How doctors choose to die (2012) | Hacker News Reader

How doctors choose to die (2012)

theguardian.com

161 pointsarfliw81 comments

This is anecdotal evidence from a small (2) sample. But not all doctors die without treatment at home. Some (many?) are aware of the drugs they need to hasten their demise in a way that minimises their suffering. One doctor I discussed this with said that assisted suicide, in a very limited and measured way, isn't uncommon, if you know what to look for.

As someone with a degenerative incurable condition, I'd like the option of being able to make informed decisions about the end of my life, beyond just refusing treatment. Because spending years dying of starvation (as MS campaigner Debbie Purdy recently did, because she was unable to cope with her symptoms, and there was no other legal recourse to help her die), doesn't fill me with excitement.

We have an insane attitude to death in our culture at the moment. We seem to want to find any way to avoid the fact that being alive has a 100% mortality rate. I think our collective attitude needs to change. And the more articles like this the better.

It's really hard to change perceptions about death when it requires considering one's own mortality. It is in this only that I understand the desperate quest for religion. The idea of going dark forever is terrifying to me, and considering I'm pretty much an atheist, I don't have much hope of anything else. When people ask me if I'm religious, I usually tell them I'm hopeful that I'm proven wrong.

I know we all die. I know our lives on a cosmic scale are infinitesimal. But even I - as rational as I am, am extremely scared of facing that reality head on.

So convincing the entire nation/world to do so... Well, good luck with that.

It doesn't frighten me. It won't go dark forever. Just as there was no 13.5bn years of darkness before I was born. There will be no qualia of time.

I think attitudes are changing. The campaign to be able to determine how and when we die is shaping up to be a significant battle for a fundamental civil right. I think we'll win it. Whether it is soon enough for my wife to avoid threat of prosecution if she is with me when I choose to act, I don't know. I suspect not.

Right - it's that ceasing to be, as before I was, that scares me. Now that I have existed, I like it much better than before.

That said, that's my hangup, and has nothing to do with your right to choose to die with dignity. It's silly to me that you could choose to jump off a bridge, but can't choose something much less gruesome without fear that your or a loved one might find themselves tangled up legally.

I know this is getting OT, so apologies. And thank you for the second paragraph. But I'm interested in the first.

To me it doesn't seem like I will cease to be, in any meaningful way. To cease to have something is to have it at some point but not another. I will never experience not being. So I find it hard to worry about that. Of course I enjoy being, but it's not like I would rather be than not be, because the latter would suck. So I find your first paragraph strange. And therefore interesting. [edit, add:] I scan sympathise with the point made about others: I'd very very much rather my wife was than ceased to be. But me? Only for other people's sake. I can't imagine how it could possibly make any difference to me. I can't even imagine the idea that I'd miss out on all those good experiences I'd have if I lived. Because again that just presupposes that I'd be missing something.

Yes, you're exactly right. I think one of the reasons a lot of people get anxious and scared about death is because they think that when they die they're going to be locked up in a dark room forever... but you won't, because non-existence is not an experience. As Alan Watts put it, death will be just like going to sleep and never waking up, just as being born was waking up never having gone to sleep.

Isn't that even scarier?

All my thoughts, memories, ideas, experiences will be gone, just vanished.

Unlike @themartorana, I'm somewhat religious (or maybe spiritual would be a better word, as I recognize how much religion is influenced by man) but like he hopes to be proven wrong I'm terrified of being mistaken.

You won't be able to experience your own thoughts and memories anymore, but we experience dead people's ideas all the time - if they put those ideas down in writing (or music, video etc.) And it's never in the history of mankind been easier to record your thoughts. Just do it.

I never said it was a rational feeling :)

I don't know the right way to explain the feeling. I think it's mostly the same sadness that one experiences when anything particularly wonderful comes to an end. I have known loss in a variety of ways, and I imagine dying taps in to that same idea of mourning. Something that I enjoy terribly must end, I have to say goodbye to not only a terrific experience - but to experience itself.

It's mostly the anticipation of the thing, not so much the thing. I'm sure once I'm dead I won't care so much that I'm dead. I just care now that one day I will be.

And thus concludes my inability to lend written word to irrational emotion.

Edit: as I sit here reflecting now, I wonder if part of it isn't the fear of regret - of not having taken full advantage, of not having loved enough or having wasted time on things actually inconsequential. It's also making me wonder if I already know that I'll have those regrets and maybe should make a few changes. Tonight got deeper that I expected it to...

"You" die every moment, and in the next moment a new "you" arises. The "you" now is different than the "you" five minutes ago- cells have been born and died, you've exchanged particles with your surroundings, your thoughts have changed, and so on. There is no "you" in the sense of an unchanging "being." It's impossible for "you" to exist for more than a moment.

On the other hand the "you"s that have arisen have left an indelible footprint of their existence on the universe. It's impossible for those footprints to go away. They are immortal.

That is not to say it is irrational to grieve your (our) unavoidable lack of being "alive," but it helps to understand clearly what we are grieving. It's not the ceasing of the existence of "you"- that happens every moment. It is the lack of the next arising.

These are largely Buddhist thoughts FWIW.

The 13.5 billion years of darkness before I was born is frightening as well, but it's done and over with, plus it's way shorter than the upcoming darkness.

The universe itself is the life you have, it doesn't die, just makes more conscious entities. Life itself will not die with me, but go on forever. We just need to think large when contemplating death.

What is your reasoning behind thinking that life will go on forever?

Life - conscious life with qualia.

Even for allowing for unobservable universe that is not given either.

There is no guarantee that there will be more conscious entities say 200 years from now.

> It doesn't frighten me.

I don't think that's entirely true - it's just that all functioning members of society displace or ignore their fear of death with some method. http://en.wikipedia.org/wiki/Death_anxiety_%28psychology%29

Why in gods name would I be frightened of oblivion? Dying is terrifying, because it comes with implications of suffering. No longer existing is simply enthralling. I will simply be gone. A just reward for making it through a lifetime imo.

I can't tell you why the thought of ceasing to exist would be frightening. It simply is to me, and I believe to most people. And most people, including me, ignore it and focus on the joys of life. There are of course different degrees of this displacement, some people may still acknowledge the idea but others might completely convince themselves that there is nothing to be scared of - or maybe there really is a way to enjoy a finite life span.

Mind you that this a very intimate and subjective topic, and I am not saying that you are fooling yourself, but from someone who is indeed scared of death (the end of life), it does seem plausible.

It's perfect, since nobody can ever prove they're not fooling themselves. Perhaps I'll keep fooling myself until I die and die a fool.

Life is not [just/only] full of joys, but of obligations, troubles, and pain. Those who enjoy life are doubtless scared of losing it - it's foolish to assume that everyone does though. Nor can such a position be swept away as illness or irrationality. It is neither.

If someone gave me a way out right now that caused nobody for whom I care any pain, I'd take it. If I am honest I reckon I'd probably wonder about "what's next" for a good few minutes before saying yes...

I am not saying that you are fooling yourself, but

The mirror image is that we aren't fooling ourselves, we've just been able to rise above our heavy inculturation to such fear. An inculturation that you're still stuck in. That seems plausible too.

That's meant in good humour btw, my point is really that speculation that other people disagree because they are in denial, or ignorant, is pretty tempting, but usually not very helpful to discussion.

I don't mean to say that "other people are ignorant". I myself ignore and displace this constantly... until at some moments I am reminded. I actually didn't intend to sound condescending, I should have made clear that I actually ignore death myself.

Regarding inculturation: I believe it is actually right the other way round! That a child when first encountering the thought of death and its implication, is naturally terrified, and that our society/culture provides means of coping with this fear.

Humorously poignant:

http://www.smbc-comics.com/index.php?db=comics&id=3625

Leaving aside the implication that I'm either in denial, or not a functioning member of society... And leaving aside that the link doesn't quite say either, from what I can see...

I agree that having no fear of oblivion is unusual.

It's hard to distinguish fear of death from fear of dying. I fear the latter.

It's hard to separate fear of death from cultural expectations of death. My reading is that most people fear oblivion partly because they haven't thought about it much, because they are focussed on worry about being wrong about their chosen afterlife scenario.

More anecdotes, but I've noticed that small children, while being afraid of a lot of things, don't seem to suffer existential death anxiety. I believe, as was pointed out in your link, that such anxiety is largely (but maybe not entirely) socially constructed through language.

And if something is socially constructed, it can be changed. With difficulty, but it is possible.

If this makes accepting death easier, the good news is the near-death experience. While I certainly don't intend to convince you that it's an afterlife experience (because no one knows quite what they are) it is typically positive and very powerful. Subjectively, it's an intense spiritual experience that seems to be unmatched by most things in life. As for whether it's entrance into an afterlife or the shutdown sequence of a dying brain... who knows? I don't think we'll have that answered within our natural lifespan. Both you and I are likely to die before we, as a species, know whether there's an afterlife. So we have to go into death without full knowledge but, to be honest, we go into every experience without full knowledge. Tomorrow we might wake up and find that the sky is purple. It's extremely unlikely, but it could happen.

Honestly, I'm as irreligious as you are but I tend to think the odds are better than even that there's some consciousness after death, although "after" might not be the right word because I'm not sure whether time is even well-defined outside of this physical universe. Presuming that I came from nothing, that means that "nothing" can produce qualia, which means that if I become "nothing" after death... it makes a plausible case for rebirth. As Voltaire said, "It is not more surprising to be born twice than once."

So, if the last moments of this life are a positive experience and the "next moment" is either nonexistent or a continuation that might be called an "afterlife", then I don't see much to worry about either way. Of course, others' deaths are still really hard to take, and I'm a hypochondriac who hates the thought of sickness (for the embarrassment and sense of failure, not the danger) but I don't fear my own impending death. I'm not likely to hurry it, but I have a lot of curiosity about it and I look forward to the experience.

The two main disagreements I have with this are, one that I can't put into words very clearly and will come back to, and my generally repetitive comment on these issues that you - MichaelOChurch2015 - weren't born, you were made by your life experiences. A child was born, a nearly blank slate, and formed into 'you' by experiences.

The idea that you could have been born "somewhere else" or "to someone else" or "in another time" is a nonsense idea. We know exactly what happens to children born elsewhere and elsewhen and to other parents - they become other people. Not people we clairvoyantly share qualia with, not people we are superimposed-upon or people we are hiding-inside, not "us" in any way shape or form, just 100% other people.

Following that, the idea that someone could be born twice also seems nonsensical. (Boltzmann Brains excepted; MichaelOChurch2015 might appear for a few Plancktimes in the near heat-death void. Not that we'll ever know).

The first point; moment by moment in life we experience our surroundings. Continuous sensory input which we continually respond to in large and small scales from planning the next week to blinking and shifting in our seats. I suspect this pervasive connection from experience to physical reality to be fundamental to qualia and consciousness, and so the idea that we could go to an afterlife with no body, no senses, no time, no drive for physical sustenance - and still in any way remain who we are - doesn't fit.

If you don't get up in the morning, because you have no body and didn't sleep, and you aren't in your normal environment, you don't put on your clothes because they don't exist anymore along with all your other property, don't breakfast or exercise, don't stretch your achey ankle, don't prepare yourself for your day filled with not going places and not doing things that could affect the organisation of matter and cash, and you don't do all that in absense-of-time and there are no faces to recognise... then who are "you" in such an afterlife anyway? Especially if you arrived there age 95, demented and memoryless. If such an afterlife exists, so what? It's so different as to be not worth thinking of as a continuation of oneself.

"Imagine waking up in someone else's body". "Is that what the afterlife is like?" "No, imagine not waking up. And you're not in a body". "What do I see?". "Nothing, you have no eyes and you aren't anywhere". That should have been laughed out the first time it was suggested.

(I guess the short version is "we don't have a body. We are bodies").

I don't think we'll have that answered within our natural lifespan. Both you and I are likely to die before we, as a species, know whether there's an afterlife

Pondering this, for how much grief it causes and how many people die every day (around 150,000), I wonder why "studying the moment of death with every instrument and method we can come up with, to work out if there's an afterlife" isn't a worldwide obsession for our species.

I think we have answered, to the extent it is possible to answer, the question of whether there is an afterlife. And the related question of whether our minds are independent of our bodies.

The typical responses of educated religious folks to this (as opposed to many religious folks who are still fundamentally mind-body dualists) is to posit some 'deeper' sense in which the mind 'can be thought of' as surviving death. Some religious folks simply defy any logical or evidential concerns and assert it based on it being a revealed fact, or a miracle, or a mystery.

There are a handful of philosophers gamely trying to keep mind-body dualism going as a philosophical idea, but they're a small minority, with no neurobiological expertise, and the arguments are entirely unfalsifiable and easily refuted (in both my opinion, and that of most philosophers, as far as I can gather).

I think people are entitled to believe what they want, and rationalise their beliefs however they choose, I am only responding to your claim of needing more evidence.

So yes, I think we can be as sure as we need to be that NDEs are functions of brain activity, not of our consciousness somehow being liberated from the confines of the neurones that run it and journeying to the afterlife, only to be returned to its neuronal matrix again. I can't imagine what more evidence we could need, unless you're suggesting that, until we understand everything about mental processes, we should act as if we understand nothing about them.

Presuming that I came from nothing, that means that "nothing" can produce qualia, which means that if I become "nothing" after death...

Apple trees come from nothing (at least to the same extent that human beings come from nothing), so nothing can produce apples, which means if the apple tree dies, perhaps the apple-producing essence of the tree can survive and still produce apples, even though the physical tree is long gone.

Qualia aren't 'things' that they can be produced.

I think we have answered, to the extent it is possible to answer, the question of whether there is an afterlife. And the related question of whether our minds are independent of our bodies.

I don't agree, if by "minds" we mean qualia itself. Of course, personality and memories and much of our experience lives in our brain. Most of what we call "mind" lives in the brain, and no one disputes this.

The question, to this point unanswered, surrounds whether anything's left over when the brain is gone. I tend to doubt that a brain-less qualia would carry much in the way of memory; it might be completely memory-less, acted upon by karma but unaware of any prior lives. A minute after I die, I don't expect to remember who "Michael O. Church" was, just as I don't remember previous lives in this one, although the karma accrued in this life will affect me.

Qualia is also impossible to measure except subjectively (and, of course, once the brain is gone, that person is not coming back to report). We can measure brain activity which is, under normal circumstances, highly correlated to subjective experience; we can't measure experience itself.

Fifty years ago, people thought that a person's thinking would cease under sensory deprivation. However, we find that people in floatation tanks actually have more cognitive activity. It seems that the increased freedom allows for a more intense and powerful experience. As for the NDE, this is likewise a time when we'd expect the person's consciousness to be dimming, but it seems to do the opposite. Of course, that doesn't prove anything about what happens when a person is actually dead, because... well, you can't interview them. Maybe the heightening of subjective experience continues after the brain shuts down, maybe subjective experience just ends. We can't ask them.

To make it clear, I don't necessarily think that NDEs are a pure, reliable afterlife experience. There's something we'd have to confront if they were: reports contradict. People've come back from NDEs with predictions like that Japan would fall into the ocean in 1997; that clearly didn't happen. If we took every report of subjective spiritual experience literally, we'd be in a lot of trouble, because people come back from such experiences with some weird ideas.

I tend to think that there's something in the NDE, but a reliable afterlife experience that can be taken at face-value seems unlikely. I tend toward the Tibetan Buddhist interpretation, which is that it's still a subjective experience as the mind enters another bardo.

Of course, it will never constitute a case for "life after death" because the people having such experiences never died. Even many people who believe in an afterlife don't believe in NDEs as reliably true afterlife experiences for numerous reasons.

I can't imagine what more evidence we could need, unless you're suggesting that, until we understand everything about mental processes, we should act as if we understand nothing about them.

That's not what I'm suggesting at all. We should learn as much about the brain and the mind and the connection between the two as we can.

All the evidence we have points to the conclusion that the mind is embodied. There are no unembodied mental phenomenon reported or observed, nor can (you seem to conclude) there be such a report.

So I repeat, to the extent it is possible to answer the question, within the bounds of reasonable skepticism, we can conclude the mind is entirely embodied and therefore that an afterlife of mental experience is impossible.

You've not on what grounds we could conclude otherwise, you've just said you can imagine it to be, and you 'tend towards' thinking this or that, and you're willing to venture some mechanics for it. What could falsify your opinions?

I don't think you've really thought about it. Outside trying to match it with your Buddhist predilections. Why would memory be a qualia that is brain based, but others would not? Isn't the experience of remembering a qualia? Can you give an example of a qualia that wouldn't use any memories or associations what so ever? Do you think some memories are encoded outside the brain, whereas personal memories are brain based? Do you think hormones are involved in qualia? Would there be virtual hormones for disembodied qualia? Qualia isn't 'magic'.

I simply can't fathom how you conclude that some more understanding is needed to figure out if parts of the mind is disembodied.

>I know our lives on a cosmic scale are infinitesimal.

I like to think of each consciousness as a prime number, an inevitable pattern if you write out every possibility. Our brains are contained within some 3 dimensional finite configuration of atoms, and in a large enough scale it will be repeated again. Even its exact position when you read this message.

My mom suffered from MS here entire life, and a few years ago left us on her own terms (with the help of some pills) before the age of 60. I don't blame her of course. I also have no idea if she had any help from a doctor or not.

> being alive has a 100% mortality rate.

Well we assume it does but so far only about 95%

Yeah, historically it has had a 100% mortality rate but there is a significant chance that things will change. eg. uploads

http://www.inquisitr.com/1883084/mind-trip-humans-to-live-fo...

and the like

This idea of "uploading" the mind shows up every now and then and it is interesting, but I think that ultimately we need a much deeper understanding in what consciousness is and how it works, because as it stands right now, it sounds like at most we would be able to replicate or copy a mind (provided the computing power gets us there), but not so much "transfer" or "upload".

This is because, as far as we know, if a computer were to perfectly recreate my brain, I wouldn't automatically exist in the computer, nor I would exists in both the computer and my body; but rather the computer would be an artificial self aware being with my data (memories, knowledge, etc) on it. But then again we need to understand consciousness better to give meaningful answers to these questions.

One way to get around this might be to replace one section of the brain at a time with an electronic equivalent.

Yeah - the brain replacement stuff is already happening in a very minor way with cochlear implants and the like.

Apart from the technical difficulties of uploading there are a lot of questions on what you'd actually want to do and why. Just having a simulation of you running on some box or a copy on Github might seem a bit pointless and I'm not sure many people would want it.

I've thought of a couple of possibly practical things. Firstly for the benefit of the friends and relatives remaining alive it might be nice to chat to a version of the person who's biological body has packed up. This wouldn't even require uploading in the manner of scanning the brain. It could just be an AI that was good at method acting and 'becoming' the person in the way that a human actor can. I'd quite like an ongoing version of my gran for example who I could chat to. I guess more of a skype type chat than a robot.

The other thing is death is annoying for the creation of art and similar stuff. It would be cool if there was an ongoing version of Beethoven say cranking out new symphonies. Also personally it would be nice to work on intellectual stuff that exceeds what I can do in a biological lifespan. I guess if the AI seems conscious at least as in being aware of stuff and interacts normally with people who are conscious in the normal biological way that's probably enough - it doesn't really matter what the philosophers think of it.

You never know. What's happening right now might be a memory in the computer's brain.

Wow... when you put it that way, you wonder why we aren't making more progress than we already are.

Sago, I hope you've heard of Alcor cryonics? It's not guaranteed, but it's better than 0 probability.

https://www.youtube.com/user/OrderoftheGoodDeath

This is an interesting and entertaining YouTube channel that seeks to address the perceived anxiety and denial of mortality of today's society.

And the bowl of petunias said: Oh no, not again.

For those interested in the collective wisdom of the HN community, here are some previous discussions:

https://news.ycombinator.com/item?id=3313570 : 1206 days ago | 177 comments

https://news.ycombinator.com/item?id=4865742 : 841 days ago | no comments

https://news.ycombinator.com/item?id=5017104 : 807 days ago | no comments

https://news.ycombinator.com/item?id=5104430 : 790 days ago | 94 comments

https://news.ycombinator.com/item?id=6040804 : 618 days ago | 1 comment

https://news.ycombinator.com/item?id=6767385 : 489 days ago | no comments

https://news.ycombinator.com/item?id=7446014 : 368 days ago | 2 comments

While that certainly is an intimidating set of links you have there, only two of those have any discussion -- one over two years ago, the other nearly four years ago.

Indeed - has anything changed?

If not, then those discussions are still relevant, and there would be value in skimming them rather than simply repeating all the points again.

If so, then it would be of value to see what has changed, possibly by reading the previous discussions. Perhaps the mood of the audience has changed, perhaps the general opinions of the HN community have shifted.

Either way, being aware of the past is of value.

    Those who cannot remember the past
    are condemned to repeat it.

        -- George Santayana

EDIT: People often misunderstand these back-links. They are not intended to scold people for submitting things that have been submitted before. On the contrary, I believe some things should re-surface from time to time, bringing them back either for the informing of the newer community members, or for re-evaluation in case things have moved on and should be re-considered. My main concern and motivation is that previous contributions should not be wasted.

The two with discussion are certainly relevant. The others were not. To me, they served only to give the false impression that this has been discussed a lot more than it actually has.

> They are not intended to scold people for submitting things that have been submitted before

So I guess that explains why you began with 'oh no, not again'

    > The two with discussion are certainly relevant.
    > The others were not. To me, they served only to
    > give the false impression that this has been
    > discussed a lot more than it actually has.

That's why I said how many comment there were - to give the data that there were lots of submissions, not all of which had generated discussions.

    > So I guess that explains why you
    > began with 'oh no, not again'

Yeah, OK, point taken. I guess I've just been around too long and read too much stuff. I went away for a while and have only just started to read again, but I guess I'm still too jaundiced.

I'll go away again. Sorry.

Do you want me to delete the comment? I think there's still time.

No, don't delete the comment. And don't go away!

I didn't realize you quoted the number of replies, I thought HN did that automatically.

>I'll go away again

haha i never said to go away. play it like it feels. i'm biased since you were responding to my submission.

   Most people are prisoners, thinking only about the future or living in the past.
   They are not in the present, and the present is where everything begins.

    -- Carlos Santana

That said tongue-in-cheek, the links do add value here; thanks for posting.

When facing terminal illness, doctors probably differ little from comparably educated subsets of the population. I don't know of studies specific to physicians, but my guess is quality of life is a priority that shapes decisions about treatment for life-threatening conditions.

After decades in practice, doctors have faced death of patients many times. It's not an experience one ever really gets used to. As a result, doctors tend to be realists about illness and its likely outcome.

It's no surprise that doctors might choose "death with dignity". Oregon, where I live, was the first state in the US to pass a law legalizing physician assisted suicide. The Death with Dignity Act went into effect in 1997. Studies have consistently shown that the leading motivations among those requesting lethal prescriptions are the desire to maintain independence and minimize reduction of QOL.

Comprehensive data/stats related to DWDA can be downloaded--the most recent report (2014) is here-- http://public.health.oregon.gov/ProviderPartnerResources/Eva...

Additional info is available-- http://public.health.oregon.gov/ProviderPartnerResources/Eva...

I'm a little frustrated with this article, but not for the reasons in the article. The doctors were angry at their patients' family members for putting them through the suffering; but, ... that form of suffering is just where medicine is right now.

Medicine is evolving, and growing; and, it's that desire to keep living and to keep those around you living, and to improve their well-being that has, in part, grown our medical abilities to the point they are now.

It feels like some of those improvements that, right now only provide a '15% chance of survival, and include pain', will be the stepping stones for 20, 30, 80 or 90% chance of survival, with varying levels of pain, including 0.

The article seemed to suggest that the doctors didn't approve of those intermediate steps, but ... those are the steps medicine takes, aren't they?

I dunno. I respected the rest of the article. That part of it bothered me.

It isn't the doctor's job to improve medicine, it is a researcher's job.

Doctors can only prescribe to you the 15% chance of survival, knowing that there's no greater benefit to medicine. They're too busy seeing patients to improve medicine.

I'm not sure this is accurate, especially in the case of cancers. Doctors were part of the studies with at least one person I know.

Atul Gawande, who's written extensively on end of life issues, had an excellent one hour Frontline special that covered the same topic. I highly recommend watching it if you're interested at all in how terminal illness and dying are handled in the United States today: http://www.pbs.org/wgbh/pages/frontline/being-mortal/

His book on the same topic is absolutely enlightening and surprisingly enjoyable to read, despite the sobering topics.

Being Mortal.

http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/...

A few years ago, I heard an NPR interview with a doctor who's friend was terminally ill. Rather than opt for treatment, the friend spent his remaining time living with his doctor friend. He died a few months later. The doctor said that this is how she wanted to die, too. I've tried a number of times to find the story, but I haven't been able to. Does it ring a bell for anyone? I'd love to listen to it again.

Thanks!

That does not specifically ring a bell, but Radio Lab did a piece on this topic once. Perhaps it's in there:

http://www.radiolab.org/story/262588-bitter-end/

This reminded me of an article I've read a long time ago which had a really strong impact on me. I've just found it by googling a couple of words that were still in my head after all these years.

Here it is (probably not where I originally read it): http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what...

Fantastic and relevant read.

This was surprisingly well written for an NBC or Men's Health article for those who are skeptical.

I thought this was thoughtful and well written but all I see is anecdote...there is no data presented that MDs choose different options than non-MD patients.

Adding to the anecdote, I'm a paramedic who has also opted for 'no heroic measures'. Even with CPR survival rates in this county being amongst the highest in the country.

Is breaking of the ribs really a requirement of CPR done correctly? My understanding was that it is possible for ribs to break but by no means a requirement of correct CPR as the article implies.

It depends. Depending on the age of the person and the fragility of the bones. It's not a "requirement" in any sense, more "if it's not a risk, you're not going deep enough" - typical standards call for 1/3 to 1/2 the chest depth.

As often as that - it's much more (almost guaranteed) that you'll tear the cartilage between the ribs at the front.

Do you have data disproving the anecdotes?

I don't, but when you title an article "How DOCTORS choose to die" (caps added for emphasis) you are making a generalization and supporting it with anecdote. I realize "Doctors' death stories" might be less attention-grabbing but more accurate. I did enjoy the article -- it resonated with me, but I still don't know if doctors choose to die any differently than the rest of us.

Here is a study that backups the claim made in the article http://journals.plos.org/plosone/article?id=10.1371/journal....

Thank you...exactly the type of information that should have been added to the article (and I should have found in search).

It isn't just how they die. Similar articles could be written on "How doctors loose weight", "How doctors pick their doctors" or "What do doctors do when their kids are sick". Insider knowledge and the education to effectively employ that knowledge always has advantages.

I do take issue with the concept that these docs are dieing "without treatment". They get treatment. They are diagnosed (a big deal) and have ready access to a host of pain management drugs. Having a full understanding of your condition, along with the knowledge that any pain can and will be managed very quickly, is a massive stress reduction. That's a form of treatment imho.

Can't speak for other people, but the fascination for me is a combination of decisions that are difficult and universal and then watching to see how subject matter experts (who view this stuff on a day to day basis) choose for themselves.

I think this invariably results in deeply moving meditations on mortality and dignity from both sides of the table (care provider and patient). Or maybe I'm just suffering a recency bias from this: http://med.stanford.edu/news/all-news/2015/03/stanford-neuro...

There's also a factor of compliance and regulation that affects what doctors are able to say to their patients.

I had a conversation about this with a friend yesterday.

What I would like to understand, is what the difference is between one incurable terminal condition and the next is, and why we're culturally stuck on trying to divide things up into "approved" and "not-approved" categories.

Death happens for everyone. Most everyone, if they make it to very old age, will have degenerated physically and mentally from where they once were. I wonder, if our sympathies are telling us to consider whether a person with X condition should be allowed to end their life, whether that same thought process shouldn't consider all end-of-life conditions to be equal, given their shared terminality and expectation of degeneration.

Or, on the flip side, should we think terminality and expectation of degeneration in these cases is not enough, whether it is appropriate to accept it in this subset of cases.

There's one thing they left out of the article. Yes, we are all going to get sick, and eventually die. Doctors--know the expected survival rates. Doctors do seem to end up with the right medications to really make those last days comfortable, or take the right amout and overdose properly?

Now, their patients, especially the poor, stereotyped, etc. are sent home, and when a doctor feels like they need Hospice, they give their approval.

I had a poor friend die. It was obvious he only had a few months left, but the doctor wouldn't o.k. Hospice? We went to two clinics, and a pain clinic and neither would give him the medications (Opioids and Benzodiazepines) he needed. One pain clinic(noted one of the better ones--in San Francisco) offered to cut some nerves?(I still don't know what these Blow Hards wanted to cut.)

Why didn't he get the right medications; well in the states we assume everyone is going to abuse drugs. It's just getting worse. Doctors are not taking away pain.

O.K., but once you have Hospice, everything is fine these fine? Doctors are trained in Pallitive care--if you get lucky. My experience watching my father die of liver cancer was a week of Hell. Hs last words to me before he went onto one of his last comas was "Son--when will this end?" Yea--no shit!

The nurse finally came around. She then let my sister manipulate his medications which made his discomfort even worse.(my sister thought he should spend more time with his grand kids, and she wanted him to give her more things?) There I said it. Yea, she's a piece of work.

I know this. When I am given that diagnosis of death. I used to think I would go to the bad part of town and buy smack, crack, whatnot, but as I've gotten older and I don't have the fight in me like I did in my 30's; I will probally just suffer through the agony of death like my father endured? Or, I might do what Robin Williams felt he had to do?

Robin's wife said she was glad he picked up his ipad when he walked by her. She said, Robin hadn't watched tv, nor went on the Internet for the last six months.

Robin was found in his stepson's bedroom with a belt around his neck. A towel was wrapped around the belt. I'm assuming to make the suicide more comfortable? Crude knife marks on his wrists--from a pocket knife. An ipad was found near the body with websites open to the the various side effects of the drugs he was given. I don't know all the drugs he was given, but they found a bottles of Seroquil? and a drug used to help with the neurological disorder he had.

Why did I repeat this story. Because this is how we are forced to die in the United States. I don't know why Robin committed suicide. He sounded like he was suffering for a long time, on many levels? I don't know if the prescription drugs he was taking made things worse? Either way, he shouldn't have had to die like this. I'll pass this along too. Don't think suicide is easy. I knew a guy who tried to blow his head off with a shot gun. He blew his frontal cortex off, and spent the next 30 years paralized in a rest home. He died of a lung infection. I didn't know him personally. I worked for the Cororners office at the time, and picked up hs body.

Enough, I feel sick from even writing about this gruesome stuff, but nothing changes. Doctors should treat the pain of their patients, and the government shoud not harass them.

And we need a "right to die with dignity" law like Oregon passed. They passed it a few years ago, and very few decided to use the kit. Most decided to go naturally, but it must be reassuring knowing you have an alternative? I yacked on, but it's something I think about often.

This has been posted a number of times in different iterations on HN. I'm curious why the user group here has such a fascination with medical doctors.

It has nothing to do with a fascination with doctors and everything to do with a fascination with death. Death today in first world countries is so far removed from what death ought to be, that it's almost unrecognizable. Dying in a sterile white room, in a building that houses thousands of sick people, with bad food, busy nurses, and often alone, is what I'd imagine a dystopian future from a Hollywood movie like Soylent Green would look like, but instead it's what Death looks like today. There is no need for this, and if most of us were asked in advance, few would choose it as the outcome. Yet very few people have living wills created, nor plans communicated with close family for these circumstances.

You can't avoid Death, it happens to everyone. So it's bizarre why so few people plan for the only truly predictable event in their entire life.

To be fair, in Soylent Green you died by opting for assisted suicide in an environment with good food, beautiful views and classical music. I'll go with that over a lot of other options. I'll swap the environment for home, and be surrounded by family, but yeah. Soylent Green was hardly the worst dystopia, I think.

Engineers have a peculiar relationship with doctors. When they have need of one, and the doctor decides on a treatment plan for them, they think about the complexity of the problem space the doctor had to navigate to reach that decision. They wish the doctor would chart the parameter space for them, so they can agree or disagree with the choice in an informed manner, and have more of a clue about the competence of the doctor. This is usually not what happens, not to their satisfaction anyway, and it's deeply unsettling having to trust rather than know when it comes to something that appears so much like engineering on the surface.

An alternative title for this article might be "what doctors really think", and thus strikes to the heart of this issue.

I'm saving that paragraph. That was a fantastic explaination.

Or, as a (former) doctor, I love telling my engineer friends:

Intuition can't be formalized.

Part of the reason simply being the "system level" thinking that has to be developed, practiced and honed by any doctor worth his/her salt. And when you think of it, even with our current understanding of the human organism and the phenomenon called life, we are primarily working using 'heuristics', barely glimpsing the ultra-complex jigsaw that makes everything tick. Someday, when the ken of this knowledge is complete, we may be able to formalize the logic, albeit, the 'computer' it runs on, may well be as complex as our own brains!

Want to bet? I'll bet that in 20 years we will have programs that can diagnose a patient and explain how it came to its conclusions.

I had a doctor back in my home country who was fascinating. He would give me hard facts about everything and he would explain all the reasoning behind his recommendations with numbers, probabilities, etc., putting everything down on paper. I loved being treated by that guy. I wish every doctor were like this.

Here in the US I've only so far had the tipical experience of:

1) Telling my symptoms. 2) Observing that half of what I'm saying is being ignored - this pisses me off because I'm very obsessive about my health, so any interested doctor can hear me give them extremely accurate descriptions of what I'm feeling, and how those things relate to daily activities, eating habits, exercise, other symptoms and a number of other things. 3) Being diagnosed with something I'm very sure I don't have (and I'm right most of the time). It's usually something super generic, like "upper respiratory infection".

I can only say why I shared it here:

I thought it would be of interest to hackers. That's what these doctors are doing...hacking the end of life.

Thanks for sharing. Reading and thinking about this makes me feel rather relieved about the 'Do Not Resusciate' status a close person to me had before dying.

I once had a conversation with some ER nurses about the best way to commit suicide. They took indeed a very hacker-like approach to the problem. Some of the suggestions were insulin or potassium overdoses. Maybe not what you'd expect as a layperson.

It seems like the go-to drug for terminally ill patients is often hoarded morphine or morphine derivatives, but death is slow and drawn-out, and someone might get the brilliant idea to resuscitate you, leaving you brain damaged and worse off than the situation you tried to escape from.

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