And won’t do it even if the patient does want the nonbeneficial, futile treatment. Right?
My mother, late in her life, racked with unremitting pain, was in one of her recurring hospitalizations and was told by one of her doctors that there was an operation that might help in some way but given her overall health it was quite possible they’d put her under and she’d never wake up.
She wanted the operation. She WANTED it – yes, because she wanted to be put under and die. She was fully competent mentally and was sick of years of suffering that increasingly hobbled her.
They wouldn’t do it. The hospitalist I spoke with, supporting my mother’s pleas with tears running down my face, saying I didn’t want to lose her but I accepted her choice and please would they go ahead, gently refused.
The hospitalist was kind; I could see he understood the family’s pain and sympathized; but no, they could not knowingly help my mother die.
It’s been years now, and every once in a while I still wonder whether my mother would have got her wish if she hadn’t admitted it.
I care. As I think most of us know, Scott Adams has gone off into conspiratorial lunatic-land in recent years, and though I don’t know what happened to him, he contributed many decades of insightful humour about the follies of corporate politics and general office nonsense. So I have sympathy for him not only as a fellow human, but as a valuable contributor to our culture, despite whatever it is that turned him to a right-wing conspiratorial mindset more recently.
This is what hospice is for. No, it’s isn’t about euthanasia. But a patient’s pain should be controlled. If that means we need to keep increasing the dose of someone’s morphine when they have a terminal, painful, disease, then that’s what we’ll do. Yes, it’s understood morphine causes respiratory depression and can lead to respiratory failure. Obviously that isn’t the goal. But if the dose needs to be increased to control pain, and the patient is already suffering from a terminal illness, well we weigh the risks and benefits and act accordingly.
Yes, blessed hospice! My mother returned from that hospitalization to her assisted living apartment and survived for another year or two, still suffering (even fentanyl patches didn’t do much for her), and went into hospice there, slipping away, numbed and rarely conscious any more, after a month or so. She died in her then home, in her own bed, went to sleep and never woke up.
I’m sorry for your loss, especially given the painful progression. My father suffered similarly.
In such cases, hospice/palliative care with appropriate uses of morphine and alprazolam (which means enough to help with pain and anxiety) should be discussed with the patient.
Listening to the news, it sounded like the routine PSA test is recommended only for men ages 55-69. After 70 its not recommended because at that age indolent prostate cancer is very common, but also if the cancer is indolent then at that age there is no point in treating it because chances are you will die with it rather than of it. So given that a there isn’t any action taken with a positive test why worry the patient. However if there are other symptoms that might indicate aggressive cancer then I suspect they will run tests.
Even if Biden has known for some time about his cancer, I have no problem with his not wanting to reveal it before now. Not every health issue is everybody’s business, especially if it’s at a stage where it isn’t particularly impacting someone’s life. Of course, now it does seem to be beyond that stage.
I’m not sure if it was brought up with or by Mom at that hospitalization, but she wasn’t terminally ill then, just (“just”) suffering viciously with arthritic pain, confined to a wheelchair, on oxygen and a smorgasbord of pills, so hospice would not have been approved for her.
My veterinarians wouldn’t hesitate to agree to euthanize any pet so debilitated [ETA:with no realistic hope of a cure] in fact neither they nor I have let my cats and horses get to that stage before releasing them.
I understand the arguments against assisted suicide but damn, seeing what my mom went through was horrible.
"The prostate-specific antigen (PSA) screening test is the most common method clinicians use to screen for prostate cancer. The PSA test measures the amount of PSA, a type of protein, in the blood. When a man has an elevated PSA level, it may be caused by prostate cancer, but it could also be caused by other conditions too. Studies show that PSA-based screening in men 55−69 comes with potential benefits and harms over a period of 10−15 years.
The U.S. Preventive Services Task Force recommends that for men 55–69, the decision to receive PSA-based screening should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening and to incorporate their values into the decision. (C grade)"
If he knew he had aggressive cancer before he dropped out Back in July 2024, I would be ticked at him, but I find that hard to believe given that he’s only evaluating treatment options now.
Well, unfortunately, in this particular situation we already experienced a real conspiracy for the past few years, hiding the nature and extent of Biden’s cognitive decline, as well as coercing the media to lie on their behalf. Under normal circumstances the principle of “when you hear hoofbeats, think horses, not zebras” would apply, but zebras have now been spotted in the area, so it’s no longer a good rule of thumb. I’ve updated my priors such that a coverup is no longer excluded, especially since a medical coverup like this would be far easier to hide from the public.
Now as it happens, I think the argument about PSA tests not being recommended for that age range is a sufficient one, and no coverup is needed. But that isn’t due to a coverup being an inherently disfavored explanation like it would be elsewhere.
Hardly any politician is going to unnecessarily admit to something voters might feel is disqualifying. This is one of the few areas where I think party affiliation doesn’t matter. So if I found out the same about Trump tomorrow, I wouldn’t think any worse of him (admittedly a difficult hurdle given how bad I think of him now).
As for Biden’s physicians, their loyalty is properly to their patient. When Trump’s doc wrote that DJT would be “the healthiest individual ever elected to the presidency,” he was making an obvious-to-me joke that acknowledges this reality.
BUT – Biden likely did NOT know before this year, or even this month. To know before, there probably would have had to be testing not supported by evidence-based medicine. That would reek of VIP syndrome. I’m sure Biden’s docs know about the dangers there and try to avoid it.
There is a good article in The Atlantic on Joe Biden’s situation, written by a Johns Hopkins pathologist with relevant expertise. Unfortunately, the prognosis sounds worse that what is being reported elsewhere:
I also get one every year. It’s a pretty common thing for older people. The President of the United states is a World leader and should have the highest level of care.
My memory is that I’ve told my Ivy League faculty family medicine physician not to order it unless clearly beneficial (given risks of missing serious cancer vs. risk of going down a road that leads to overtreatment). Looking at my online chart, I did have the test this past January, at age 69, but the last before that was in 2017.
Here’s U.S. National Cancer Institute guidance as of 1/16/2025 (historical to make sure it is not coming from Trump/RFK):
I’m 75, and because my PSA readings tend to go up and down, I see a urologist twice a year to monitor it. I had an MRI a couple of years ago due to some high readings, but it was inconclusive. It has spiked again, so another MRI in June. (More than 10 years ago, before MRIs were possible for the prostate, I had a big spike, and my then urologist recommended a biopsy. That was awful, was completely clear, and ruined my sex life). So they didn’t stop looking for me, but that may be because of that history.
I hope that’s not the argument, because (as I understand it) Benign Prostate Hyperplasia (BPH or enlarged prostate) does not affect the PSA score. PSA is for detecting cancer. I think the argument is that some forms of prostate cancer are very slow growing and in those cases it may be counterproductive to treat it. It’s also not a question of false positives – PSA readings don’t give positive diagnoses, they only indicate whether further testing should (probably) be done.
A PSA test is not a yes/no decision tool. It only indicates whether further testing may be advisable. So I would not call a normal PSA reading in a person with prostate cancer a false negative. That may seem like nit picking, but there seems to be a fairly widespread misunderstanding, here and everywhere, around what the test is for.
I am not a doctor, but it has long been my understanding that difficulty urinating is usually considered as a symptom of BPH and not, usually, cancer, and the digital exam is usually to detect BPH and not cancer. As for the ability to detect cancer by a digital exam, before I had that biopsy I had the very most thorough digital exam by that urologist that I have ever had, before or since. He was then able to describe the shape of my prostate and note that it was a little irregular but that fact by itself was inconclusive. That irregularity plus my spiking PSA readings are why I had the biopsy. Had I known the outcome and the consequences, I most assuredly would have declined.
Curiously to me, I have not had a digital exam since then, through three different PCPs and a new urologist.
Current data indicates that the digital rectal exam is not very useful at all as a screening tool for prostate cancer. The US Preventive Services Task Force (USPSTF) does not recommend DRE as a primary screening test due to limited evidence on its benefits.