Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future.

We're not talking about saving lives, we're talking about briefly delaying an inevitable death. How much suffering would you be willing to endure for the possibility of another few days or weeks in a hospital bed?

Doctors know what these deaths look like. They know what it feels like to effectively torture someone for no good reason. Doctors overwhelmingly choose palliative care for themselves, because they know that extraordinary medical efforts for very sick patients are invariably brutal, miserable and futile.

One significant problem, at least in my experience, is when doctors take that approach with someone, based primarily on their age and on inaccurate diagnoses, who has multiple serious health problems and does not die in the very immediate future.

The common view seems like an inversion of Blackstone's ratio (better to prematurely end the life of one individual than to let however many other individuals suffer). To be fair, as a personal point of view this is fine, but it may also merge with socio-economic constraints in a really ugly way. In addition, no one I've spoken to has made any effort to even consider and explore differences in how other people experience pain or view death.

When all is said and done, it can be a real shit show.

I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in sight but death. An 80-year-old with Alzheimers, diabetes, and cardiac problems doesn't have a "root cause" that you can just fix with an experimental treatment. They're old. We all get old. In that kind of case, I hope the doctors' perspective makes more sense...

My grandfather had advanced Parkinson's, but had zero intention of dying to it or its cornucopia of related symptoms/effects. So what if he has a major disease that made life many orders of magnitude worse for him? Life is still life, and death is still infinitely worse.

Giving up and accepting death may seem reasonable to some, but not for me or my grandfather. There's always a root cause, and there's always a way to keep going.

Giving up is suicide.

I assure you that this is untrue. There's a reason why people on the upper floors of the World Trade Center jumped from the windows, and it's not because they expected a soft landing. There are many, many things in this world worse than a peaceful death.

People failing to realize a truth doesn't make it less true.

Peaceful death is suicide, if chosen. Period.

Then suicide is preferable.

Stop using the word suicide as if it was an insult.

And I've seen enough suffering and death to know that not everybody shares your opinion. I've seen people who, when they were healthy, held opinions just like yours beg for death when their time had come.

Count your blessings that you've not known pain, fear, or panic like the dying do.

^^ That's an opinion, phrased as if it was a fact. It's a value judgement and nothing more. I respect that it's your opinion, but just because you fervently believe it doesn't make it objectively true.

If you wish to engage in a meaningful and productive conversation, you'll need to be more honest about separating your opinions from fact. I think that, underneath all the shouting, you have a very interesting take on the issue. I'd like to discuss it. But it's drowned out by your inability to recognize that other people can have a different -- and equally valid -- interpretation of what "quality of life" means.

(Also, no: You cannot "decide things" about excruciating pain. It takes over a person's ability to reason. Chronic, debilitating pain very much robs a person of their agency.)

The fact that you can identify what my opinion is and still not address it, preferring to have this semantic argument, is a great example of someone avoiding the conversation because they know they're in the wrong.

Actually it's a perfect example of the other kind of suicide, not due to permanent illness so much as temporary circumstances that could be resolved and lead to the person not wanting to do that. That is something for which friends, family, and medical professionals ought to intervene.

The South Tower was struck more obliquely leaving one intact stairwell, but this was difficult to locate and descend due to the huge quantities of thick, black, choking smoke. At least 600 people were unable to find an escape route before the tower collapsed. Most of these people would have likely died of smoke inhalation if the tower had not collapsed.

My reference to 9/11 was, in my opinion, entirely apposite. On that day, nearly 2,000 people were faced with no choice other than the manner of their death. Around 200 people chose to jump.

https://usatoday30.usatoday.com/news/sept11/2002-09-02-jumpe...

I still think the number is likely nonzero (a word I chose to indicate it may not be a high number but it is not zero) and my earlier point is reenforced: they were forced into it by circumstance, and would have taken another path had it been on offer.

It was most certainly not a "peaceful death".

Edit: I will be honest, some of my reaction came emotionally from offense at the implication that theirs was somehow a "peaceful death" (your words). The USA Today piece you cited says it was officially called "homicide". That is accurate. Assisted suicide is a totally different thing.

And if that's truly your choice, you can choose it. In fact, as the article makes clear, your choice is the default one as things are now.

But you should understand that other people's choice might be different from yours, and you don't have to right to insist that they get your preferred treatment if they don't want it.

> there's always a way to keep going.

Did your grandfather die? I'm assuming he did, since you don't refer to him in the present tense. If so, doesn't that falsify this statement?

My grandma tried the chemo. She did die anyway, which I'm sure some folks will see as a reason that she never should have tried.

Doctors bullying patients seems like a problem regardless of the direction they're pushing them.

I think one reason is because they see people with terminal diagnosis take a beating from heavy medication like chemo and being unable to spend time with their family instead of just taking pain killers and spending their last months with family and friends.

The problem is that excruciating pain is only obviously better than death if there’s something positive at the end of it.

Otherwise it’s comparable to being tortured 24 hours a day for the rest of your life.

From what I have seen I would prefer to go out in dignity at my own will instead of being an experiment of the medical machine. Others may feel different and I think both paths should be available.

What does dignity buy you if you're dead? Nothing. You can have yours, I'll spend mine to stay alive as long as possible.

In the end you will only know how you will really feel once you are in such a situation.

If you're not coming back, the doctor performing CPR will push harder and harder to try to get you to breath again. And yes, that means broken ribs.

Medicine is ugly. We rip out veins in the legs and attach them to the heart to "cure" blocked arteries and prevent heart attacks. We pull tendons out of corpses, drill screws into bones, and re-attach the knee bones... to provide additional support to torn tendons.

And in some cases: doctors tell the patient to live with the condition (ex: some peculiar shoulder bone breaks), because the treatment is sometimes worse than the ailment.

---------

I don't know all treatments or all ailments... and even doctors won't know all the possibilities. But, the overwhelming expert opinion of the health care industry seems to be against full code. (and btw: they make money when they drag lives out... they have a financial incentive against this recommendation. The longer they drag out your life, the more money that they make.)

Mark Twain was quipping, not building a life philosophy.

Like I said, your ego-- the sense of self-- is doing a weird flex. But ok.

Pretty much every healthcare worker I know, religious or non-religious, leans towards DNR over "Full Code" on themselves. To the people who have watched others die on the operating table, they do not believe that the final moments in a hospital is worth it.

Death is inevitable. You can either have it with dignity, perhaps a week or month earlier than usual. Or, you can drag it out for weeks or months in a hospital (possibly bankrupting your family). Regardless, you'll die eventually.

There are plenty of stories about brain-dead patients staying in a hospital for years (!!) while their bodies atrophy and inevitable brain damage prevents any hope for a reasonable life afterwards. Modern science can keep someone technically alive, but at an unfortunate cost.

Its far luckier to die peacefully (and suddenly) in your sleep... without dragging out your life. Doctors for the most part know this, but they don't want to change American culture or trample on people's right to choose how they die. But its pretty clear what option is preferable.

There is literally no such thing as a peaceful death. It may sound poetic, and it may be comforting, but it's not true or real in any sense to the people actually dying.

The reality is, it's peaceful to the living, and so we falsely optimize for that.

This seems to be in the realm of philosophy, meta-science and religion. I don't really want to bring the discussion there, but I simply need to point out that many, many religions (and atheists) have different opinions on this matter. For example, a dignified death may bring you closer to the creator (emphasis on "dignified", because suicide doesn't count for some religions).

And I don't believe there's any way to properly gather evidence about what happens to someone after they die. And without establishing our religious ideals as ground rules, I don't think we can really have a good discussion on the matter.

They see the kind of suffering that prolonging people's lives with certain conditions can inflict and choose to have none of it.

Other than that your comment is incredibly rude towards people who will do everything in their ability to keep you alive anyways - if you/family so insist - and also borders on being a conspiracy theory.

[1]: https://www.zocalopublicsquare.org/2011/11/30/how-doctors-di...

I think you totally missed the point of the article. The doctor there did what you advocate, it's just that he doesn't consider that doing everything they can.

In any case, how exactly do you know what they didn't do that they could have? I don't see where you get enough information to derive any such conclusion. Considering that the doctor writing the article was just an intern, chances are he doesn't know everything they tried; how can you possibly claim to know?

I can claim to know because of all the comments in this thread, because I've had loved ones get terminally sick, because I know what every doctor says when you ask them about this, and the stark reality is it's more about the masses than it is about the individual.

We literally can't try everything on everyone because that'd lower the average level of care overall, not to mention the ethical concerns over experimental treatments that haven't been sufficiently tested.

You can interpret the text however you want, it's still entirely topical to call out the medical profession on the false notion of death as peace that they're trying to sell us for their own sakes, at our expense.

If you’ve just been diagnosed with something terminal you’d want to try every experimental treatment no matter how violent or dangerous. But if you’ve already established that nothing is working and your body has begun the shutdown process I don’t see why you’d want your last feelings to be shocks to your heart, your ribs broken or your throat being cut and plastic tubes shoved in.

Emergency reactive procedures (codes) for a 20 year old who had an accident on the way to the gym and a 80 year old in the last stages of terminal cancer are the same, the article is arguing that they shouldn’t be.

If the rest of my life will be nothing but pain, I don't think I'll want it.

Lying is consciously uttering something you belive to be untrue. It can't be your opinion at the same time.

So unless you're planning to insult the people you are talking to by calling them dishonest, you should cease this way of discussing the topic.

It's obvious you care greatly about this matter and tempers can understandably get heated, but people calling each other liars rarely have productive discussions that leave all parties wiser.

Also, I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie." Getting upset about a fact is yelling at a cloud.

And why is it obvious I care greatly about this matter? Because I've written less than a page's worth of content on the topic? Seems like a weirdly low bar...

Where opinion means "belief held", that's an obvious oxymoron.

> Also, I don't care if I insult people by stating facts, including, "Your opinion is wrong/a lie." Getting upset about a fact is yelling at a cloud.

Let me quote yourself at you:

> Stop trying to interpret my opinions as facts. Are you seriously fooled into thinking what I'm saying here is even arguably fact? Of course it's my opinion...

As another commenter already said, you can't have it both ways. Right now you're directly contradicting yourself.

> And why is it obvious I care greatly about this matter? Because I've written less than a page's worth of content on the topic? Seems like a weirdly low bar...

I said so because that would excuse your uncompromisingly hardheaded and rude conduct towards virtually everyone in this discussion. I often try to think the best of people.

I have a hunch this will go nowhere and I am not going to reply to whatever comes next.

You're right, this will go nowhere because you're trying to have a semantics argument while also being wrong about the semantics you're trying to correct.

And again, I don't care if you find me to be rude. Bringing it up is distracting from the larger conversation, about how we're being sold a bill of goods by doctors about "peaceful death" because it makes their lives easier to think about, at the cost of giving up earlier on patients.

At last, an actual substantive statement. But unfortunately, it's still your opinion.

I have no problem at all with you choosing to fight to the last and continuing to seek treatments right to the end even if you are diagnosed with a terminal illness where all known treatments have slim to no chance of success. But that's your choice, and other people might choose differently. And the problem with accusing people of lying simply because they don't share your opinion and would make a different choice from yours isn't that it's rude (though it is); it's that it's not justified.

Jesus dude, why the fuck would anyone listen to that level of hubris? What the hell kind of incentives are you giving me here, because right now my only incentive is to laugh at the person who can't actually have a conversation because they're too busy derailing it with semantic arguments about things they did understand, but didn't like how it was presented.

It has nothing to do with offending anyone. (Note that I explicitly said that rudeness was not the issue). It has nothing to do with how you presented what you said. It has to do with the substance of what you said--your accusation of lying--being unjustified.

Again, I urge you to read about epistemological knowledge. Basic philosophy concept that will educate you.

Yes, exactly, which is why I keep objecting when you express your opinion but then treat it as if it were fact.

Yikes. Okay. You goaded me into replying.

About lies and opinions: If you said something factually incorrect that you nevertheless believed to be true at the time, you were not lying.

That is why it can't be a lie when you say something that you honestly believe (i.e. your opinion).

Now it might be that "Lie" means something different in your culture, but in the English language it means "[..] an assertion that is believed to be false, typically used with the purpose of deceiving someone". (https://en.wikipedia.org/wiki/Lie).

Here's a good article on the matter: https://philosophynow.org/issues/27/The_Truth_about_Lying

Now whether I lied when I said I would not reply is for you to figure out.

You can't know their opinion is wrong, because you've already admitted that's just your opinion. It's not a fact. Your opinions are not facts.

You have pointed out no fact that justifies your accusation of lying.

You've already said what you have to say about death pretty clearly, so if I were going to derive any benefit from it, I would have already done so. But if it will set your mind at rest, no, I haven't derived any benefit from what you have to say about death.

No, it's your opinion that death is not peace. "Peace" is not a word with a single fixed meaning, so you have no basis for saying that other people are lying when they express the opinion that death is peace. All you can say is that your opinion disagrees with theirs.

> Rudimentary philosophy will help you understand this conversation, as it covers fairly extensively the truth/false of beliefs, and the very nature of what truth is. I recommend you spend some time looking into it

Sorry, not buying it. Blowing smoke won't change the fact that you're making an unjustified accusation of lying.

That's your opinion. Other people have different opinions. You don't get to declare by fiat what the meanings of words are.

That said I'm going to speculate that as a doctor being asked to do long series of futile actions while watching a person die has to be traumatic. So I can understand why many doctors like the idea of palliative care.

Suicide and euthanasia are valid options in some situations, which are up to each individual to evaluate for themselves.

The doctor in the article has been confronted to the selfish side of love too many times. People want their family members to be kept alive because losing them would make them sad. Somehow more sad than seeing them suffer and slowly die anyways.

1) Pain, often pain management becomes a much bigger issue than going all out fighting vehemently to prolong your life by a few more days/weeks/months. Its hard to understand what chronic pain does to you and your mind unless you or a close loved one goes through it. Often pain management also aligns with 'slipping gently into the night'.

2) Incentives, hospitals are in the business of making money and they's gladly run marginally useful tests and medicines until they max out whatever coffers they can. as I see its not long before the ethical/common sense minded providers get overpowered by the money making machine and give in. as it is perhaps you are not aware there was a study that concluded most (IIRC 75%) of a persons healthcare expenses happen in last 18months of their lifes. just ask yourselves this, would you rather give your inheritance to your kids & grandkids or some hospital trying to maximize profits by promising you random treatment that increases you life by a few months? ultimately this should be your decision to make but there should be strong protections around the options providers can present to you.

edit:formatting

https://www.kff.org/medicare/issue-brief/medicare-spending-a...