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djoldman 5 hours ago

> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again.

> Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it.

It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.

delichon 5 hours ago | parent | next [-]

There is a huge unspoken blind spot for a terminal hospice patient. The medicine cabinet just opens up. My dad asked the doctor exactly how much of what he shouldn't take if he didn't want a quick easy death, and the doctor just told him. He didn't end up using it but it was a comfort to him.

Loughla 4 hours ago | parent [-]

The amount of morphine available to the patients on hospice that I have known has made it very clear what the actual intent of those scripts is.

Granted, my sample size of 6 isn't great, and 3 were in terrible pain so it made sense for them, but they had ALL the opiates. . . One had liquid injectable morphine in case he couldn't swallow. He had no issues with swallowing and wasn't in pain.

I wanted to ask the doctor if the intent was to allow a calm end, but chickened out.

gopher_space 4 hours ago | parent | next [-]

Amazing how frequently people die after they’re turned over right when the family is all together.

Amazing and appreciated.

DANmode 4 hours ago | parent | prev [-]

Open secret.

Cowardice of the system, society, that doesn’t allow practitioners to discuss this.

Leads to scary grey areas, actually.

lostlogin 2 hours ago | parent [-]

> Cowardice of the system, society, that doesn’t allow practitioners to discuss this.

This depends on where one lives. Where I am (New Zeland), the arguments getting it into law were pretty grim.

DANmode 2 hours ago | parent [-]

Serious stuff is serious!

Ignoring addressing it doesn’t make it go away - just forces it into the shadows.

lostlogin 2 hours ago | parent [-]

Exactly. Abortion being the example that immediately comes to mind.

ourmandave 5 hours ago | parent | prev | next [-]

This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer.

He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.

dj_gitmo 4 hours ago | parent [-]

I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity. I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.

awakeasleep 4 hours ago | parent | next [-]

To me, it doesn’t seem strange at all because I’m thinking about how complicated the system would have to be to carry out such a directive.

parpfish 2 hours ago | parent | prev [-]

shouldn't finding a way to kill yourself be pretty easy, even without legal DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun.

lostlogin 2 hours ago | parent | next [-]

> DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun.

Someone with sound mind is likely to worry about what’ll be left for loved ones to clean up.

And someone suffering dementia/Alzheimer’s may well forget the plan.

throwaway173738 2 hours ago | parent | prev [-]

None of these things guarantee death and if you fail they come with some awful complications. Overdosing on Morphine is probably the easiest, most humane way to die.

gerdesj 5 hours ago | parent | prev | next [-]

Does the US have the concept of DNR (Do Not Resuscitate)?

djoldman 5 hours ago | parent | next [-]

Yes.

If one lives in the US and feels strongly about it, they should file an Out-of-Hospital DNR and POLST with every local hospital. Also consider wearing or carrying official bracelets/necklaces (varies state to state).

I'm neither a lawyer nor a doctor. :)

netsharc 5 hours ago | parent | prev | next [-]

There was a "culture war" (the rightwing government intervening due to religious reasons) in the 2000's involving a "DNR"-esque case https://en.wikipedia.org/wiki/Terri_Schiavo_case

ButlerianJihad 2 hours ago | parent [-]

Let us not forget https://en.wikipedia.org/wiki/Karen_Ann_Quinlan

And also https://en.wikipedia.org/wiki/Jahi_McMath_case

But it is disingenuous to invoke "rightwing government", when a Franciscan friar was sneaking into the hospital trying to feed a starving woman [Terri], who was so hated by her husband that he would take extreme measures to get rid of her.

I have found it quite elusive to get a DNR properly executed. I could do all the other Advance Directives from home, and I could get them notarized without issue. But in my state, a DNR must be printed on a special hue of orange paper, and shit, if that isn't the most difficult step...

Also there are probably at least 12 facilities where it'd need to be filed, because who knows where the EMTs would haul me off to, around here. There are so many health care systems, not to mention the BH ones, which are quasi-medical.

glimshe 5 hours ago | parent | prev [-]

Yes

Simulacra 5 hours ago | parent | prev [-]

[flagged]

denkmoon 4 hours ago | parent | next [-]

These ideas seem to be at odds with one another. I'm reasonably sure you can't harvest organs from a resuscitated person in a vegetative state, coma, severely brain damaged, whatever.

wildzzz 2 hours ago | parent [-]

Do you mean technically or legally? Legally you need to be dead for the hospital to recover organs. But technically, the amount of time you need to be without oxygen to go into a persistive vegetative state is much less than the viability window of your organs. The time between death and viable organ recovery varies on the organ itself and how soon the body was chilled. Heart and lungs must be transplanted within 4-6 hours but other organs and tissue can last much longer. It also depends on how you die: starving to death several days after having your feeding tube removed may make your organs unviable but dying shortly after being removed from a ventilator could still produce viable organs.

Loughla 3 hours ago | parent | prev | next [-]

Your statement is confusing. Please explain.

DNR means let me die and do not intervene in that process. Which is what hospitals would want if they were secretly killing people to harvest organs, right?

wisty 2 hours ago | parent [-]

Both sides are wrong. Resusitation is more likely for a donar (if there is any bias).

OK, maybe a panel of neurologists looking at an ECG are going to be biased if you are stable but not reviving. But it's a panel of neurologists looking at an ECG. Mistakes are rare.

Before getting to the ICU, you've got the paramedics, triage nurse, and ED team, all of whom are also hypothetically going to be biased just as much to get you stabilised if you're a potential donar. Is the paramedic going to run a red light? Will the ED doctor work an hour past their shift when they can just read out the time and go home?

The info isn't on your license to tell the panel of neurologists. It's there so that the paramedics know to switch on the lights even if they think it might be a hopeless case.

Xorakios 4 hours ago | parent | prev | next [-]

Like many older people I know, my notarized DNR, provided by and on file with my insurance company, local hospital, primary doctor, and medical power of attorney, includes standard language permitting organ harvesting.

Loughla 3 hours ago | parent [-]

The step that a lot of people miss is letting their family know their wishes as well in very clear and strong language. Don't forget to do that.

4 hours ago | parent | prev | next [-]
[deleted]
croes 5 hours ago | parent | prev | next [-]

Aren’t that contradicting actions

Fomite 2 hours ago | parent | prev [-]

Like many conspiracy theories, yours seems to require holding two contradictory pieces of information as true.