How odd to present you with consent forms and then insist you have no say in whether or not you sign them.
I suspect what the good doctor meant was:
Your choices amount to sign the forms or almost certainly die this week, if not on the table this very afternoon. I ‘know’ you don’t want the latter, so the former is the only sensible practical choice.
IOW: you don’t have a choice … if you want to live until breakfast.
Some folks just aren’t real good at expressing themselves.
I just remembered a woman who went to the same church as me in my old town, who in her early 90s called 911 because she thought she was having a heart attack. Tests revealed that she had a dissecting aortic aneurysm, and asked the doctor if it could be fixed. He said, “The operation for this would kill you.” “What if I went to St. Louis?” “It would kill you there, too.” Therefore, she and her family all agreed that she would be put on comfort care measures, and it blew a few days later and she died almost immediately.
Some of her friends from church wanted people to submit their favorite memories of her, to present them to her family at her memorial service. This person’s favorite memory? For many years, this woman had been a dance teacher, specializing in tap, and when she was about 85 years old, the church had a talent show. Most of them were kids playing their musical instruments, and this woman showed up in a tap costume, complete with top hat, white gloves, a cane, and sequined tails, and brought the house down with her routine. This was a few years before I moved there, and not only did I find it believable, but that kind of thing kept her active and healthy.
But that was not true. I’d studied my options and knew that controlling my symptoms medically was an option. Cites are out there comparing medical vs surgical approaches to coronary artery occlusion and while surgical treatment is wonderful, in many retrospective analyses the differences between bypass and medical treatment aren’t that different.
IANACardiologist, but I’ve read the literature and am competent to decide on my own care.
ETA: I remember being surprised in reading one study that followed 150 patients who refused bypass. Not everyone placidly follows their doctor’s advice.
And my very strong endorsement as well. Excellent, approachable, realistic. Would be great as a book and discussion shared between spouse or children and their aging parents.
I did home health nursing for 10 years and saw a lot of regrettable last journeys. Every single one would have been improved by reading this book. Every. Single. One. I’d be surprised if your library couldn’t get it for you.
One of my mentors had two strokes. The first left him aphasic, but he could respond to a yes/no question and even think about mathematics at some level. I was able to get him to answer a question I had about whether he had answered a certain question but not published it. He seemed to say yes to both. Then he had a second stroke and was left vegetative. He had a directive to not be kept alive in such a situation, but some distant relative (I never found out how distant but he once told me that his entire family had perished in the Warsaw ghetto) came and threatened to sue the hospital if they didn’t take every possible measure. So they kept him “alive” for two more years.
I certainly wouldn’t want this happening to me and my wife and kids are clear on that. One of my kids (the one married to a physician) has medical directives for me and my wife.
On the other hand if I could be returned to some sort of conscious life, follow audiobooks read the dope, etc., I would want it.
Not true in the sense that you believe that is not what the doc thought/meant, or not true in the sense that you believe the doc was mistaken about your survival odds with just a stent?
He clearly was mistaken, given the fact you’re here all these years later. What’s I’m asking now is what he meant, right or wrong though it may have been.
He said I “didn’t have a choice” which, factually was/is incorrect. As long as a patient is competent (another whole kettle of fish) they can refuse to consent to surgery.
He was trained in cardiology, was doing a fellowship with an excellent cardiologist, but I think maybe attitudes under the UK’s NIH may be different. He thought that when he explained that my condition might best be treated surgically via bypass surgery that I would automatically consent. Well fuck that. The stats generated in many studies favors bypass over alternative treatment (medication, lifestyle changes, etc), but the numbers aren’t that far off. People refuse bypass quite often, and they overall don’t do poorly.
When all’s said and done, he caused his patient who was post myocardial infarction to become extremely distressed, to the point of requesting release. Looking back right now, my heart is racing and I’m pissed. And that’s with atenolol, losartan, and amlodopine (and cannabis) in my veins. Great doctor.
OK. I’m not defending the guy. Just trying to figure what he meant by the screwed up crap he said.
My mother too. She chose her time to die. She technically died of either dehydration, or she starved to death, I’m not sure which. She had ovarian cancer, and had gotten to the point where she had little quality, because she couldn’t eat.
She refused anything but an IV with pain medication, and just enough fluid to deliver the medicine, not to keep her hydrated.
Several heroic things were suggested-- some kind of nutrition delivered through an artery could have let her live several more months, and there were experimental surgeries that might have been done before her last month or so, when she was too weak to survive them. That could potentially have given her years, but it might have given her only months, and she could have died on the operating table. She also could have suffered a lot during recovery, and never lived to the point of getting any enjoyment out of the extra time.
I have told DH I don’t want to live as a quadriplegic with a respirator, and little ability to communicate. He feels differently. He wants everything done, even if he ends up extremely disabled, and needing constant care. The only stipulation he made was that if other heroic measures left him permanently vegetative, he doesn’t want fluids, a feeding tube, or a respirator, and wants a DNR.
I think mine did also. She stopped eating. Doctors said there wasn’t any specific medical reason; but I’m also pretty sure that it wasn’t a matter of willpower as it would need to be for a healthy person to quit eating, but that she wasn’t hungry and wasn’t about to force herself to eat.
It’s my impression that loss of appetite is pretty common right near the end. And I’ve certainly seen it in several cats.
The hospice and euthanasia vet who was Widget’s final friend says that “the body refuses food it knows it won’t be able to use” when he stopped eating his regular food and would only take treats from my hand because he was polite like that. She also brought him triple chocolate brownies for his last treat. She has style. 
I work for a company that handles pre-authorizations for health insurance companies. You would be surprised at how many doctors don’t know or don’t care what the evidence-based guidelines say.
Myself, my insurance provider, and/or the state. I don’t have a family to worry about me, so I’m not concerned about spending everything I have to keep myself alive.
If you’re just a lump of useless flesh with no signs of recovery, after your money runs, insurance and or the state aren’t going to be to keen on paying for you to stay a useless lump of flesh forever. So you better start saving your money.
My sister, who works in hospice, would agree with that. As the body shuts down frequently so does hunger and thirst.
I do think some doctors are so heavily biased towards intervention and saving life that they don’t hear/understand when a patient refuses. Because surely if they just explained things the patient would agree with them, the doctor, right? In these discussions I’m always reminded of the argument I had with a doctor who tried to pressure me into putting my terminally husband on dialysis three days before his death. He seemed genuinely offended that I said no, and in disbelief I wouldn’t do “everything possible”. Well, fact was that prolonging my loved one’s life further was not possible dialysis wouldn’t do anything to make him more comfortable so the answer was “no”.
Some doctors may be so arrogant as to imagine that their detailed knowledge of their particular patient’s history means they know better than some insurance company bean counter.
I can’t tell you how many conversations I’ve had that go like “but Doctor, these studies of 10,000 patients show that, on average, Cheap-Ass SSRI works just as well as the expensive drug you’re prescribing, so why won’t you try that instead?”.
Sometimes they take “Well, she hasn’t tried that particular one, but she’s tried seven other SSRIs and none of those worked and she lost her job and attempted suicide while on them, so maybe we should just stick with what’s actually working” for an answer. Sometimes they don’t. Or you say they HAVE tried the preferred cheap med, and they demand a level of documentation that allows them to deny any patient unwise enough to have failed to obtain and preserve their complete medical records from every doctor they’ve ever seen.
In the first case, I can accept it as a nuisance that helps keep the cost of health care down by verifying that the doctor has an actual reason for their decision. Once they start second guessing those reasons, though, my head gets all explodey.
Anyway, to the OP…I think it may have actually been in that Gawande book, which I agree is awesome…I once heard of someone who said that he wanted to be kept alive as long as he was able to eat ice cream and watch a football game. I think that’s actually a pretty brilliant guideline. It means that your alimentary system is working at least well enough to not need a feeding tube, and you’re mentally with it enough to follow a simple narrative (if you don’t like football, substitute “TV sitcom”). That’s about what I would consider the minimum acceptable quality of life. If I fall below that, just crank up the morphine.
Yep, I remember this story from the book. It was a guy having a conversation with a family member about what quality of life he would be willing to live with, and then soon after he was incapacitated and a decision about his medical care had to be made for him. That family member was able to recall the conversation and make the decision in accordance with what he had said. It (“if I can watch ice cream and football”) wasn’t an incredibly detailed criteria, but it was enough. Imagine instead having to make that decision on behalf of someone with zero prior knowledge of what they would want.
This made me tear up. Often it seems to me that we are nicer to our pets than to our people, and vets like this just underline that notion. Know when to try and know when to quit. I wonder if Widget’s vet would take some people patients. I’m glad Widget had a great last treat.
I am too. And was exactly the same treat I would like as a last one.