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Comment by djoldman | Hacker News Reader

> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again.

> Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it.

It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.

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There is a huge unspoken blind spot for a terminal hospice patient. The medicine cabinet just opens up. My dad asked the doctor exactly how much of what he shouldn't take if he didn't want a quick easy death, and the doctor just told him. He didn't end up using it but it was a comfort to him.

The amount of morphine available to the patients on hospice that I have known has made it very clear what the actual intent of those scripts is.

Granted, my sample size of 6 isn't great, and 3 were in terrible pain so it made sense for them, but they had ALL the opiates. . . One had liquid injectable morphine in case he couldn't swallow. He had no issues with swallowing and wasn't in pain.

I wanted to ask the doctor if the intent was to allow a calm end, but chickened out.

Open secret.

Cowardice of the system, society, that doesn’t allow practitioners to discuss this.

Leads to scary grey areas, actually.

> Cowardice of the system, society, that doesn’t allow practitioners to discuss this.

This depends on where one lives. Where I am (New Zeland), the arguments getting it into law were pretty grim.

Serious stuff is serious!

Ignoring addressing it doesn’t make it go away - just forces it into the shadows.

Exactly. Abortion being the example that immediately comes to mind.

Amazing how frequently people die after they’re turned over right when the family is all together.

Amazing and appreciated.

I do not know how it is in other countries, but in Sweden hospice is for a calm end. You are dying regardless

> It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment

Is it? One action is reversible and the other is not. And it's not very rare that moral systems treat an action and its opposite in different ways (cooperating with police vs hindering, rendering aid vs withholding aid, etc).

It's not reversible. You can't undo the suffering that has been inflicted on the patient.

This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer.

He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.

I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity. I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.

The big problem with Alzheimer or dementia is related to consent and timing. People's memory dissolves pretty slowly. You'd almost certainly not want to be euthanized when you've just started forgetting where you've put your keys more often. Many would rather be euthanized than continue being a burden when they have stopped even remembering that bathrooms exist or who their family was. Between these extremes you can have many years, maybe even a decade, of good and bad days, weeks, months.

To me, it doesn’t seem strange at all because I’m thinking about how complicated the system would have to be to carry out such a directive.

You can do it in Canada. Canada is on a euthanasia tear, and something like 3-4% of all deaths are by euthanasia or assisted suicide, and on track to reach double digits in the coming years. But euthanasia for dementia is a fine ethical line to navigate (Canada notwithstanding) because consent is either absent or suspect when the time comes.

In Switzerland, there are four agencies - one treats foreigners as well (Pegasos Association)

shouldn't finding a way to kill yourself be pretty easy, even without legal DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun.

> DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun.

Someone with sound mind is likely to worry about what’ll be left for loved ones to clean up.

And someone suffering dementia/Alzheimer’s may well forget the plan.

None of these things guarantee death and if you fail they come with some awful complications. Overdosing on Morphine is probably the easiest, most humane way to die.

Once you reach that state, you cannot accomplish anything like that.

It's not just the punishment but also how it's investigated / reported / charged. If somebody dies and there is just the slightest hint that another person was involved, by neglect or active help, police gets going right away. If somebody died "of natural causes" while suffering, or isn't even dead, just suffering, who is going to bring the charges? The suffering person won't. They are often unable to do so, that's why they are suffering in the first place. It's just an accepted part of being old and dying. Not even to speak of religious grounds (some of which consider suffering just being part of god's will).

Does the US have the concept of DNR (Do Not Resuscitate)?

Yes.

If one lives in the US and feels strongly about it, they should file an Out-of-Hospital DNR and POLST with every local hospital. Also consider wearing or carrying official bracelets/necklaces (varies state to state).

I'm neither a lawyer nor a doctor. :)

There was a "culture war" (the rightwing government intervening due to religious reasons) in the 2000's involving a "DNR"-esque case https://en.wikipedia.org/wiki/Terri_Schiavo_case

Let us not forget https://en.wikipedia.org/wiki/Karen_Ann_Quinlan

And also https://en.wikipedia.org/wiki/Jahi_McMath_case

But it is disingenuous to invoke "rightwing government", when a Franciscan friar was sneaking into the hospital trying to feed a starving woman [Terri], who was so hated by her husband that he would take extreme measures to get rid of her.

I have found it quite elusive to get a DNR properly executed. I could do all the other Advance Directives from home, and I could get them notarized without issue. But in my state, a DNR must be printed on a special hue of orange paper, and shit, if that isn't the most difficult step...

Also there are probably at least 12 facilities where it'd need to be filed, because who knows where the EMTs would haul me off to, around here. There are so many health care systems, not to mention the BH ones, which are quasi-medical.

> But it is disingenuous to invoke "rightwing government", when a Franciscan friar was sneaking into the hospital trying to feed a starving woman [Terri], who was so hated by her husband that he would take extreme measures to get rid of her.

I don't think he hated her, he just didn't want to be under the crushing medical debt to keep someone alive who wasn't really alive.

And absolutely there was Rightwing government involved. Here is an entire wiki article. https://en.wikipedia.org/wiki/Government_involvement_in_the_...

> someone alive who wasn't really alive.

Wow what a completely horrible and deliberate misunderstanding of the facts. I hope that if you're ever in a state where all it takes to keep you alive is food and water, that people continue giving food and water to you, rather than seeking to starve you to death.

Because someone who eats and drinks is alive, usually by definition, and what her husband sought was to kill her off, because her "aliveness" wasn't "useful" to anyone, and in fact was an inconvenience to him and other people.

Nobody, at the time or since, said that Schiavo "wasn't really alive" but rather, some people wanted her dead, and they wanted that boundary of "ordinary life-sustaining care" to be moved so that it didn't include food and water, administered into her stomach.

> Nobody, at the time or since, said that Schiavo "wasn't really alive" but rather, some people wanted her dead

I'm saying it. She was in "an irreversible permanent vegetative state". That is as close to dead as you can get. Even a coma is better. You can wake up from a coma, but this is an amount of brain damage where the part of the brain responsible for consciousness is dead and never coming back.

Yes

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