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Comment by tpoacher | Hacker News Reader

This article is making a LOT of "convenient" assumptions.

For all we know, the more likely scenario is that Charlie, like a sizeable percentage of his doctor peers, was burnt out, tired, and depressed, did not really have an overwhelming (some might say "healthy") desire to survive (in fact, perhaps quite the opposite), and saw the cancer as a non-undignified quick "way out".

Doctors (and medical professionals more generally) rank among the highest in occupational risk of mental health disease, especially for things like addiction, alcoholism, generalised anxiety, ptsd, depression and suicide.

I have no objection regarding the choice he made, but let's not glorify it as the "natural" thing to do either. This narrative is harmful to people who "do" desire to survive but are scared, which may then prevent them from making a dispassionate decision regarding their care.

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This is an interesting point and the article should definitely take these factors into account.

It's indeed very worrying what we ask medical professionals to put themselves through for their jobs. I think we can all agree that having a well rested doctor or nurse would be preferable over a stressed/tired one. The amount of hours and night shifts that (young) doctors have to do and the extreme competitiveness of the field (partly) drives this.

I understand that it would drive wages down (somewhat) if we educated more doctors and obviously we shouldn't lower our standards substantially but it seems like everyone involved would benefit from this.

A friend of mine, whose a doctor, told me once that the best way to ask for medical advice is to ask the doctor what he/she would recommend for their own sister/brother. Siblings are close enough that he would not want them to suffer unnecessarily but it eliminates the personal factors. Obviously it differs per doctor but in my experience it usually leads to a good conversation about the trade-offs for medical care.

Why do you think this was basically a form of suicide?

Pancreatic cancer still has a dismal "survival" rate, and I hesitate to even call it "survival" as it's more a matter of not having died yet. He's seen what chemotherapy does to patients, he knows it's trading the horrors of chemo for a bit longer life. That article is 10 years old--pancreatic cancer is still very deadly. No reprieve was coming down the road.

False hope generally leads to inferior outcomes.

I'm not necessarily arguing it was a form of suicide (or blaming the victim, as it were).

I'm arguing that the impetus to prolong life is generally a very strong and biologically ingrained urge rather than the result of cold rational thought, and therefore in general such rational thought is often predicated on having lost the biological imperative to some extent (e.g. through a mental health process).

And secondly, the "danger" I'm cautioning against is that this narrative that glorifies rejecting treatment is usually painted as "horrible chemo" vs the implicit scenario of dying peacefully in your bed. But this is not the case, cancer can have horrible symptoms, typically excruciating pain. Chemo is often performed exactly in order to control those symptoms by shrinking the cancer, even if prognosis of survival is poor. There's a reason hospices exist, and it's not because people are ignorant or cowardly and afraid to die in a dignified manner and choose horrible chemo instead of quietly dying in their homes.

In fact, one thing one might want to consider here is that, as a doctor, he may have had easier access to morphine, and this may well have influenced the decision.

> For all we know, the more likely scenario is that Charlie, like a sizeable percentage of his doctor peers, was burnt out, tired, and depressed, did not really have an overwhelming (some might say "healthy") desire to survive (in fact, perhaps quite the opposite), and saw the cancer as a non-undignified quick "way out".

Why do you consider it "more likely"?

> Doctors (and medical professionals more generally) rank among the highest in occupational risk of mental health disease, especially for things like addiction, alcoholism, generalised anxiety, ptsd, depression and suicide.

You are suggesting that majority of doctors are depressed with suicidal ideation (hence "more likely")? Care to provide a link to research/data?

It was widely known that doctors are at a considerably increased risk when I was studying medicine, enough to warn us and have professional wellbeing modules in the curriculum. Plus, it's a special population in having significantly different access to relatively covert means, making it more likely to go through with said ideation.

I have seen academic references in the past confirm it. I'm not about to waste time on a scholar deep-dive just to defend my comment but I'm sure you'll find such references easily if you look. Having said that, if "you" have time and you do decide to look and find conflicting evidence that you care to share, I'd be interested to hear more.

> You are suggesting that majority of doctors are depressed with suicidal ideation?

No. I'm suggesting they rank among the highest in occupational risk. In Bayesian terms, the difference between the two is the distinction between a prior and a posterior statement.

> Why do you consider it more likely?

Because, subjectively, the likelihood (low drive for survival given mental disease) should be overwhelmingly higher than the prior (low drive for survival given average person) in this case. Hence more likely.

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