Recently watched someone close die over a couple days, after a long decline.
The last 24 hours were monstrous to inflict on anyone. Torture. Evil.
Hours and hours of faltering breathing, often restarting with what was plainly a panicked adrenaline-pumping response. It looked like they felt like they were about to drown every few minutes, hour, after hour, no relief. No IV fluids (terminal anyway, so no trying to keep them alive with techniques like that) and unable to drink, so certainly terribly thirsty the whole time. Unable to communicate or really engage with surroundings, and quite high on pain meds anyway (the closest thing to a mercy in all this). It’s fucked up that that’s a fairly normal way for dying people to make their exit. I’m sure there are all kinds of problems with trying to provide a way out when someone can’t make the choice for themselves, without opening it up to abuse, but damn, I hope this isn’t the best we can do because it’s terrible.
> and unable to drink, so certainly terribly thirsty the whole time.
I know people that work in hospice, and they say this is a big misconception (the article hints at it too). they patients don't die from lack of water, they don't want water because they are dying, and their body can't process it. In fact, as you kind of touched on at the start, giving them IV fluids can cause them to drown since their body can't process the water.
Death is pretty ugly thing, that comes for us all. I got to learn the fun way that in the state of Oregon, it is illegal to disable a pacemaker. Even when the person has a DNR, and it is really the only thing keeping them alive. The best the doctors can do is turn the pacemaker down as low as possible, and hope its not enough to keep the person artificially alive. Which seems kind of really weird, when its also the first and one of the only states that allows medically assisted suicide..
I'm no expert myself but recently had a relative in hospice,[0] which prompted me to look into this issue a bit. There are a few papers (for a recent example, Kingdon et al. (2020))[1] that say that the data is actually extremely low-quality on both sides of the issue. Personally, this makes me wonder if "fluids are bad" might just be received wisdom and/or anecdata... hopefully someone will do a better study(ies) at some point in order to get actually reliable data.
[0] We did end up following the hospice's recommendations not to administer IV fluids, for what it's worth.
Here they would ask you (unless dementia and not arranged, which is an ongoing issue) if you want more morphine and you can keep saying yes until you don’t wake up. Or click the button yourself; there is no limit (also; very hackable these limiting machines). Probably many people in a long decline would just hold the button until not waking up; that is the way it should be. Some people worry about the gov making us wear masks; I worry about govs preventing me from getting out when I want to. Not your fucking business mate.
Yes, this has been my experience with a family friend who died of a brain tumor. Basically, once you're in hospice (in this case it was home hospice) and it's clear you're going to die, they just hook you up to the morphine drip that you can press yourself.
Obviously for many people it's still very scary - it is death after all. But the self-administered morphine drip has been around for ages and is relatively uncontroversial.
He got pneumonia at the stage where he was having to use an oxygen machine at home. At the hospital he asked the doctors if he'd be able to go home, and they said it was highly unlikely.
So, he asked them to turn off the oxygen, which they did. He passed peacefully a few hours later.
Sure, we might have gotten a few extra months with him, but I'm so glad the doctors respected his wishes. My worst fear was him having to endure something like what you describe.
That was my mother's philosophy. The hospital is for fixing you up and sending you home. If the sending home part isn't going to happen she didn't want treatment.
The reality is there comes a point where the doctors can only prolong the dying--and in an awful lot of such cases that's a negative for the person.
I’ve witnessed similar and in a way, I think the person was kept alive too long. I personally think they would’ve died from other causes well before it got to the stage they were at. Euthanasia is probably a pretty important thing because of this. If we’re going to resuscitate people in their 80s, then maybe we shouldn’t let them go through the “long death” a few years later.
All in all it’s a tragic thing the only constellation is that I guess after 24 hours in that, one welcomes death with open arms.
I saw it with my father--to take the pain the morphine also took his memory. And in the end there was only suffering--fortunately, the problem would quickly kill making him eligible for terminal sedation.
Watched my grandfather pass in the same way. Didn’t seem right to let him pass of basically lack of food and hydration after 95 years even though also terminal. I just wanted to see him comfortable and he was far from it.
So sorry to read of your loss, and the painful way it goes.
Sadly, this is just one of millions of descriptions of why the phrase "Slow as death" exists. Generally, life really does not want to give up, and the process is indeed terrible.
I watched someone die of ALS for 6 months, it was pure hell on earth. A middle aged guy who basically was vibrant and in average health struck down from out of no where, the final moments were horrific when they turned off the life support. Even his diagnoses was difficult since no doctor wanted to deliver the news and it required a trip to the MAYO Clinic to finally get an answer.
I have often wondered why he was chosen to carry such a burden, a harmless and kind person.
Edit: I feel a bit dumb now, I hadn't actually read the article yet, went straight for the comments. Seems like I'm just reiterating what it says.
When I'm in that shape I just wanna go in peace. Preferably at home, in my own bed, surrounded by loved ones. No tubes down my throat, no shots to keep me alive at any cost, with no end in sight.
The problem with this perspective in my opinion is that many times, especially for an elderly person, a small emergency can very quickly escalate into a life and death situation, and the outcome is not clear until it’s too late. you may enter the hospital thinking you have a decent outcome, but you end up with a bad outcome.
for example, nobody plans to go on a ventilator. But if you need one (like severe pneumonia), you’re already pretty messed up and you’re going to have a painful death with or without the tubes.
I wonder what 'go in peace' means if you explain it medically. Possibly abrupt heart failure?
From the deaths of older relatives that I've (sort of) witnessed, if any other part of your body fails it's going to be slower and a lot more unpleasant.
I’m quite convinced that I live in a country where we never let people die like this.
Also, I guess prolonging treatment is in the interest of for-profit hospitals as found in other countries, thus as long as your suffering is profitable, you wil…
> I guess prolonging treatment is in the interest of for-profit hospitals as found in other countries
France does the same but has nationalized healthcare, so it does not seem motivated by profits. It puts pressure on the healthcare system and only brings additional suffering. We could change that, but implementing assisted death needs careful consideration and defeating politically the small subset of people that think life with extreme suffering is precious.
I would be surprised if there exists a country where people never die like this. You would have to euthanize every single person who died of a long list of natural causes.
I made a similar comment already but I kind of agree. I’m not sure if it’s about profit it’s also about legal concerns. I think legally doctors are supposed to keep you alive until they can’t anymore?
When my dad died last year from aggressive relapse of cancer, his death rattle was so intense my mum couldn't deal with it and had to leave the room when it was happening, it's a disturbing experience. She's still traumatised by it today.
It's worse than the article says, because it's from a doctor's perspective.
I have CRPS, one of the contenders for worst chronic pain you can have. It's a "suicide disease", because if it advances to stage 3/4, there's a suicide rate of about 70%. It sucks a lot. I've had well over 200 spinal procedures over the last 30 years to try to mitigate the pain, with dozens of other surgical procedures in less tricky spots.
I also have Brugada Syndrome, a "drop dead suddenly without warning" disease. When diagnosed, I wanted to take my time before consenting to having an implanted defib. The doctors announced that "Mr Foster, we believe you are not rational at the moment", fortunately I had a friend with me who assured them I was probably the most rational man in Brisbane.
I was threatened with an ITO (Involuntary Treatment Order) if I didn't go ahead with having an internal defibrilator put in me. I went ahead with the procedure.
So I can't even die by refusing treatment, as "sane" people resist dying at all odds. If I don't want invasive, painful procedures that take over a year to recover from, then the courts will claim I'm suicidal and issue an order to the hospitals to proceed with more bloody cutting.
No, sane people say "I've had enough". Fortunately my current GP understands, as he says "Sometimes people feel they've had enough medicine".
> Did this threat come from a doctor? What an astounding lack of empathy.
Perhaps this is a US vs. other countries thing, but I live in Germany and was born in the UK, and I'm quite shocked that you are surprised by unempathetic (or downright evil) doctors
May I ask if you’ve considered taking measures to end your own life?
I think I’ve had an unusual number of people close to me choose that option, including my father recently so I guess I’m still trying to reconcile it all. Their pain vs mine, what could have played out differently, etc.
I sincerely wish the best outcome for you and yours.
Yes. I don't qualify for Voluntary Assisted Dying though. If I ever need it I can take stronger measures, using simple science and engineering. I did have a cardiologist suggest that if he was me he'd refuse getting implant upgrades and fixes, which was sobering.
Chronic pain changes you, and rarely for the better. It's nigh impossible for someone who hasn't had to deal with 24 hours a day, 7 days a week, for months or years on end pain that's up on the extreme end of the scale. We try to hide it, to protect our families and loved ones for what we live, but sometimes it's too much.
Suicide is natures' rational solution to unending torment. Christian teachings and traditions try to say that suffering is holy, and it is righteous to endure. How come it makes people into assholes then?
Between knowing I have the option, and the amazing power of venlafaxine, I do not need to either fixate on or commit suicide though. At least for a while now.
I will never judge anyone who intentionally kills themselves as I don't know how painful their reality was.
Kind of a tough read, I just turned 37 and this was the year when it really hit home that your body degrades and sometimes it never goes back to "normal". I was used to sports injuries being a pattern of injury -> recovery -> ramp back up to 100%, but have suffered some injuries recently and am coming to terms with realizing I will never return to 100%. They will be lingering things I deal with for the rest of my life.
It is terrifying transitioning from seeing health as innate to viewing it as something you need to carefully nurture or it will slip away.
Hey you're me 15 years ago. I stopped the sports and switched to sustained low damage exercise like cycling, hiking, swimming etc. While you can't undo the damage done if you have a very high level of fitness, you can reduce the effects of the further progression of time. Better be as fit as a 50 year old with some damage when you're 70 than as fit as a 70 year old with some damage.
End game is not pretty. My ex wife didn't do any fitness stuff at all and she's walking with a stick while I'm doing 30km hikes at 3000m...
Same here. I had to switch from doing crazy stuff to just maintaining health. Hiking really fits the spot. I still get a lot of cardio (I have hiking trails with 1000m elevation gain within 10 minutes of driving) that way. But things like running or martial arts are out of the question. I am glad that I was able to adapt to a declining body. Some people my age still do high impact stuff and constantly get injured, take lots of painkillers and get surgeries.
Part of me really wants to pick up hockey - just for fun, recreationally - but at 40, I'm worried that I'll get injured to the point where I won't be able to do other things I enjoy, like cycling.
Hell, I fell off my bike from a stop a few weeks ago, and landed on my knee, and it took a week and a half before I felt like I could trust my leg to hold weight.
I'm a fair bit older than you... What you're saying is true but it's also worth mentioning your body has capabilities you're probably far from reaching. Most people your age can still exceed any physical accomplishment they've had in their lifetime if they really want to. E.g. they can play sports better than they ever had and they can achieve personal bests in any physical ability. If you were a top level professional athlete that's probably not true (though even professional athletes have longer careers than they used to) or if you've been a top 10 GM in chess than that's probably behind you too, but otherwise you're young!
I don't know what specific injuries you're suffering from but I've suffered from back pain and really improved my situation a lot. I'm physically stronger than I've ever been in my life. I've worked through some knee injuries. I've even recently improved my gum health (in a way someone said wasn't possible). It takes more work and more focus but our bodies are amazing machines and 37 ain't old.
I’m in my late forties and sprained my back/hip pretty badly right at the start of COVID. A year later I was having trouble descending stairs and starting to develop knee pain on the same side of my body. So I began a fairly rigorous resistance training program about two years ago with hopes of regaining full mobility. The results have been fantastic. I still have a bit of pain from in both the knee and back, but it’s not disruptive. Most importantly, I have normal mobility and the injured areas have stabilized. With any luck it will continue to improve so long as I stick with it. That’s in addition to all the other benefits that come with being in better physical shape.
I'm unsure your first point can be true. The pinnacle for a 37 year old is surely lower than for his 23 or 24 year old incarnation, if both life stages were given the same fitness programme. 37 is still very young, but there's already some trace of physical deterioration by then, most apparent in athletes who in almost all sports aside from golf, are off their peak by then.
It might not be applicable for you, but just in case -- take a look at myofascial release, similar to trigger point therapy. Basically foam rolling on your legs, using a lacrosse ball and progressively smaller rubber balls across your back and shoulders and pecs, and a TheraCane on shoulders, neck, sides, etc. Also Alexander Technique lessons, which retrains you to use your muscles without the tension habits you've accumulated over your lifetime.
The two of them together have changed my life. A lot of acute injuries of mine had healed, but had left my muscles extremely tight and essentially kind of frozen, which then creates problems with movement and posture and which then generates other kinds of pain. I too thought I'd never get back to "normal", and then was shocked to discover that I basically could, after a couple of years of undoing all the muscular tightness and "frozenness" through myofascial release and Alexander Technique. (Basically, the myofascial release gets rid of it, while Alexander teaches you how to prevent immediately re-forming it.)
It's funny that myofascial release is only just starting to gain awareness among the medical community, while Alexander Technique still mainly only has awareness in the acting and musical performance communities.
Use the next several years to build as much muscle as you can without damaging your joints. It gets extraordinarily difficult to add new muscle as you enter your mid-30s, but fortunately you still have time. I work out 3-4 days per week for ~90 minutes each.
If you've never done strength training before, you may be pleasantly surprised to learn how much extra mass you can add, while remaining on a typical diet, with zero chemical assistance. Your trainer will be able to help you.
Not everyone gets even that - I've had mobility issues since I was seven years old. It's been strange to realize that it probably shaped my personality somewhat; I always felt older than my peers in some way. The silver lining might be that while now they are starting to say how old they feel (I'm basically the same age as you), I'll often tell them that I don't feel any older.
> The silver lining might be that while now they are starting to say how old they feel (I'm basically the same age as you), I'll often tell them that I don't feel any older.
As someone with chronic back pain since my late teens, this is... a nice perspective. My friend group isn't old enough yet for it to come up very often but I feel like I can relate.
I hear you. I’m almost 50, and see it coming as well. I highly recommend the book Outlive by Peter Attia. Just found it recently, wish I had read it at 37. It has really good ideas on extending your “health span “.
your situation is probably not completely relevant to age, many injuries are not recoverable no matter how old you are. You accumulated risks of such injuries which produced result.
If you switch to safer kinds of sport/workout, you still can have a chance to be very active for many years until old age.
On the flip side changing diet and it's effects on what folks might have seen as something they can never fix/change without _____ drug, might be transformational.
With that said, my better half can't bend her arm past a certain part on her body, however, b.c of a really small/stupid collision/fall coming down a Tahoe MTN ski run. It always depends on the problem.
Same age, same realization - stuff that used to be just ‘tiring’ now knocks me out the next day too while I recover; and everything, bumps and bruises and blood etc, seems to take nearly 3x the time to heal now.
I'd like dying to be as easy as flicking a switch.
Medically-assisted suicide ought to be available to anyone (not only of sound mind and not only with a terminal condition), and at any time. People ought to have the right to die, just like they have the right to water, food, and shelter. In most countries it is currently easier to take other people's lives than to take one's own.
People ought to be able to step into a hospital, ask 'hey, I'd like to die', sign a couple of forms saying 'yes, I'd really really like to die', step into an anoxic chamber, and be put into hypoxia and brain death in a matter of minutes. Obviously, an emergency stop plunger ought to be available in case the person in question changes their mind.
The belief that life is a gift from a god is a highly Christocentric, Western view that I disagree with. We are brought into the world without any real consent; we should at least be able to easily choose the date, time, and manner of our passing if we so desire.
How do you reconcile that with many people that attempted suicide due to some illness like depression, and then later very much we're glad they didn't die. "Only of sound mind" sounds difficult to measure.
Related: Majority of gun deaths in the USA are suicides. In the gun control debate you might want to exclude those, right? But actually having ready access to a way to die increases the total number of suicides - it's not that all of those people taking their own lives would use different methods of suicide - some would but some would never die from suicide at all. So it's used as a argument against having easy to access firearms, and generally an argument against an easy way for suicide.
> How do you reconcile that with many people that attempted suicide due to some illness like depression
I believe that depression should be treated seriously as a mental illness. But treat the depression, and not the choices made while depressed (i.e. suicidal ideation, suicide attempts), which are symptoms of depression. It's not like we treat so seriously any of the other choices made while depressed like over/under-eating, alcoholism, impulsive purchases, etc.
> So it's used as a argument against having easy to access firearms
Personally I believe in restricting access to firearms because they are usually used to kill other people. If someone wants to use their gun to take their own life, rather than take their guns away, I'd like to spare them and their family the mess, and give them a way to die peacefully and quietly in a supine position.
The only people who regret suicide are the ones who survive. Subjectively on success, you stop, and removing any and all future possibilities is the entire point. Suicide prevention has nothing to do with the subject, but everything to do with everyone else. You feel bad if someone else dies with unfulfilled potential. So should lawmakers empathize with the suicidal or their loved ones? I tend to think Assisted Dying laws should focus on who has a right over someone else's life (parents? children? siblings? friends? councilors? colleagues? employers?), and be about under what situations they get to block suicide assistance. Rather than the existing situation where the laws are all about granting an individual the right to die, and making it harder for people to exercise their innate right to die by their own hand.
> How do you reconcile that with many people that attempted suicide due to some illness like depression, and then later very much we're glad they didn't die
You don't have to, it's not your business, it's their right to make that choice and no one else's. "My body, my choice" applies to suicide even more than abortion, if you don't control your own life and body you can't call yourself a free man.
I disagree with dismissing someone's decision because they have a mental illness like depression too. Depression and other issues don't always respond to treatment, and even when they do it's often after trying different treatments for months! I've been through very dark times with depression, OCD, and much more. I live a life of luxury now that most of the country would envy with a wonderful wife. If I knew I had to face a year or too of my past issues again and I would get to spend the last 40 years in my wonderful life again afterwards I don't think it would be worth suffering like that for a year. Some issues like OCD really are that bad. If someone with a mental illness wants to die, offer to help, but respect their decision if they don't accept.
I greatly offended my mother's psychiatrist once with a similar thought. He was using my mother's suicidality as proof that she needed inpatient treatment.
I told him - "She suffers from migraines, and for 3 out of 4 weeks in an average month she must spend the entire day immobile in a dark room. There are no treatments in the near term which are expected to improve her outlook. The pain is debilitating. Doctor, who is "insane" - the person who wants a way out of the constant agony, or the person who says "More, please!""
I believe that the right to life as enshrined in the Constitution (and endowed by my Creator) must, inherently, also include the right to end that life, if a man (or woman) so chooses.
I think death should be easily accessible, but not immediately executable. Mental states can swing quickly and dramatically, and it would be a shame for suicide to be in reach for a short-term, temporary situation.
I'm not sure about the best delay, but my current ballpark is at least around a month delay.
Disagree. It should be a considered decision over time.
1) Is the patient of sound mind when the decision is made? (Not necessarily carried out. I have no problem with someone saying "kill me when my mind is gone.")
2) There should be a medical evaluation of whatever the problem is with an eye to what can be done to make life more palatable.
3) There should be a waiting period. (I would, however, say that if the person is no longer capable of confirming it that should count as confirmation.)
Suicide should only be for when one's remaining life is of negative value, not because of temporary bad things.
> The belief that life is a gift from a god is a highly Christocentric, Western view that I disagree with. We are brought into the world without any real consent; we should at least be able to easily choose the date, time, and manner of our passing if we so desire.
Too bad that's only one of many arguments against euthanasia, and one of the easier ones to grandstand against.
Let's run a thought experiment - you make death super easy like in a suicide booth in Futurama. How many people are going to fight life obstacles, pushing society forward, or rather terminally quit at the first sign of troubles? Nihilism was quite popular in the 19th century and led us to two world wars already. All you'll get is a quick extinction of people like you in favor of those that persist and your opinion will be eliminated from the gene pool.
Nihilism has nothing to do with either world war. You’re likely trying to blame Nietzsche, who was the polar opposite of a nihilist, for German nationalism. The radical optimist Nietzsche, in his old age while writing Ecco homo, disavowed his German heritage and spoke about how awesome Poland and his polish identity were.
Nihilism is only just now having an impact in the academy as it is the intellectual foundation of post modernist and critical theory.
> your opinion will be eliminated from the gene pool
The impulse to die being eliminated from the gene pool is a good thing ? Or rather the characteristics to fight for life at all costs is what one would want in the gene pool ?
If what you assume is true, at some point people will want to die less and the problem will self correct .
Death is important tool in evolution delaying it is not argument for it .
In the West I think alcohol is a massive factor, when talking about the moods of large numbers of people in those days. It is no accident that alcoholic drinking was banned outright for some time, despite the deep cultural roots.
> How many people are going to fight life obstacles, pushing society forward, or rather terminally quit at the first sign of troubles?
Not many, probably, but the option should be available to those who need it.
> Nihilism was quite popular in the 19th century and led us to two world wars already
I'm sorry, but this is rubbish. Firstly, I'm not nihilistic, but practical. Not everyone who wants to die is suffering; sometimes they just want out of a pointless and meandering life. They don't want to put in the effort to up themselves, and frankly, why should they? What right do other people have to impose their views on someone who's feeling like this?
Sometimes one is suffering, but can't be bothered to, or might suffer more while trying to convince the state and a medical team that they deserve to die. It's 2024, and we have increasing acceptance of the gender spectrum, of the autism spectrum, of recreational narcotics, and more. Why is dying so marginalised? Like I said, this is a Christocentric view. A modern society must allow its citizens to die quietly, peacefully, and cleanly, whenever they choose.
Next, what led to the two world wars was not 'nihilism', a very loaded single word, but rather a bunch of overly-complex defence pacts, treaties, and arms races in 1900s Europe that eventually collapsed into a bloody shit show. The second world war happened because of a feeling of revenge, anti-semitism, and Slavophobia on the part of the Germans, and imperialism on the part of all the Axis powers. Nothing more, nothing less. Depending on who you ask WW2 began as early as 1910 with the invasion and occupation of Korea by Japan.
> your opinion will be eliminated from the gene pool
Wanting to die is not (only) passed down in someone's genes. It is highly environmental and depends on what people do, who they talk to, and where and how they live.
There exist supervised injection sites for narcotics. You bring the drugs, the healthcare workers give you clean syringes/needles/paraphernalia and help you with the injection. As a society we have decided that it is OK for people to potentially wreck their own lives with narcotics.
Why not a similar concept for dying, where the end is only eternal oblivion? Step into a room, step inside a pod, press a button, pod closes, press another button to replace the air with nitrogen, done.
> life as more precious
I'm sorry, but 'life is precious' is a religious view, even if you call yourself 'atheist'. Life is just life, it is an emergent property of chemical and physical processes and laws. It is interesting, to be sure, but precious? Sorry, no. Humans have killed each other since they evolved from Australopithecus, and have only found more efficient, violent, and deadly ways to do so in the intervening five million years.
The topic of a “living will” came up in a family discussion after my mother’s funeral.
None of us have a pathological desire to live at all costs, but as it turns out, figuring out when to say “yeah I’m done, see yah” and halt treatment is way more complex than it first seems, especially when making the decision for someone else. Things can happen very fast, and there’s a bunch of things that basically require a job in the industry to know ahead of time.
If anyone knows of some comprehensive resources for helping define reasonable limits, I’d love to hear it.
The Order of the Good Death has loads of resources on how to have these conversations, what your options for advanced directives etc. are, and guides on how to set everything up.
They also do a lot of advocacy around green burial, alkaline hydrolysis, and whatnot as well.
Caitlin Doughty (who founded the Order of the Good Death) Ask a Mortician channel on youtube covers this stuff too, but the older videos might be out of date.
Thank you so so so much for posting this! I had no idea it existed, and I am so happy that it does.
I also discovered that my home state has ZERO listed green burial sites, which is shocking to me because... I live in VT. I would have guessed it would be the leader in green burial, it is right up our wheelhouse!
"especially when making the decision for someone else"
This gets additionally terrible when it's for someone else whilst handling the wishes of everyone else with significant ties to them.
Had a relative die a while back who was going through absolute hell the final few days; some family members still have a massive grudge towards the hospice for what they feel like were moves done to ensure they died quicker. I've absolutely no clue why they seemed to think dying in massive pain over a longer span of time seemed better but they did.
I saw it with my father, also. Some people aren't ready to accept that death is coming and blame anyone/anything they can rather than accept it. Just try harder, you can do it!
No. The cancer was everywhere and it was aggressive. Try what harder? There was nothing to do. Someone close to them felt my mother was being evil and incompetent in not pushing him to eat more. While he lost a lot of weight the cause of death was when it got his kidney (one had already been removed when it was thought to be stage 1.)
There is the POLST form for governing interventions. There is durable medical and general powers of attorney. There are irrevocable trusts to protect trust assets from long term care.
Talk to an estate attorney and they can give you some advice, but ultimately you'll never be able to account for every possibility, and you're going to have to trust somebody to make the right decisions for you at some point.
Anecdotally, a family friend was barely clinging on to life for a couple weeks enduring heavy pain meds and abject misery. Only when his close friend, and executor of his estate, sat beside him and told him everything was going to be alright did he finally find peace and let go. He was gone within 30 minutes.
Had a pretty close childhood friend choose assisted suicide (in California) a few years ago after a year long battle with blood cancer. It's not easy to do, I think his biggest fear was losing his ability to consent as his mental condition declined rapidly. The link below outlines the process. He was getting home hospice care staying at an Aunt's house hear the hospital he was treated at. I don't think it is the right choice for everybody, but I certainly think in my friends case it was.
Slightly tangential, but I believe this article segues into a discussion about assisted suicide or euthanasia at the end of life.
My entire family has been suffering over the past 18 months watching my 88-year-old grandmother slowly pass away from age-related deterioration and AD.
I worked with mice during my PhD training in the US. If a lab was caught with lab mice suffering like my grandmother is without euthanizing them, the lab would be liable to be shut down.
So I ask: why am I forced to sit and watch my grandmother suffer slowly to death? Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering?
Because far too many people believe that human life is the most precious thing on Earth and willingly ending it is literally the worst thing you could ever do.
There's also the worry that it will be abused. Kids who want their inheritance, people who have been abused and told it's the right thing for them when it's not, or just insurance trying to save money by avoiding more expensive treatments
You aren't forced to. You can take matters into your own hands and trust that a jury will let you off the hook.
> Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering?
Even most religious people believe in mercy killing. The issue is the slippery slope, and the fact that various people have slid down this slope in every country with legal assisted suicide or euthanasia. Whenever you are going to have a third party, or even just a second party, involve itself in someone's death, you have to figure out how to deal with issues every bit as serious as letting someone suffer to death.
I faced a similar problem as my wife had a chorionangioma, a placenta tumor. Or it was my son, it’s even hard to tell who had it as placenta is external to both. In the hospital where we were, they were doing their best to keep the baby alive despite all the issues with the rupture of the amniotic sac and body damages that he already had, which I understand. What I didn’t understand, and still don’t, is how they were getting ready to try and keep him alive once he would be born, most probably at the 6th month and with probable brain and other physical damages. I respect doctors who can’t choose between their patients life and death, and most of all parents who love their to be born kids so much that they are ready to face a life or hardship. I just think that medicine should not just focus on keeping patients alive, but also consider the quality of their life before taking a decision together with the relatives.
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The last 24 hours were monstrous to inflict on anyone. Torture. Evil.
Hours and hours of faltering breathing, often restarting with what was plainly a panicked adrenaline-pumping response. It looked like they felt like they were about to drown every few minutes, hour, after hour, no relief. No IV fluids (terminal anyway, so no trying to keep them alive with techniques like that) and unable to drink, so certainly terribly thirsty the whole time. Unable to communicate or really engage with surroundings, and quite high on pain meds anyway (the closest thing to a mercy in all this). It’s fucked up that that’s a fairly normal way for dying people to make their exit. I’m sure there are all kinds of problems with trying to provide a way out when someone can’t make the choice for themselves, without opening it up to abuse, but damn, I hope this isn’t the best we can do because it’s terrible.
I know people that work in hospice, and they say this is a big misconception (the article hints at it too). they patients don't die from lack of water, they don't want water because they are dying, and their body can't process it. In fact, as you kind of touched on at the start, giving them IV fluids can cause them to drown since their body can't process the water.
Death is pretty ugly thing, that comes for us all. I got to learn the fun way that in the state of Oregon, it is illegal to disable a pacemaker. Even when the person has a DNR, and it is really the only thing keeping them alive. The best the doctors can do is turn the pacemaker down as low as possible, and hope its not enough to keep the person artificially alive. Which seems kind of really weird, when its also the first and one of the only states that allows medically assisted suicide..
We know how to end life's.
[0] We did end up following the hospice's recommendations not to administer IV fluids, for what it's worth.
[1] https://spcare.bmj.com/content/bmjspcare/11/1/68.full.pdf
Obviously for many people it's still very scary - it is death after all. But the self-administered morphine drip has been around for ages and is relatively uncontroversial.
They care about your relatives who are burdened not “accidentally” holding that button for you when somehow you would still like to live.
He got pneumonia at the stage where he was having to use an oxygen machine at home. At the hospital he asked the doctors if he'd be able to go home, and they said it was highly unlikely.
So, he asked them to turn off the oxygen, which they did. He passed peacefully a few hours later.
Sure, we might have gotten a few extra months with him, but I'm so glad the doctors respected his wishes. My worst fear was him having to endure something like what you describe.
The reality is there comes a point where the doctors can only prolong the dying--and in an awful lot of such cases that's a negative for the person.
All in all it’s a tragic thing the only constellation is that I guess after 24 hours in that, one welcomes death with open arms.
Sadly, this is just one of millions of descriptions of why the phrase "Slow as death" exists. Generally, life really does not want to give up, and the process is indeed terrible.
I have often wondered why he was chosen to carry such a burden, a harmless and kind person.
Edit: I feel a bit dumb now, I hadn't actually read the article yet, went straight for the comments. Seems like I'm just reiterating what it says.
When I'm in that shape I just wanna go in peace. Preferably at home, in my own bed, surrounded by loved ones. No tubes down my throat, no shots to keep me alive at any cost, with no end in sight.
Here's some good discussion on the topic between two doctors that I watched recently: https://youtu.be/O0YIGAUDlzQ?t=242
for example, nobody plans to go on a ventilator. But if you need one (like severe pneumonia), you’re already pretty messed up and you’re going to have a painful death with or without the tubes.
I wonder what 'go in peace' means if you explain it medically. Possibly abrupt heart failure?
From the deaths of older relatives that I've (sort of) witnessed, if any other part of your body fails it's going to be slower and a lot more unpleasant.
Also, I guess prolonging treatment is in the interest of for-profit hospitals as found in other countries, thus as long as your suffering is profitable, you wil…
France does the same but has nationalized healthcare, so it does not seem motivated by profits. It puts pressure on the healthcare system and only brings additional suffering. We could change that, but implementing assisted death needs careful consideration and defeating politically the small subset of people that think life with extreme suffering is precious.
I have CRPS, one of the contenders for worst chronic pain you can have. It's a "suicide disease", because if it advances to stage 3/4, there's a suicide rate of about 70%. It sucks a lot. I've had well over 200 spinal procedures over the last 30 years to try to mitigate the pain, with dozens of other surgical procedures in less tricky spots.
I also have Brugada Syndrome, a "drop dead suddenly without warning" disease. When diagnosed, I wanted to take my time before consenting to having an implanted defib. The doctors announced that "Mr Foster, we believe you are not rational at the moment", fortunately I had a friend with me who assured them I was probably the most rational man in Brisbane.
I was threatened with an ITO (Involuntary Treatment Order) if I didn't go ahead with having an internal defibrilator put in me. I went ahead with the procedure.
So I can't even die by refusing treatment, as "sane" people resist dying at all odds. If I don't want invasive, painful procedures that take over a year to recover from, then the courts will claim I'm suicidal and issue an order to the hospitals to proceed with more bloody cutting.
No, sane people say "I've had enough". Fortunately my current GP understands, as he says "Sometimes people feel they've had enough medicine".
Did this threat come from a doctor? What an astounding lack of empathy.
I would switch medical providers in a heartbeat if at all possible.
Perhaps this is a US vs. other countries thing, but I live in Germany and was born in the UK, and I'm quite shocked that you are surprised by unempathetic (or downright evil) doctors
I think I’ve had an unusual number of people close to me choose that option, including my father recently so I guess I’m still trying to reconcile it all. Their pain vs mine, what could have played out differently, etc.
I sincerely wish the best outcome for you and yours.
Chronic pain changes you, and rarely for the better. It's nigh impossible for someone who hasn't had to deal with 24 hours a day, 7 days a week, for months or years on end pain that's up on the extreme end of the scale. We try to hide it, to protect our families and loved ones for what we live, but sometimes it's too much.
Suicide is natures' rational solution to unending torment. Christian teachings and traditions try to say that suffering is holy, and it is righteous to endure. How come it makes people into assholes then?
Between knowing I have the option, and the amazing power of venlafaxine, I do not need to either fixate on or commit suicide though. At least for a while now.
I will never judge anyone who intentionally kills themselves as I don't know how painful their reality was.
It is terrifying transitioning from seeing health as innate to viewing it as something you need to carefully nurture or it will slip away.
End game is not pretty. My ex wife didn't do any fitness stuff at all and she's walking with a stick while I'm doing 30km hikes at 3000m...
Hell, I fell off my bike from a stop a few weeks ago, and landed on my knee, and it took a week and a half before I felt like I could trust my leg to hold weight.
I don't know what specific injuries you're suffering from but I've suffered from back pain and really improved my situation a lot. I'm physically stronger than I've ever been in my life. I've worked through some knee injuries. I've even recently improved my gum health (in a way someone said wasn't possible). It takes more work and more focus but our bodies are amazing machines and 37 ain't old.
The two of them together have changed my life. A lot of acute injuries of mine had healed, but had left my muscles extremely tight and essentially kind of frozen, which then creates problems with movement and posture and which then generates other kinds of pain. I too thought I'd never get back to "normal", and then was shocked to discover that I basically could, after a couple of years of undoing all the muscular tightness and "frozenness" through myofascial release and Alexander Technique. (Basically, the myofascial release gets rid of it, while Alexander teaches you how to prevent immediately re-forming it.)
It's funny that myofascial release is only just starting to gain awareness among the medical community, while Alexander Technique still mainly only has awareness in the acting and musical performance communities.
This year I got a personal trainer for the first time.
I’m really trying to fight to get in shape and stay in shape.
I spent my 20’s working and for the last 5 years I work remotely, largely ignoring my health.
Sitting in a home office all day is really bad for you.
If you've never done strength training before, you may be pleasantly surprised to learn how much extra mass you can add, while remaining on a typical diet, with zero chemical assistance. Your trainer will be able to help you.
As someone with chronic back pain since my late teens, this is... a nice perspective. My friend group isn't old enough yet for it to come up very often but I feel like I can relate.
If you switch to safer kinds of sport/workout, you still can have a chance to be very active for many years until old age.
With that said, my better half can't bend her arm past a certain part on her body, however, b.c of a really small/stupid collision/fall coming down a Tahoe MTN ski run. It always depends on the problem.
Medically-assisted suicide ought to be available to anyone (not only of sound mind and not only with a terminal condition), and at any time. People ought to have the right to die, just like they have the right to water, food, and shelter. In most countries it is currently easier to take other people's lives than to take one's own.
People ought to be able to step into a hospital, ask 'hey, I'd like to die', sign a couple of forms saying 'yes, I'd really really like to die', step into an anoxic chamber, and be put into hypoxia and brain death in a matter of minutes. Obviously, an emergency stop plunger ought to be available in case the person in question changes their mind.
The belief that life is a gift from a god is a highly Christocentric, Western view that I disagree with. We are brought into the world without any real consent; we should at least be able to easily choose the date, time, and manner of our passing if we so desire.
Related: Majority of gun deaths in the USA are suicides. In the gun control debate you might want to exclude those, right? But actually having ready access to a way to die increases the total number of suicides - it's not that all of those people taking their own lives would use different methods of suicide - some would but some would never die from suicide at all. So it's used as a argument against having easy to access firearms, and generally an argument against an easy way for suicide.
The point is, the mind changes constantly; it's its nature. What should one do?
Personally, I'd rather avoid the rollercoaster of "I'm happy I didn't die" and "I should've died."
I believe that depression should be treated seriously as a mental illness. But treat the depression, and not the choices made while depressed (i.e. suicidal ideation, suicide attempts), which are symptoms of depression. It's not like we treat so seriously any of the other choices made while depressed like over/under-eating, alcoholism, impulsive purchases, etc.
> So it's used as a argument against having easy to access firearms
Personally I believe in restricting access to firearms because they are usually used to kill other people. If someone wants to use their gun to take their own life, rather than take their guns away, I'd like to spare them and their family the mess, and give them a way to die peacefully and quietly in a supine position.
You don't have to, it's not your business, it's their right to make that choice and no one else's. "My body, my choice" applies to suicide even more than abortion, if you don't control your own life and body you can't call yourself a free man.
I disagree with dismissing someone's decision because they have a mental illness like depression too. Depression and other issues don't always respond to treatment, and even when they do it's often after trying different treatments for months! I've been through very dark times with depression, OCD, and much more. I live a life of luxury now that most of the country would envy with a wonderful wife. If I knew I had to face a year or too of my past issues again and I would get to spend the last 40 years in my wonderful life again afterwards I don't think it would be worth suffering like that for a year. Some issues like OCD really are that bad. If someone with a mental illness wants to die, offer to help, but respect their decision if they don't accept.
I told him - "She suffers from migraines, and for 3 out of 4 weeks in an average month she must spend the entire day immobile in a dark room. There are no treatments in the near term which are expected to improve her outlook. The pain is debilitating. Doctor, who is "insane" - the person who wants a way out of the constant agony, or the person who says "More, please!""
I believe that the right to life as enshrined in the Constitution (and endowed by my Creator) must, inherently, also include the right to end that life, if a man (or woman) so chooses.
Why have people here who don't want to be here?
You're at a party. You politely say goodbye to everyone and start heading for the exit.
You are restrained and drugged.
Nice party, bro...
I'm not sure about the best delay, but my current ballpark is at least around a month delay.
1) Is the patient of sound mind when the decision is made? (Not necessarily carried out. I have no problem with someone saying "kill me when my mind is gone.")
2) There should be a medical evaluation of whatever the problem is with an eye to what can be done to make life more palatable.
3) There should be a waiting period. (I would, however, say that if the person is no longer capable of confirming it that should count as confirmation.)
Suicide should only be for when one's remaining life is of negative value, not because of temporary bad things.
Too bad that's only one of many arguments against euthanasia, and one of the easier ones to grandstand against.
https://www.bbc.co.uk/ethics/euthanasia/against/against_1.sh...
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I always ask: for how long? What is the ultimate goal? If you don’t know, it's time to seek answers before pushing society forward carelessly.
Nihilism is only just now having an impact in the academy as it is the intellectual foundation of post modernist and critical theory.
The impulse to die being eliminated from the gene pool is a good thing ? Or rather the characteristics to fight for life at all costs is what one would want in the gene pool ?
If what you assume is true, at some point people will want to die less and the problem will self correct .
Death is important tool in evolution delaying it is not argument for it .
Not many, probably, but the option should be available to those who need it.
> Nihilism was quite popular in the 19th century and led us to two world wars already
I'm sorry, but this is rubbish. Firstly, I'm not nihilistic, but practical. Not everyone who wants to die is suffering; sometimes they just want out of a pointless and meandering life. They don't want to put in the effort to up themselves, and frankly, why should they? What right do other people have to impose their views on someone who's feeling like this?
Sometimes one is suffering, but can't be bothered to, or might suffer more while trying to convince the state and a medical team that they deserve to die. It's 2024, and we have increasing acceptance of the gender spectrum, of the autism spectrum, of recreational narcotics, and more. Why is dying so marginalised? Like I said, this is a Christocentric view. A modern society must allow its citizens to die quietly, peacefully, and cleanly, whenever they choose.
Next, what led to the two world wars was not 'nihilism', a very loaded single word, but rather a bunch of overly-complex defence pacts, treaties, and arms races in 1900s Europe that eventually collapsed into a bloody shit show. The second world war happened because of a feeling of revenge, anti-semitism, and Slavophobia on the part of the Germans, and imperialism on the part of all the Axis powers. Nothing more, nothing less. Depending on who you ask WW2 began as early as 1910 with the invasion and occupation of Korea by Japan.
> your opinion will be eliminated from the gene pool
Wanting to die is not (only) passed down in someone's genes. It is highly environmental and depends on what people do, who they talk to, and where and how they live.
It is. Just flick the blade open on a switchblade and stab into your temple. You don't need a fricking second or third party to help you with this.
Some of us atheists view life as more precious than many religious people do because this is it.
> fricking
Do you really have to be so violent in response?
There exist supervised injection sites for narcotics. You bring the drugs, the healthcare workers give you clean syringes/needles/paraphernalia and help you with the injection. As a society we have decided that it is OK for people to potentially wreck their own lives with narcotics.
Why not a similar concept for dying, where the end is only eternal oblivion? Step into a room, step inside a pod, press a button, pod closes, press another button to replace the air with nitrogen, done.
> life as more precious
I'm sorry, but 'life is precious' is a religious view, even if you call yourself 'atheist'. Life is just life, it is an emergent property of chemical and physical processes and laws. It is interesting, to be sure, but precious? Sorry, no. Humans have killed each other since they evolved from Australopithecus, and have only found more efficient, violent, and deadly ways to do so in the intervening five million years.
None of us have a pathological desire to live at all costs, but as it turns out, figuring out when to say “yeah I’m done, see yah” and halt treatment is way more complex than it first seems, especially when making the decision for someone else. Things can happen very fast, and there’s a bunch of things that basically require a job in the industry to know ahead of time.
If anyone knows of some comprehensive resources for helping define reasonable limits, I’d love to hear it.
https://www.orderofthegooddeath.com/
They also do a lot of advocacy around green burial, alkaline hydrolysis, and whatnot as well.
Caitlin Doughty (who founded the Order of the Good Death) Ask a Mortician channel on youtube covers this stuff too, but the older videos might be out of date.
I also discovered that my home state has ZERO listed green burial sites, which is shocking to me because... I live in VT. I would have guessed it would be the leader in green burial, it is right up our wheelhouse!
This gets additionally terrible when it's for someone else whilst handling the wishes of everyone else with significant ties to them.
Had a relative die a while back who was going through absolute hell the final few days; some family members still have a massive grudge towards the hospice for what they feel like were moves done to ensure they died quicker. I've absolutely no clue why they seemed to think dying in massive pain over a longer span of time seemed better but they did.
No. The cancer was everywhere and it was aggressive. Try what harder? There was nothing to do. Someone close to them felt my mother was being evil and incompetent in not pushing him to eat more. While he lost a lot of weight the cause of death was when it got his kidney (one had already been removed when it was thought to be stage 1.)
https://www.uclahealth.org/patient-resources/support-informa...
My entire family has been suffering over the past 18 months watching my 88-year-old grandmother slowly pass away from age-related deterioration and AD.
I worked with mice during my PhD training in the US. If a lab was caught with lab mice suffering like my grandmother is without euthanizing them, the lab would be liable to be shut down.
So I ask: why am I forced to sit and watch my grandmother suffer slowly to death? Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering?
> Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering?
Even most religious people believe in mercy killing. The issue is the slippery slope, and the fact that various people have slid down this slope in every country with legal assisted suicide or euthanasia. Whenever you are going to have a third party, or even just a second party, involve itself in someone's death, you have to figure out how to deal with issues every bit as serious as letting someone suffer to death.
https://www.pewresearch.org/short-reads/2015/10/05/californi...