That’s a valid position. For me, a huge part of being who I am, is being someone who is reasonably self sufficient, rational, able to communicate at some relatively sophisticated level… I VERY MUCH do not want to be a burden on anyone, and I have very strong philosophical positions as to the $$$ that should be spent on (at least some) nonproductive individuals (open to definition/debate).
As far as extreme end of life decisions, I wonder how many choices are expressed by the individual, or other people acting on their behalf, for people who failed to express their preferences beforehand.
For example, I recently read an article in the Atlantic about medical ethicists debating which COVID patients should get scarce respirators. Then they said one of the people was endstage Alzheimers. I understand people feel differently, but I personally can’t understand why such people are provided any care other than pain relief and easing their death.
When I would see folk in the Alzheimer’s care unit of a nursing home my band used to gig at, I really wondered whether any of those folk would have wanted to be warehoused in the condition they were in.
What LSL says about not falling through that trapdoor is key. I remember being horrified reading about the results of having pacemakers implanted after a stroke, only to realize AFTER the patient fails to recover, that the damned batteries last a decade, and it can be VERY HARD to get the damned thing turned off.
I have a DNR on file with my medical provider and my daughter is aware of my wishes. If I can no longer care for myself, I’d just as soon scoot on out.
I hope I will have the courage of my convictions when and if the time comes.
Hell, my wife and I have agreed to help each other off ourselves should we get to that point, and 2 of my 3 kids have agreed to do the deed is my wife is no longer around. Damn, I just went to the ortho this a.m. Shoulda seen if I coulda scored some more narcotics to add to the stash…
Three family members who died after several weeks in hospital were clear in each case that enough was enough. My parents were both over 90, my brother was in his sixties, but after several months of cancer treatment and the prospect of a really nasty lingering death from kidney failure he decline any further measures. I have heard that a number of cancer say that they would not have gone through with the treatment if they had known beforehand what it was like, and that it would not succeed anyway. But your mileage may vary.
All three died peacefully and with dignity. I should hope for so much.
While modern medicine can do wonders, bear in mind that not everyone comes back even close to what they were, mentally or physically. Older people especially do not recover as well, and a medical episode can leave them with a really diminished quality of life.
When my best buddy was diagnosed w/ C at 49, he had planned trips to Egypt and Tibet, which his oncologist told him to cancel for treatment. When he died a year later, he told me his biggest regret was canceling those trips.
I have a daughter that is a cardiac ICU RN; she runs ECMO, ventilators, and so forth.
We just conversed about this a couple of days ago after an article exploring lawsuits for “Wrongful Life”, where people were kept on life support against their pre-determined wishes, including the wishes of their loved ones.
What I learned:
Protocols in many hospitals are TERRIBLE in this area. While sometimes “DNR” notices are posted next to patients, that doesn’t cover everything in-between, and extremely busy staff don’t always have the time to dig through files to find the instructions. It’s not that they don’t care or want to respect the wishes; it’s that they often don’t know what the wishes are.
With ECMO and other tools, they can keep someone alive basically forever, for certain definitions of “alive”. They can keep blood flowing for years, even though the patient has no chance of recovery. No one thinks this is a great idea, so someone needs to make the choice of when, and it’s better for the family or patient (via directive document). Staff aren’t usually going to be aggressive about terminating a patient, so if someone is on life support who, if aware, wouldn’t want to be, a loved one should champion the enforcement of that wish.
I actually have a written medical power of attorney and I’ve discussed my wishes with those who will be in a position to make decisions. If I have a decent (and yes, we’ve discussed how I define that) chance of recovery to a meaningful life (and yes, we’ve discussed how I define that) then I’ll put up with a lot.
But if, for example, I was diagnosed with stage IV pancreatic cancer (as just one example) I’d opt for quality over quantity.
This surprises me, as I know a number of people who have chosen to stop doing stuff. My father chose to to play tennis when he had a blood clot in his lung. His doctor thought it was pneumonia. He died on the court. In the days before that, he stocked the freezer with easy-to-reheat foods my mom liked, and he looked up the current contact info of one of her ex-boyfriends. He knew he was likely to die, and he didn’t seek treatment. My mom said that he looked happy when she arrived at the still-warm body.
More conventionally, I know dozens of people who chose to enter hospice care, and died shortly thereafter.
When my grandmother was old and senile, she got some minor infection and she was treated with antibiotics. One of the last things she said to my mother (as the dementia advanced) was that next time she preferred they not treat her.
I know three elderly people who stopped eating. One had previously begged her grand-daughter to help her commit suicide. Her grand-daughter pointed out that doing so would be murder, and refused. Yeah, the grandmother knew that refusing to eat would hasten her death.
I guess those last three are “last days”, not “last minutes.”
When my great aunt was minutes from death she asked my brother to leave the room. Then she took out her false teeth, saying she didn’t want to die with them in her mouth. Then she died.
Anyway, I doubt that GP’s experience is universal.
I accept that at some point I will not a productive member of society in the sense that I will generate more than I consume. I hope that it will be a long time coming and a relatively short time in duration, but the value of a person is more than economic surplus.
I think the question of what to do about alzheimers/dementia sufferers who are no longer able to express what they’d want to do is a deeply challenging one.
The issue of allocating scarce medical resources in the face of a novel pandemic is also an interesting one (and I’m inclined to say we should give the ventilators to whoever is most likely to live the longest), but I don’t think it’s relevant for most decisions of this nature. Yes, resources used to keep me alive with expensive medical care could go elsewhere, but nearly everyone posting on this board could give up luxuries to save the lives of impoverished people and we don’t, so it’s not like that ethical consideration should only come into play when the luxury in question is medical treatment. Seems rather the opposite. If it’s not deeply immoral for me to own a big house and a nice car and go on vacation instead of helping the less fortunate, surely it’s even less immoral for me to spend that money on not dying.
“When my best buddy was diagnosed w/ C at 49, he had planned trips to Egypt and Tibet, which his oncologist told him to cancel for treatment. When he died a year later, he told me his biggest regret was canceling those trips.”
I would certainly believe it.
My brother had planned a cruise for the time of the anticipated all clear. He was cautiously optimistic until the tests revealed that the (very nasty) treatment had failed.
If I was diagnosed with the same thing, I would go out and travel for as long as I was able. Which probably might not be long, as one symptom was anemia and extreme tiredness, but you need to live a little.
And 49 is waaaaay too young. I lost a schoolfriend to skin cancer, he went at 46.
My mother made it very clear her last weeks that we were not to resuscitate her or even try, and we did not. Her quality of life was gone. She’d been rushed to the hospital that last time after choking on food and was unhappy with that. She asked us “why? Why did you save me?”.
I know how I’d react, having been in a situation requiring decision making. Sixish years ago I’d had a heart attack as well as increasingly frequent episodes of unstable angina.
When they prepared me for cardiac catheterization, they explained that if they could treat me with one or more stents they would, otherwise I’d be looking at immediate bypass surgery. I refused to consent to bypass. They explained repeatedly, I refused repeatedly.
And hope your family don’t end up financially and emotionally shattered over the costs of warehousing the shell of who you used to be.
Like not_what alluded to - who do you expect to pay for your unlimited care, Smapti? If you are personally rich, I guess I don’t really have an issue w/ you donating your wealth to the longterm care industry.
My elderly dad’s quality of life has diminished significantly in recent years, and he has a health care directive that puts limits on what he wants done to him if he can’t decide for himself. A couple of years ago he was suffering from angina, and the recommended treatment was the insertion of a stent. The joke was that this would address his pain with the unfortunate side effect of prolonging his life.
This was a sobering moment. The consent forms were proffered by a visiting fellow from the UK. When I told him I was fine with the catheterization/stent but would not consent to a bypass, his initial response was to tell me I “didn’t have a choice”. That made me freak out. I threw the pile of paperwork at him, pushed the nurses’ call button, and began screaming “I NEED HELP”!
A nurse responded and I asked that my IV be removed, as I was leaving. She suggested I allow her to get my cardiologist.
Meanwhile, my gf had run to the gift-shop to get me a book. She returned to chaos in the hallway outside my room; a security guard, nurses, doctors, all discussing what was going on.
My cardiologist assured me that I was free to consent or not as I saw fit. He said that the visiting fellow did not understand how things worked in our health care system. The fellow stopped later to apologize, but I told him I wanted nothing to do with him and suggested he get the fuck out.
