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..
Granted death penalty opponents are biased, but it's often said that barbituate overdose is a very unpleasant way to die. I've also heard opiod overdose is unpleasant.
I was once helping take down a 10-foot weather balloon full of helium, and took in two breaths in a row of pure helium. I started to get tunnel vision, said "whoah", sat down when I realized I was about to lose consciousness, fell down, and twitched just long enough for my friend to realize I wasn't joking around before I woke up. From my experience, hypoxia from pure helium is slightly pleasant all the way to loss of consciousness. I presume pure nitrogen would be nearly the same.
Let my last words be something witty in a high-pitched helium voice.
(Side note: pure nitrogen hypoxia would not be a particularly humane form of execution because the condemned would likely fight it by holding on to their last breath.)
Yup, AFIAK hypoxia is the best way to go. Survivors who are rescued in time (or, like you, self-rescue) don't have a bad experience. The MAiD protocol used in Canada likewise appears to not be a bad experience as the only thing the patient experiences is anesthesia.
I'm also coming to the conclusion that inert gas hypoxia is going to be my way out. My end has to be, as far as I can make it, painless and polite, meaning a happy exit with minimal inconveniencing of as few as possible other people. Any suitable substance for this seems to be taken off the market, even basic stuff like metal nitrites (as used in curing meat. Try getting hold of a nontrivial amount of this in the UK). I don't have the inclination to follow up Project Peanut; I don't have the background for this.
I fully understand why this has been done, to stop people who only intermittently get the urge, but for someone like me it's a major bloody inconvenience, so inert gas it most likely is.
(The above is not an opener for a discussion, it's an FYI for a different perspective. Please don't respond).
I had general anaesthesia for a surgery, and I can remember the falling asleep was only very slightly uncomfortable. so I think it can be done - once I'm under, just cut out something important and throw everything in the furnace.
It's probably ironic that it's never been easier to buy that drug (and others) and decide your own fate compared with trying for a dignified and hopefully pain-free death the "legal" way.
I suspect it's the only Europe-UK supply chain that hasn't been affected by Brexit :) Maybe the Tories need to persuade a few drug dealers to go straight and fix the whole supply chain problem.
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.
All the US death with dignity laws are lethal prescriptions only, the patient must self-administer. Turning off a pacemaker would be the doctor doing it, not the patient.
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.
Is it? As an atheist I welcome the nothing; no more worrying about filling out taxes and such. Being religious you really should be jumping for joy (although you cannot kill yourself probably), but how is death scary if you believe in something after?
It’s not the death that is scary, it’s the Judgement Day that’ll come after. Because you don’t know whether you did enough good stuff to go straight to heaven, or first have to suffer in hell to account for your sins. Not all of us believe in a religion that says you are already forgiven and you’ll go to heaven, because God sent himself down to Earth to become His own son to sacrifice Himself to Himself to convince Himself to forgive you.
I was raised with a particularly idiotic strain where you cannot repent or be forgiven; one mistake (however tiny) will be hell and that’s it. It is what made me an atheist at a young age (I think I was not even 10 when I decided it’s a bag of bull): it particularly exposes how weird religion is.
as an atheist who has been suicidal from around age 12, I'm not afraid of being dead, but actually causing my own death has been very difficult - it's not so much a logical fear as a mental block, it's like you're moving through very thick syrup trying to get the thing done, you're fighting a mental force that's holding you back, and eventually all the commitment and energy that you had invested in getting it done just seems to have dissipated and you just feel empty. I'm my case at least, the survival instinct has won every battle. unless of course we have quantum immortality, it would explain why I keep failing.
That has nothing to do with it. Society in general is just uncomfortable with the idea of euthanasia and politicians don’t want to be labeled as promoting “suicide”
It’s just not a great hill to die on since most people that actually care strongly about the issue are the ones bed ridden in the hospital.
There’s an interesting case right now in Vancouver against the largest hospital downtown which is affiliated with Catholics (I think, St Paul’s is the facility in any case).
Several in-patients that opted for medical assistance in dying were refused that treatment by administrators of the hospital on religious grounds, and their families are sueing based on the additional suffering inflicted by having to transfer to other facilities.
If your job duties might go against your religious beliefs, you are responsible for finding other work. Not doing so should be grounds for termination.
In general in the US only White Evangelical Protestants and Black Protestants have less than a majority who believe assisted suicide / euthanasia should be available for "great pain and no hope of improvement", and those two groups still have over 40% who believe it should be available.
> who are burdened not “accidentally” holding that button
That’s almost always a financial incentive though; if you remove that you can see who really cares. I have an open will for my friends and family; everything goes to charity with the taxes and tangible assets worked out so they don’t have issues; they get a net amount of a few million. Everyone else knows they don’t get 1 cent; helps with the accidental button holding.
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.
you’re going to have a painful death with or without the tubes
But I feel that was the main point at the start of the thread: if death is certain and going to be painful, why must we drag it out? Why is that additional lifespan (measured in days) so much more important than comfort?
There's a good article[1] on this topic that talks about how older doctors generally choose to forego lifesaving measures. I think about it a lot because it seems like when a professional who's in the best position to know the tradeoffs makes this kind of decision for themselves they probably understand the risk/reward better than you or me.
Plenty of people who make the sausage don't want to eat it.
I never wanted to go into medicine. Thus I do not believe the preferences of a typical older doctor represent my preferences in this respect.
I read an article once of a nurse who kept CPR going on her husband for somewhere around 2 hours until they could get him to a hospital that was able to restart his heart. I believe he ended up okay. CPR obviously isn't invasive tubing, but it's still kind of hard on the body.
I think that's the article that made me change my opinion on CPR. When the hospital asks me to sign the form indicating if I want to be resuscitated, I answer no without hesitation. It's harder when my vet asks before operating on my dog, but in the end I made the same call for my dog that I would make for myself - do not resuscitate.
> Yet families are often asked to make the call within 72 hours of someone sustaining a severe brain injury. Unless patients make a rapid recovery in the first few days, it's thought they are unlikely to survive or recover much at all.
> The data Sanders and colleagues analyzed tentatively suggest otherwise.
> The data revealed that 31 of the 56 brain trauma patients who stayed on life support died within six months; and 45 percent survived. Of the 25 patients who survived, more than 30 percent recovered enough in that same six-month period to have at least some independence in daily activities.
> Just four patients recovered 'fully' to how they functioned before their injury.
"some" is doing a lot of work in this sentence. Recovering enough to have "at least some" independence after several months is not a great outcome. That very likely means lifelong daily care is required.
I know. That objection was brought up in the first article I read on this issue. Still, depending on the care required, it's pretty bad to imply that someone is better off dead.
And 7% of the study subjects recovered completely.
The idea of living long term, near death, while medical expenses slowly eat away the savings I would prefer to leave to my loved ones makes me very unhappy.
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.
> but implementing assisted death needs careful consideration
Yes.
> and defeating politically the small subset of people that think life with extreme suffering is precious.
You don't need to defeat us. All you need is a clear-cut agreement between the patient and the doctor, preferably in advance for those who are physically unable to decide at the end, similar to a DNI. Between the patient and the doctor, and possibly the patient's family, it's no one else's business (though I still think second-party euthanasia of non-terminal persons is disgusting, and that they should commit suicide without involving a second party). It's when government or other third parties start getting involved that everyone should have an issue with euthanasia.
> All you need is a clear-cut agreement between the patient and the doctor,
Then you are not part of the group of persons I was pointing out. Is was thinking of people against it regardless of the conditions. Some form of consent is needed for euthanasia. How strong this consent should be (written agreement before? Or must explicitly tell the doctor right before the injection?) needs to be decided after thinking carefully about how to keep the law being useful while avoiding abuses. But right now euthanasia is fully illegal; the best one can get is starving to death.
I actually am probably one of the one's you are pointing out. In that I don't want a government sanctioned process for this (it leads to a slippery slope in the countries it has been enacted in[1]). At best I'm basically in favor of decriminalization, not legalization, and not a standardized process that can be altered over time.
"By establishing a social policy that keeps physician-assisted suicide and euthanasia illegal but recognizes exceptions, we would adopt the correct moral view: the onus of proving that everything had been tried and that the motivation and rationale were convincing would rest on those who wanted to end a life.
Also this case in Canada of a woman with MCS who couldn't get better housing away from the chemicals. It was easier to give her medical assistance in dying than to get her to a house or apartment free from other people's smoke and cleaning chemicals: https://www.ctvnews.ca/health/woman-with-chemical-sensitivit...
She's not the only Canadian case of it being easier to grant MAID than to get functioning health and welfare services. One person was granted it because he was about to become homeless.
If you reread my comment more closely you'll see that I'm not. I list a couple of options, only one of which is suicide. I'm willing to tolerate various things that I consider repugnant, even though there is a limit.
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.
This is from personal experience, but there is a difference between letting someone take 2 weeks to starve or die of dehydration, and big-letters "euthanasia". Sometimes the people who work in palliative care are nuanced enough to ease you out when your final days come. Where I live, euthanasia is not legal. But when my sister was dying from cancer she directly told her palliative meds guy "I watched my uncle gasp for two weeks. I'm not going like that. You hear me?"
When it came to it, she didn't. It still wasn't petty because death-by-cancer never is. She was extremely weak and thin and tired. But on her last day she spoke to everyone in the family, gave weak hugs, said goodbyes. I guarantee you that guy took away days (at least) of suffering. We all knew that. He knew that. She knew that. Nobody said it though.
And I think that's better than someone who can't afford to deal with a disability being asked if they're prefer to die than cost the state lots of money. Horror stories both sides of the nuance.
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?
No, truly, doctors are not legally required to keep people alive against their will. It’s just that you have to have made it clear in advance what kind of life-saving and comfort measures you want. You have to say “yeah actually I don’t want all that.” It’s hard on the doctors to watch people dying painfully with too much life support, too. They know what kind of death they want, and it’s not that. (As the article reflects.)
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".
It's not personal-- the docs are there to cure disease and just doing what they know, personhood be darned.
Also, in the moment, it's entirely possible that somebody who is otherwise completely rational who just had a life-altering experience is temporarily less than completely rational and you're only hearing that one side of the story.
That's the problem. It's not personal, and humanity is not even a factor in that hospital's assessment.
Why does society refuse to allow people to have mental and physical autonomy in matters like this? Sure, they pay lip service to it, but when it comes down to the hard moments, we almost always end up erring on the wrong side.
Yep. They just see a life to save, and will do everything they can to achieve it. It get's worse with a rare disease, as they want to be in the paper about it.
> 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 did MMA at 40. Problem is your reflexes just can't keep up with an 18 year old. My knee got blasted by a faint intended to just make me move back because I just couldn't move out of the way as fast as the kid's kick.
Whatever you do my advice is if it's high impact join the 'old man's league'. They better understand everyone's limits.
Don't do it. My sister took up hockey when she was 16 and lost 4 front teeth within 3 months. She's 45 now and just had the second set of replacements...
Of all the hockey injuries, this one rates pretty low for adult beer league if you just wear a cage. Wearing a full face cage reduces the risk of losing teeth to almost 0% chance of happening.
Hockey does have risks of course, but playing in a non checking league takes the risk down to manageable levels in my opinion.
My teeth are already sufficiently bad that I'll likely need implants in the future anyway; I don't want to lose them, but it wouldn't impact my life as negatively as, say, a permanent back or knee injury would.
I recommend it fully! I learned to play at 32 and I am having a blast. Still some risk, but my local league is very laid back and we run very safe games. Being kitted out in protective gear really does make a difference in preventing injuries.
Check and see if your local rink has an intro to hockey class and use that to get a feel for hockey.
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.
Nice! In my experience small issues can escalate if left unchecked because you start compensating and your body also "learns" to do things the wrong way.
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.
> 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.
So not people who were at the peak of their ability/potential in their 20s – most people, however, do not perform at their limits in their 20s, simply because that isn't their priority, they don't train for it, etc.
They're saying that you can be the best shape of your life beyond your prime potential years because almost nobody reaches their potential in their prime, which is trivially true, not that you can perform better at 37 than a theoretical maximum in your 20s that you never achieved.
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.
I started lifting weights at 37 after 10 years of being very sedentary, and within a few months people were mentioning that I had put on muscle. My impression was that sarcopenia doesn't start until the 60's and even then there are benefits to resistance training.
Reduced physical activity in old age will accelerate sarcopenia. If you're hospitalized, especially for long period of time, that will also accelerate muscle loss.
In my case it was regaining strength from taking weight-lifting semi-seriously in my 20's. It was actually amazing at how fast muscle can come back even after a decade. But I continued lifting and am stronger now at 38 than I ever have been in my life. What I am saying is that mid-30's is hardly when sarcopenia sets in. I'm sure it's individualized, but I don't seem to have a harder time gaining muscle now than I did back then; for me it's always been joint/tendon issues that have been limiting anyway.
> It gets extraordinarily difficult to add new muscle as you enter your mid-30s
Only because it requires you to create a major new habit after 30 years on earth of not doing it, not because it's difficult physically. If you are putting in the time and especially the effort, it should be easy.
That said, the common mistake in the gym is when people just kinda do reps at some easy weight and then stop short with a bunch more reps left in reserve. Never really pushing themself. I guarantee that describes anyone finding it extraordinary difficult to build muscle.
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.
Sorry if I'm being nosey, but I'm curious about the chronic back pain. Is it something that developed over time, is it gwneti, is it an injury? How do you cope and manage it?
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.
I don't quite understand this. Postponing my death won't solve the problem; it's inevitable. The real question is, whose time takes priority—others' or mine?
This is a good point. I guess the only counter argument is that, so far, in general, postponing elective death also leads to a bunch of solutions to other problems over the course of a life, even if the original problem is unsolvable.
People forget that the other problems are created by life itself. There is no way out by playing its game. You cannot escape the problem making machine by using it: it will only produce more problems.
But the truth is that I'm not convinced that death is the "the winning move is not playing it". You see death is life: in order to die you must be alive first.
That's why lately I'm thinking unconsciousness is the way out, but I'm not sure about that too.
The end of the universe is created by pre-life physics. I think it's unknown to humanity at this point whether a sufficiently advanced technology can deal with that.
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.
You are referring to an incident where a caseworker mentioned that MAID is an option to a permanently disabled veteran suffering from pain, and it was deemed out of scope for their job. The policy has now changed so that caseworkers are not allowed to even bring up MAID. No one was coerced into the option.
The outcome of the incident you are citing is that it is now less accessible for people to learn about the option.
Meanwhile there are cases across Canada where people have been blocked from getting MAID because of religious hospitals, outside objectors, and debates about what kind of permanent illness qualifies even if two doctors and the patient have all agreed.
The process is not fast, requires psychological assessment, and must be signed off by a doctor.
There is precisely no evidence that anyone has ever undergone MAID when they weren’t 100% consenting and having made there own decision.
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.
It’s also vastly ignorant of the causes of World War I which had fuck all to do with nihilism. A radical fighting for Bosnian independence assassinated a Hapsburg, and then entangling alliances escalated what might’ve been a localized conflict into a world war.
> 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.
booze has been around for thousands of years. it's not good for you but it's also not a new phenomenon driving suicide numbers up.
IMHO it's a combination of low wages, high cost of living, and scrolling/gaming/streaming/porn addiction. we don't know how to talk about it yet but it's fucking people up. human brains were not ready for what the internet has become
If anything I suspect booze reduces suicide numbers. For some people it's an escape that makes life tolerable.
I'm thinking of a book whose title eludes me at present. It's by a doctor, talking about their ER experience. One of their frequent fliers--and one time he talked a bit about why. He had been a sniper in Afghanistan (Afghani, fighting the Russians), he drank to keep from killing himself because of the horrors he had experienced.
People with alcohol use disorder are many times more likely to commit suicide. Alcohol makes depression worse in the long run, even if someone finds some temporary comfort from a bottle.
Booze - yes. Culture around booze… not exactly. Serious drinking was reserved for festivals and generally frowned upon. Nowadays… it’s much more common and much more abused. And modern alcohol is getting stronger and stronger, same with other drugs.
I’m curious - are you American? I’ve had some former coworkers (non-Americans) who used to work in San Francisco and it sounded like they encountered a culture of drinking at work that I’ve never seen in Germany or Austria. I remember one story about every Wednesday afternoon a booze cart would go through the office and people would get absolutely hammered on hard liquor (while still at work!)
I don’t know if this was specific to that (large, household name) company or if that’s emblematic but it sounded like a very bad idea (they had more stories of excessive drinking but that was the one I recall off the top of my head).
No. Lithuania. Here drinking culture reached bottom of the barrel during Soviet era. It’s getting somewhat better as the old generation heads for greener pastures. But it’s still pretty bad with full-on alcoholism being tolerated.
I envy some parts of German drinking culture. E.g. seemingly preferring light beer over heavy drinks. But having visited many music festivals in Germany… You guys got some issues too :D
> 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.
> Do you really have to be so violent in response?
I was trying to meet your request for an option that came as close as possible to just flicking a switch.
> Step into a room, step inside a pod, press a button, pod closes, press another button to replace the air with nitrogen, done.
I know of a friend of a friend who did this on his own. If you are of sufficient capacity to step into some place and press a button then you are able to buy or make this equipment on your own and do it yourself.
> I'm sorry, but 'life is precious' is a religious view, even if you call yourself 'atheist'.
And some religious people also believe that taking care of Earth's natural environment is also a religious duty. That doesn't make it a religious view, it makes it a general moral view that is shared between some religions and some atheists. The justification for a moral view is what makes it religious or secular.
> Humans have killed each other since they evolved from Australopithecus
And how many of these deaths have been because of religious beliefs? I think enough of them to say that killing people for moral reasons is a religious view, even if you call yourself 'atheist'.
No. The tank that can hold enough nitrogen (or helium or argon--same volume means the same pressure which means effectively the same weight) to do the job reliably is heavy. By the time your health is such that you would choose that path you likely can't lift it. I have seen my wife struggle with lifting that weight when it's in a form meant to be lifted. I've seen her fail when it wasn't as cooperative.
Too bad, I guess that leaves out the "use disproportionately large amounts of the agent to hotbox the room" method. But that doesn't invalidate the point of the parent comment.
The have a volume in cubic feet specified, multiply by the 165 bar that's what's typically used to see how much space it will fill. Looking around our house there's a very odd-shaped closet under the stairs that would be difficult to measure. Of the more typical places the smallest room in the house is a closet. 6' x 5' (minus a 1' x 1' chunk that I believe contains an air duct) x 8' = 232 cubic feet. Suppose you dump 232 cubic feet of material into it--you'll displace half the air which gives a time of useful consciousness of 20-30 minutes. Not good enough. Let's try doubling that, now we end up with a time of useful consciousness of 30-60 seconds. That's probably enough. That's 2 cylinders at 137 pounds each. Or if you use aluminum, 3 cylinders of 90 pounds each.
I think religion has done more harm to humanity as a whole than anything else, and none more so than the two most popular monotheistic, evangelical, 'convert or die' religions. Religion is a vehicle to power, and I dislike it.
There are of course some very positive side effects like beautiful architecture and music, and plenty of philosophical debate, but I wish it came without the baggage. But then again, I feel the two Abrahamic religions are philosophically scarce—can't have debate when everyone who disagrees with you is killed or converted.
It's three main ones (Judaism, Christianity, Islam) and a bunch of off-shoots such as Samaritanism, Mormonism, Baháʼí.
I'm opposed to religious philosophies in as much as non-real/provable beliefs, and feelings based on these non-provable beliefs, are used as justification for the philosophy or moral stance.
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!
They've got template letters for sending to politicians on the topics of greener death options and other related stuff. Maybe you can help your politicians know that it's an option that people want.
I want to be composted, personally. I hate those 'put your cremains in a seedling pot and turn into a tree' things because cremains can't nourish anything. Skip the cremation, have a green burial or be composted, and ACTUALLY nourish a tree! I'd have thought green burials and human composting would be an easier sell because of the popularity of those cremains tree things, but apparently not.
Soapbox time: you (almost certainly) do not have to have your loved one embalmed. Bodies are safe and clean and won't smell if kept appropriately. If you are utilising the services of a funeral home and they tell you they won't (or can't) let you have an open casket or other viewing without the person being embalmed, it will be a policy of the funeral home at highest authority. It almost certainly is not the law, as much as some of these homes may try to convince you it is. If it is the law, make them explain which law it is and check. Bodies do not have to be embalmed for viewings. You can take your loved to another funeral home who doesn't pull that rubbish and they will have to release the body. Death is not an emergency and you can take a little time to know your rights and the law before being strong armed into an expensive and unnecessary procedure like embalming. Do it if you want to do it. Don't do it because you've been pressured into it in a time of grief.
"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.
I think sometimes these articles don't pose the question all that well. The way I would ask it is:
Imagine a pain scale of 1-10; pretend 10 is so high that you die from the pain.
Is it worth living at a 7-8 at every moment continuously, to extend your life for 2 months? How about living at a 9 for just 2 more weeks?
If you say "no" that just means you're not hooked up to a machine where that's your living experience (not like someone is actively killing you).
I think, when you put it that way, it becomes easier to set some rules around it. Btw I'm pretty close to someone who would always choose to live longer, but even I would say no to, for example, living at a 10 of pain for just 1 more week of life.
This is overly simplistic. There is little to debate about your example of living at a 7/8 for 2 months. What is more realistic is some hypothetical situation where the average patient has an expected survival of 6 to 18 months, with the hope that the 7/8 pain can be reduced to a 4/5, and with acknowledgement that some days may be a score of 5, some days may be a score of 9. Then what?
As a provider on the other side of it you witness two similar patients take two different paths. Perhaps the first patient lives 36 months with pain score averaging a 3. The family will often appreciate the intervention and effort. The other patient experiences a string of complications and dies after 2 weeks, living at a pain score of 10. Their family paints you as an evil torturer who should have never been listened to.
In fact you can see both types of opinions in this very thread.
Thank you for taking the time to explain this, a really valuable contribution to this thread. When I consider this going forward, I'll think of it this way.
While I agree he's being too simplistic I think you're not getting it, either. You're making the standard error of the medical world of focusing too much on stuffing pigeons into pigeonholes because once you have found the supposedly correct (look at the patients who go to doctor after doctor after doctor until someone finally finds the rare issue that's the correct diagnosis--and realize that there are those who never get answers) pigeonhole you see the pigeonhole rather than the patient.
You're looking into that pigeonhole and observing the result is anywhere from two weeks of horror to three years of not too bad. Just because you can't predict how any given case will turn out doesn't mean you can't look at the patients and see how things are turning out. And recognize that things are not static--your first patient doesn't exist. Things don't just sit there at three for three years and then kill you.
> You're making the standard error of the medical world of focusing too much on stuffing pigeons into pigeonholes because once you have found the supposedly correct (look at the patients who go to doctor after doctor after doctor until someone finally finds the rare issue that's the correct diagnosis--and realize that there are those who never get answers) pigeonhole you see the pigeonhole rather than the patien
This is another common misunderstanding of why people so commonly struggle to get a convincing diagnosis. The problem isn't a clueless doctor robotically listening for keywords. It's that the doctor has 10 minutes to dedicate to you and if it's not in the 80% of straightforward cases for them, the patient gets the bare minimum and then becomes someone else's problem. To solve that you need to fix provider shortages and (in the US) remove the corporate overlords constantly applying pressure on the little worker bees beneath them.
> out doesn't mean you can't look at the patients and see how things are turning out. And recognize that things are not static--your first patient doesn't exist. Things don't just sit there at three for three years and then kill you.
It's becoming clear to me you have a really odd sense of what doctors generally know and don't know. I don't really have an interest in exploring the left side of the Dunning kruger curve with respect to how medicine works.
Regular reminder to read Being Mortal: Medicine and What Matters in the End by Atul Gawande. It offers a detailed and sometimes shocking look into the end of life/palliative care system in the country and show just how broken the incentives are industry-wide.
This sounds appealing in the abstract but one thing to consider is the impact on other family members. My parents had a neighbor who chose to remain at home. However that meant his wife also had to stay at home to look after him (yes there were nurses who came in a couple of times a day, but a lot of the burden was still on the wife.) This meant her own life basically shut down. She never went out, and spent at least a year fully housebound for his care.
Once he died, she was able to go out, reconnect with friends, kickstart her life again. Couldn't help feeling the husband's choice here was a selfish one.
I think that's easy to say in the abstract, but the reality can be quite different. Of course every case is different, but for example:
* Spouse has dementia, does not recognize you, abuses you for being an intruder in the house, constantly shouts for help all times of day and night.
* Feeding, cleaning (double incontinence).
* Can't go out except for a few minutes when nurses are present.
The above goes on for months and even years with no end in sight. No chance to go out for exercise, hikes in nature, meeting friends. Isolation. At home carers have significantly reduced life expectancy for good reason.
Having hospice care where they can be well looked after is not a bad option, and is not a sign of weakness or failure for a partner.
ICUs are amazing technology. You can keep almost anyone in a temporary state of stasis. This is great for people who have a condition that just needs more time to heal (like a lot of people with Covid, or people after car accidents). But for people who have something unrecoverable, it’s a very weird place to be. You’ve been pushed off the ledge and are now frozen in midair. You will hit the ground when the magic is removed, but you also can’t stay frozen forever.
if you opt to stay home to die but youre in terrible pain, who's going to administer the pain meds? whos going to be there 24/7 to clean up or get you whatever you need? what this article is talking about is either very very very expensive home care or a family that basically become full time carers. with our society no longer advocating communal living and a sort of "every man for themselves" attitude throughout life, how is all of this actually supposed to work in reality? -- nice sentiment but unrealistic except for a very lucky few it seems. this is what hospitals are for now.
In California, "hospice care" consists only of drug and supply deliveries plus occasional checkins from a nurse. The rest of the 23/7 care falls to the family.
Someone in the medical profession explained to me what 'do everything you can' means to doctors and surgeons, it's a binding command. My instructions are likely going to be 'do two things that you probably should at this point and then go have lunch'
...and it's getting harder on the families too with nothing to really address it. It used to be one day you'd drop dead, or get really sick and be dead not long after, and your family after a terrible shock could begin readjusting to the new reality without their loved one. Now you can have what used to be a death sentence and continue living for years or even decades. But the systems which support the patient's life are not supporting their families, who have to live with the stress and financial burden of keeping their loved one alive, and the prolonged grieving process which can now take up a huge chunk of their lives and still doesn't really prepare them for death anyway.
I'm not saying that we need to get rid of medical advances that prolong life, it's just that these things have created new problems that we aren't dealing with and that not many people are really talking about.
The problem is it's not black and white what the long term outcome will be. A cancer diagnosis that was terminal 20 years ago could mean in 20 years you'll die of a heart attack with a short period of horrible treatment.
It gets even more dicey when you start talking about things like "well, the 20% chance is you'll survive this. The 80% chance is you'll die". Almost everyone is going to want to roll the 1/5 chance of living rather than taking the "you do nothing and you die" path, even if the 1/5 path is horribly terrible.
It means also that "Do not go gentle into that good night" is not realistic most of the time. We have a saying in Arabic that I only understood after my father died, it to the effect that something is so difficult that:'' it is harder than the spirit leaving the body'. I think it is time that hospice care evolve to make it easier.
how about suicide? i'd compare it to knowing when the party is over and then going home instead of getting yet another drink and miserably trying to score with the last remaining woman. it's an art and it can be trained at many occasions. now for the act itself - the regular hn crowd should be technically apt enough to assemble the required gear around a big gas cylinder of nitrogen. that's as peaceful as it gets.
in this modern day of increased privatized medicine, health insurances and self-absorbed people, what is the incentive to let a person die?
the longer you keep someone with medical needs and decent insurance the more you can milk the their insurance or whatever wealth they may have accumulated.
self-absorbed closed ones can also easily dismiss the sick person desires and needs.
Humans have long handled death in a very backwards and disgusting manner.
We have humans, who can clearly assert a particular desire when of sound, lucid mind. Yet we do not allow them to have any control over one of the most personal experiences their life will ever offer them, when in a medical establishment. We don't allow people to assert a desire to be euthanized gently. We force them to die on their own (by being unwilling to do anything more than remove care), no matter how much they may be suffering. Of course, we always have the option of taking matters into our own hands, with all the potential stumbling blocks that provides.
In contrast, we have pets, who can not verbally assert any particular desire, due to the lack of common language. We can't ask them if they want to stay with their loved ones, or if they're suffering and want to be free. Yet we make the decision to actively end their lives every single day in the world.
Logically, this seems completely backwards to me. It seems like we should err on the side of not ending a pet's life when they don't want us to, and that we should allow people of sound mind to articulate a self-aware desire to have a more dignified, gentle death as much as possible.
There is a great book called The Conspiracy Against the Human Race that talks about this in a way that makes sense to me:
As a survival-happy species, our successes are calculated in the number of years we have extended our lives, with the reduction of suffering being only incidental to this aim. To stay alive under almost any circumstances is a sickness with us. Nothing could be more unhealthy than to “watch one’s health” as a means of stalling death. The lengths we will go as procrastinators of that last gasp only demonstrate a morbid dread of that event. By contrast, our fear of suffering is deficient.
The book is very pessimistic but that’s the point, I quite enjoyed it.
This is a really good article, not least for the list of ways that you will be kept medically alive.
As for the premise of the article, it is definitely getting easier to die. We had the plumbers and the rubbish collecting workers clear up our communicable chronic diseases, we de-industrialised and cleared up the air, we quit smoking, put on our seat belts and reigned in the alcohol. So far so good.
But, if you look at the physiques of people, the levels of car dependency and the predominance of the Standard American Diet, it seems that people are going the way of Joe Biden in old age, to have what you might call a loss of cognitive abilities, yet able to be preserved near indefinitely. The President isn't unalive, but he isn't really there. Millions are in the same boat, functionally alive but only from the eye-sockets down, and probably with bits of their colon or bladder removed due to cancer that they have bravely fought with a diet of highly processed food and a sedentary lifestyle.
When it comes to how to live a healthy life, there is so much misinformation that we are all an experiment of n = 1. There is no realm of information that is anywhere near as confusing as diet. Really you are forced to join one tribe or another if longevity is your game. Either you are going to go all in on 'everything in moderation' or go fully ketogenic meat only carnivore, or the other way, full on vegan.
The Google confirmation bias is strong with the whole topic, and I am sure that I could look up 'can I get omega three fatty acid things from eating goat hair' and somewhere there will be an article or 'scientific paper' promoting the eating of goat hair, with a study from some goat herders living in Outer Mongolia, thousands of miles away from any fish, with excellent omega three things going on. There will also be an 'adsense' advert for where you can get goat hair online and Reddit threads on whether you need yak shavings instead.
>> But, if you look at the physiques of people, the levels of car dependency and the predominance of the Standard American Diet, it seems that people are going the way of Joe Biden in old age
If I can continue in my career at 80, let alone run one of the biggest countries in the world, I’ll be pretty happy. Car dependence, the SAD and obesity are going to bring back heart attacks in ones 60’s - not a generation of hard working octogenarians.
Biden was not all there with his 'Cornpop' speech of 2017. After that performance he should have made a dignified retirement. The people around him should have shuffled him off the stage too. There was too much going on in his 'Cornpop was a bad dude' rambling that it really should have been game over, there and then.
Notionally he has his finger on the nuclear button and he is a decade past his sell by date. You have to question the intellect of anyone, up to and including Obama, that do not see this.
My cousin has an elderly dog that has a habit of knocking expensive crockery off a coffee table with his tail, blissfully unaware and unable to see the problems caused. We love the dog and tell him that he is a good boy, but we don't let him drive the car or light the barbeque. We commend the dog for being able to lay a golden nugget in the park but nobody else in the family gets told they have done well for doing a number two.
For some reason people with Trump Derangement Syndrome seem to ignore reality with Biden, if he falls up the stairs then they make excuses for him, plus they know so much about him that they have no knowledge of the legendary 'Cornpop was a bad dude' speech, despite it being comedy gold.
I have no problem with people that have mental disabilities, but the territory known as the United States can do better than to have octogenarians that have brains clearly addled by the American lifestyle of unhealthy food and unhealthy modes of transport.
I am not a fan of Biden , but for an octogenarian to go on a stage and debate extemporaneously like that , as poor as his performance was, puts him in an above average category of health or capabilities. The average 80 year old does not exist (average life expectancy is 78) or much worse shape overall. We're not talking doing crossword puzzles, but stepping up on a stage before a national audience as President and debating. I think part of the perception of his bad performance can be explained by overinflated expectations. Trump's performance was not much better--not answering questions and defaulting to a few points that he attempted to shoehorn at every turn to speak-- but, yes, he looked and sounded better. Again, Trump is also an exception: it helped that his dad lived to 93; good genes are a thing.
The fundamentalist stance on Schiavo's case (to continue care at all costs) was always interesting/puzzling to me. On some level I would assume that people with a strong belief in the afterlife would be more open to letting people pass from this mortal earth than those of us who don't have strong beliefs about an afterlife... but clearly that wasn't the case :P
Growing up in the church, it eventually became pretty clear that nobody actually believed in heaven. Almost nobody’s actions were congruent with what you would do if you actually believed in heaven.
The stances on death, the reactions when people died… it all matched what you’d do if you believed death was the end and none of it matched what you’d do if you believed people went on to eternal paradise.
These are easily explained, and not evidence of your claim that Christians don't actually believe in heaven.
I assume that by "stances on death" you mean that Christians generally believe that it is immoral to allow people to die. That is because we believe that the life of humans has a fundamental moral worth, such that it is wrong to kill them no matter the circumstances. Many Christians would agree that the patient of some terminal illness would be better off dead, but that doesn't give us the right to do the deed. We aren't consequentialists, we are deontologists. If something (i.e. killing people) is wrong, then it is wrong no matter if it leads to a better outcome.
As far as "reactions when people died", it should be obvious but it sucks to lose your loved ones no matter what. Even if you felt completely certain that someone's soul was in heaven (and few would claim to be that certain, more on that in a bit), it's still very painful to have to be separated from them. It's comforting to believe that someone is (or will be) in heaven, but that comfort does not just erase the pain that you have to endure in the here and now. People aren't Vulcans, who can shrug things off through logical reasoning. They have feelings that are sometimes irrational but no less real because of it.
Furthermore, nobody can have complete certainty of the future. If I were to lose my job, I would be upset and worried because of how that might impact my family. By your logic, this would mean that I don't actually believe that I'll be able to find a new job. But no, it just means that I know that the future isn't certain. I believe I could find a new job if I lost my current job today. But I'm not certain, and that means I would be upset if I did lose my job. In a similar way, Christians believe in heaven but we can't be certain, so we still fear death sometimes. I mean, Jesus himself was afraid of his impending torture and death at the hands of the Romans! It's just part of being human.
Fundamentalists don't do things for others, they do them for themselves, to make themselves look better, or to be praised. They are superficial and fake. No one will miss them when they are gone.
I'd like to see a survey about opinions on keeping people alive using modern medicine. The survey would have a filter for people who believe in evolution and survival of the fittest. How is the cognitive dissonance around it resolved?
I think this:
> The survey would have a filter for people who believe in evolution and survival of the fittest.
Just means that the survey would ask that question. I'm guessing that GP wants to check whether those who believe in the Darwin awards as well as the moral justness of evolutionary pressure killing certain people earlier that other people, would be more opposed to using modern medicine to keep people alive.
Maybe? It really depends because modern medicine is part of social Darwinism, even though it is against evolutionary biological survival of the fittest. So I could see this going multiple ways among this subset of people. I'd expect the richest of them to believe both in medical extension of life (and fertility treatments) as well as believing that only those who can personally, or societally, afford such intervention should get it. This may be the dissonance GP is mentioning.
Tell me more about the dissonance you see. “Survival of the fittest” just means that in a challenging environment, those who can adapt will survive to go on and have children.
If you are saying that modern medicine keeps some people alive through to parenthood who would otherwise have perished: yes, that’s true. We have made our environment less challenging.
I'm not the GP, but a social Darwinist would presumably be in favor of medical extension of life (for those who can access it), while a moral evolutionist would presumably be against it. I think there is the possibility of a philosophical dissonance here in some of the Randian types.
I hope "noble sacrifice" becomes a viable end-of-life option one day. Specifically, one-way tickets to Mars, which will be invaluable for doing human-led research and construction, paving the way for future colonists, but without the expense and burden of a return journey.
There must be some ultra-high-risk test pilot jobs available for 75 year olds with inoperable diseases. Go out with a bang!
Or maybe people got softer. Do we remember the 90% of time where humans roamed this planet barefoot without painkillers, or healthcare, or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes, or anti polar bear sprays so they didn't tear you off and eat alive?. Those were hard deaths.
The 120% of the times, being alive is the smartest option, even if this carries a cost.
Someone in the tribe knew how to make a splint and what herbs or foods were best for what ailment.
: or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes
In general I expect that there would be few enough people, and they'd be sufficiently knowledgeable of the water sources among the areas they frequented, that this usually wouldn't be a problem.
> One group of students decided to put this method to the test. They hoisted their water-filled deer hide directly over a fire, and they planned to let it go as long as the hide stayed intact. The hair on the outside singed, but the skin itself held up just fine. So the students waited and waited and waited. Four hours later, the hide was still intact. It did get very hard, but neither sprung a leak nor burned.
: or anti polar bear sprays so they didn't tear you off and eat alive?.
I'm pretty sure that by the time some of us migrated to where polar bears live we had some pretty good spear technology.
> Or maybe people got softer. Do we remember the 90% of time where humans roamed this planet barefoot without painkillers, or healthcare, or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes, or anti polar bear sprays so they didn't tear you off and eat alive?. Those were hard deaths.
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.