I was going to miss them (or worse: derail them), then I would be forced to admit it wasn't for the best for me to keep going as is. If I was sure that was the case, it would be easy.
Conversely, it's easy to examine "from the outside" someone else's situation and say they should keep on going. I'm not so sure I could endure what TFA describes either, especially since it's probably hopeless, and especially after watching my own father sit dying for days in a hospital after his heart attack while the doctors poked him to make him move to show my mom he was still alive. It was gruesome and he died anyway.