Hacker News Reader

Comment by hylaride | Hacker News Reader

I suspect the medical industry is so heavily regulated that it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion, though maybe it depends on the country.

Here in Canada, before assisted suicide was legalized, my grandfather (in his late 80s) refused any treatment for his kidney failure. He was ready to die and could barely walk or eat on his own anymore. There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal. The death certificate still said renal failure, though.

For me, if I ever got terminal cancer, I'd weigh the quality of life of treatment versus non-treatment. I've seen people go both ways and I've seen the results being right and wrong both ways. I don't want to spend my final months semi-alive on a bed or constantly messed up, though.

View on HN

> it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion

Not my experience. I have a loved one going through cancer treatment right now and they've been very up front about risks, side effects, and even talked about DNRs with them what they mean and how they can be applied.

People and their loved ones don't want to experience death. It's often as simple as that.

> There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal.

In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.

> I'd weigh the quality of life of treatment versus non-treatment.

Something to consider, it's not a binary and treatment can look entirely different depending on the cancer.

You can, for example, do a lower than effective dose of chemo which will still be effective at slowing the growth of cancer.

Some therapies, such as immunotherapy, can be practically a walk in the park.

I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.

> People and their loved ones don't want to experience death. It's often as simple as that.

People also don't want (their loved ones) to suffer, especially needlessly. (I want to also stress that I'm not advocating terminating life, though I do think it should be an option - just that this is what my grandfather wanted).

> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.

I've anecdotally heard that a huge percentage of US medicare costs is desperately saving elderly people at the end-stages of life instead of a more palliative (and some would argue dignified) end. This was made worse during the Terri Schiavo case when the very idea was put up as anti-life and we were warned that "death panels" would be inevitably setup. DNRs are allowed, but alleviating the suffering leading up to the end is, for both better and worse, heavily restricted.

> I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.

I've been extremely lucky that cancer hasn't been much of an experience I've had to deal with in my circles. I'm mostly pro-modern medicine and I know a lot of progress is also being made. I hope that it never happens, but if it did I'd want to be informed as possible to make my own decisions. The decisions I'd make depend so much on where I'm at. I'd be likely more willing to risk it now as I have a 7 year old to live for, than I would be in my 90s where the odds are a lot less for a comfortable experience.

> People also don't want (their loved ones) to suffer, especially needlessly.

You might be very surprised how family actions very often are not consistent with this supposed desire. 98 year olds in the hospital with multiple end stage illnesses - full code, happens all the time. Ask any healthcare worker in the US, pretty classic the elderly rotting away in a nursing home, rarely visited, then they get admitted and their healthcare proxy wants “everything done”. Often seems to be a reflection of their own guilt. Sometimes it’s just poor healthcare literacy.

But no, regardless of what you think these people may

> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.

This is basically false. Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available. Usually the barrier to these are patients themselves or their families.

Also even the US, the principle of double effect prevails in palliative care.

> This is basically false. Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available. Usually the barrier to these are patients themselves or their families.

I could be wrong, but it's my understanding that a fair number of laws have been passed tracking opiates specifically to try and stop this from happening. The dosage, amount, and time is pretty closely monitored. (Could be a state by state thing).

Mainly because a lot of people lost their minds about the idea of someone ending their life early. Jack Kevorkian spawned a number of laws against euthanasia.

Sure tracking exists, but doctors do not hold back for a patient in comfort care in the inpatient setting, where a patient and their doctor are now optimizing for comfort not quantity of life.

I think we sort of agree, but have different lived experiences (no doubt because we're in different countries).

The crux, to me, is that healthcare isn't as patient centric as it should be, either because of "greedy" healthcare providers, families thinking more about themselves and not the patients, government/politics, combinations of all of the above, etc.

> Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available.

Most systems do, but some allow the end to be sped up more than others, either informally or formally.

Reply on news.ycombinator.com