Modern Medical Care Or High-Tech Torture?
Just because we can keep people technically alive...should we? Internist Craig Bowron writes for The Washington Post on "The Drawn-Out Indignities of The American Way of Death."
Take one of my patients. She started dialysis six months ago at the tender age of 85, and the diabetic vascular problems that put her kidneys in the tank persist. One leg has been amputated above the knee, and several toes on her remaining foot have succumbed to gangrene. Robbed of blood, they appear dry, black and tenuously connected, like an ash dangling off a cigarette.This patient was brought in for a decreased level of consciousness and low blood pressure, but she has been having periods of nausea, and her appetite seems to have died with her kidneys. The initial workup revealed little, perhaps a low-grade bladder infection, but treating it and her low blood pressure doesn't seem to make much of a difference. She is withdrawn; food goes into her mouth, but she won't chew and swallow unless her children instruct her to. She intermittently refuses pills. There's a language barrier, but her children are there to interpret for her. Translation: She feels exhausted and weak, and she feels that way most of the time.
This woman is suffering from what we call "the dwindles," characterized by advancing age and illness. Although dialysis is a miraculous technology -- she'd be dead without it -- it exacts a heavy toll from someone her age or with her medical problems. Three days a week are spent in dialysis, and the other four are spent recovering. It is extending her life, but she's miserable.
Her family has designated her "full code," meaning that if her heart stopped or she were to cease breathing, we would do CPR to revive her, even though there would be a very slim chance of success -- and even though it would be God's or the universe's way of giving her an easy way out.
...Among the patient-care team -- nurses, physicians, nursing assistants, physical and occupational therapists, etc. -- there is often a palpable sense of "What in the world are we doing to this patient?" That's "to" and not "for." We all stagger under the weight of feeling complicit in a patient's torture, but often it's the nurses who bear most of that burden, physically and emotionally. As a nurse on a dialysis floor told me, "They'll tell us things that they won't tell the family or their physician. They'll say, 'I don't want to have any more dialysis. I'm tired of it,' but they won't admit that to anyone else."
This sense of complicity is what makes taking care of these kinds of patients the toughest thing I do. A fellow physician told me, "I feel like I am participating in something immoral." Another asked, "Whatever happened to that 'do no harm' business?"
...At some point in life, the only thing worse than dying is being kept alive.
What should the alternatives be? What alternative do you want? And how do you plan to make it happen?
I opt for being put out of my misery. And honestly, I am not entirely sure that under the circumstances described, insurance companies should be obligated to pay for continued care.
My only reticence at allowing them not to cover it, is that it would set dangerous precedence. While I am loathe to use slippery slope arguments, I don't think it's an unreasonable jump in this situation. I must admit that I have mixed feelings here.
DuWayne at January 20, 2009 5:15 AM
I wouldn't want to stay alive under those conditions, and I sure as hell do not want someone else making those decisions for me. That's why I have had a living will (medical directive) and a medical power of attorney since my divorcing in my mid-30s.
Monica at January 20, 2009 5:32 AM
I think this entry got the problem by the wrong end. I find comfort that such a vast array of solutions exist for the extremely ill. I can only wonder what will be in store for me in fifty years. The real problem in the picture is, as Monica said, the lack of living will. In this case, the medical personnel is duty-bound to keep the lady alive at all cost. Asking to them to chose arbitrarily between those who should live and those better left dead is gruesome at best. This is not triage during world-war one,this is modern medicine.
Toubrouk at January 20, 2009 5:50 AM
I agree drs should not get to decide when you die. That's your choice, as an adult. I do support an adult's right to refuse treatment or even do euthanasia. I would not want to live in the situation, nor would I have any loved one do so. My husband and parents are all very aware of my wishes (not to live if I'm in pain and very unlikely to recover a worthwhile life, or brain dead) I also have a living will. It's irresponsible not to.
I also think that, much like the NICU drs who are very upfront with parents of super preemies that survival odds are slim, long term disabilities likely, and lots of pain is assured, that drs should make that clear to family members of the elderly. NICU drs also can refuse to attempt life support if they see no chance of survival. I think there needs to be some standard for the elderly as well. I sure don't think an 80 year old should be getting an organ transplant, for example. We do need to look at the likely level of return on investments. As a whole, the money is better spent on a baby than a really old person. The baby has a much better chance of being productive for society. The old person already has been, true, and should not be denied ANY care, but there need to be limits.
momof3 at January 20, 2009 6:20 AM
Anyone else find it ironic that people who beleive in an after life are the mose trying the hardest not to die?
lujlp at January 20, 2009 7:17 AM
Give me a nice bottle of Cabernet and a handful of Percosets, with Dark Side of the Moon playing in the background....
My grandfather had Alzheimer's for two years before he died, and it freaked my Mom out. She was always terrified of living without knowing who she was or why she was living in a home. Now she is there, with Alzheimer's. Her life is miserable because she is always afraid and angry, always agitated about the littlest things. Dignity went out the window a few months ago. And it only cost $6,500 a month!
My dad died of colon cancer after years of suffering and indignities.
The hell with it. Why save all your money to be comfortable when you are looney? Enjoy it today and go peacefully into that good night when you are ready.
Eric at January 20, 2009 7:38 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/01/20/modern_medical.html#comment-1621991">comment from EricTotally with you on that, Eric -- although I'll take the Sancerre, thanks.
Amy Alkon at January 20, 2009 7:49 AM
My kids have promised to purchase a small step stool for me when faced with similar circumstances. The stool will be used to help me get over the railing of the tallest bridge here in town. Initially it may not sound very spectacular, but I’m jumping naked. Problem solved.
Roger at January 20, 2009 7:50 AM
My girls have strict orders to take me out behind the dumpster and shoot me. o.O
Nah, all kidding aside, I, like Monica, specifically state in my living will under what circumstances I want my life terminated. No being kept alive by artificial means, etc. I'm watching my own father deteriorate, mentally and physically, and it's no picnic. The doctor said my mom is a saint for putting up with dad, while he's doing things (smoking and drinking alcohol) that he knows he shouldn't be. Next step is putting him in a nursing home, and I told mom I'll back her up 100%. She had dreams of traveling and enjoying their retirement. He just wants to die, because he can't do some things he used to do, because of various medications he's been on, and because, I think, he knows he's slipping into dementia. We don't know how long he'll be around, but until he's too infirm to stick a cigarette in his mouth or slug down a shot of booze, my mom has to deal with him. Sometimes he lucid and great to be around, but lately, not so much. And I'd feel badly for him if there was nothing he could do about his situation. But HE'S the only one who can stop smoking and drinking. He's got to want to. Right now, he doesn't. And he doesn't care how detrimental it is to him. He's also very depressed, and we know this, but he refuses to even consider the idea. I don't know how to help him.
Flynne at January 20, 2009 8:06 AM
What do you mean by that, Luj? Like atheists are lining up to die? SOme christians believe not to try to live is suicide, which damns them.
I don't think that refusing care, when it's futile, is suicide. And I think people ought to be allowed to kill themselves outright. What god does with them is his business.
momof3 at January 20, 2009 8:09 AM
Naked Jumping is a great fucking idea!!! I have other plans, or I would be all about stealing yours.
DuWayne at January 20, 2009 8:09 AM
Things is, we don't get to choose.
Crid [cridcridatgmail] at January 20, 2009 8:56 AM
Amy,
I work in a hospital and I see a lot of families of the elderly that choose to continue lifesaving procedures during a full code on the chronically ill. While I identify with the hardship of losing a loved one, parent, or grandparent, I feel that if these people are not of sound mind or are out of consciousness, they should be treated with dignity. End of life care is very difficult and the decisions that need to be made have to be made according to what the person would have wanted in life. I know for a fact that when my elderly grandmother approaches end of life, I will go let her be with her Lord. She would not want to hang on by a thread for weeks with a tube down her throat. MAKE YOUR WISHES KNOWN!!! This keeps your family from a lot of heartbreaking decisions and assures that the doctors will do what YOU want, not what your kids want.
Jessica at January 20, 2009 9:03 AM
Government healthcare is going to make your wishes moot.
MarkD at January 20, 2009 9:06 AM
I wouldn't want my body kept alive if my mind was gone, or if I was in constant pain with little or no hope of recovery. It's too bad some people either don't realize that their loved ones life is no longer worth living, or are too selfish to let them go.
William (wbhicks@hotmail.com) at January 20, 2009 9:54 AM
My parents- who are young- have made it very clear to Brother and I that they are NEVER to be kept on life support. They have a living will and advance directives and all that jazz, and I have a copy of everything.
I wonder about the patient mentioned in the story... Did she instruct her children to keep her alive as long as possible, even when her quality of life is so low? Did they ever have that discussion? Are they following her wishes, or their own? Are they just keeping her alive because they'll feel guilty if she's allowed to die?
ahw at January 20, 2009 10:11 AM
lujlp said "Anyone else find it ironic that people who beleive in an after life are the mose trying the hardest not to die? "
I think it's because they haven't spent much time thinking about it and getting used to the idea. I also think that while they may consciously believe in an afterlife, sub-consciously they don't, which leads to the anxiety. I think the majority of our thinking is sub-conscious, and it only passes on to our conscious mind what it thinks it can handle. Look into cognitive dissonance and rationalization.
William (wbhicks@hotmail.com) at January 20, 2009 10:29 AM
1) Doctors should not be making this decision. It is moral and human, not just medical.
2) When these situations fall upon most non-religious people in the West, most of them suddenly find that:
- they haven't spent much time thinking through the bigger questions of human existence and their own values - mostly they've coasted on layers of Oprah-media pseudo-spiritual pablum.
- they don't have a community for support or religious leaders for guidance.
Whatever happens to my parents, and then to me, we will have extensive family and community support (which makes stuff like hospice, palliative care, and home care viable options).
We will also have objective yet engaged Torah-based moral guidance on the end-of-life decisions - everything from active/passive withholding of therapy and food, to definition of end-of-life, to organ donation and burial - from Rabbis who are not just experts, but who know us and our family.
Ben-David at January 20, 2009 10:39 AM
See also.
Crid [cridcridatgmail] at January 20, 2009 10:41 AM
Think i have said this before on this site; firm plans are easy to make but emotions make them very hard to keep. Mom did not want to be machine maintained but when she asked me if she should be unplugged I could not force myself to say yes. Turned out she got out of ICU and got a few more months at home before dying (at home).
Jim at January 20, 2009 10:59 AM
Give me a nice bottle of Cabernet and a handful of Percosets, with Dark Side of the Moon playing in the background....
"Guns are always the best method for private suicide. Drugs are too chancy. You might miscalculate the dosage and just have a good time." - P. J. O'Rourke (Modern Manners)
Conan the Grammarian at January 20, 2009 12:24 PM
I've thought about that Conan, but I'm not a gun guy. Plus I don't want anyone to have to clean up my old carcass. Someday someone will be on the local news saying "yeah, we saw this old guy in a wheelchair with a boombox and a bottle of Jack Daniels rolling into Yosemite...
Eric at January 20, 2009 12:42 PM
Unless Congress does something, there will no federal estate taxes in year 2010.
So, if Bill Gates died in 2010, his estate will pay zero taxes instead of paying 30 billion dollars to the IRS.
The year 2010 is to die if you are terminally ill to save some money for your out of job children or kill your parents if you are greedy children.
The estate taxes come back in full force in 2011, so the greedy children have an incentive to pull the plug at 11:59 pm on 12/31/2010.
I pray to the Obama Christ do something to change this stupid tax law.
Chang at January 20, 2009 1:35 PM
I said my good-byes w/ my grandfather a long time before he actually died.
When he finally did pass one he had: failing kidneys, pneumonia, internal bleeding, emphysema and a staph infection - which is what actually killed him. He was in enormous pain. He was in the bed squirming and wincing and mumbling things to himself. Totally out of it. I was actually the one at the nursing home when they were considering getting an ambulance to take him to the hospital. I guess they couldn't make him comfortable enough. It wasn't a shock, either, he'd been in bad shape for a long time.
I held his hand a little and he talked crazy things. I didn't cry when he died though b/c I was so relieved he was done with the pain. It surprised me a little but the relief was just enough to make it ok. When he was dying my dad, the irrational/mentally unstable person that he is, starting flipping out for them to operate on him or something.
Like - give it up, guy. This isn't about you. This 87 year old man has everything wrong with him except cancer and drugs are just barely taking the edge off his pain. He's DNR. Like, keeping this poor, old prideful man alive so he can live off IV fluids while kept in drug haze isn't what grandpa woulda wanted. I know people deal with things differently but it just one more thing to make me lose respect for my dad.
I firmly believe that if grandpa could've gotten a glimpse at his future self, while he still had his faculties, he would have ended it himself. I think a lot of people would. You can't leave it up to their kids, esp. when they're like my father. The idea of losing the loved one outweighs the obvious, true love of relieving their suffering as they would have wanted.
Gretchen at January 20, 2009 1:35 PM
I pray to the Obama Christ do something to change this stupid tax law.
Eliminate the estate tax. It's double-taxation.
Shockingly, I'm in agreement with Oprah Winfrey: "I think it's irritating that once I die, 55% of my money goes to the United States government. ... You know why that's irritating? Because you would have already paid 50%.... When you leave a house or money to people then they're taxed 55%, so you got to leave them enough so that once they're taxed, they still have some money." - Oprah Winfrey
So, if Bill Gates died in 2010, his estate will pay zero taxes instead of paying 30 billion dollars to the IRS.
Bill Gates will pay only the taxes he wants to pay. Do you really think Bill Gates wouldn't have set up a trust so that his money goes to his wife and charity instead of the US government?
It's not rich people like Gates who suffer under the estate tax. It's the working class folks who want to leave what little bit they have left to their children - so the children can climb a little higher on the socio-economic ladder. But the children find themselves taxed back into their working class pigeonhole. Pity Mom and Dad didn't have enough spare cash sitting around to hire a lawyer and set up a trust.
Conan the Grammarian at January 20, 2009 2:05 PM
Things is, we don't get to choose.
Shy of an accident, I most certainly do. I have a pretty reasonable line on what my end is going to be like, given my genetics and what I've done to my body. I don't intend on spending years suffering from cancer, heart disease or debilitating arthritis. When I get to a certain point, I am going to call it quits on my terms, in the way that I want to. This will be discussed with my family and I will do everything I can to make it easier on them, but I am not going to spend a year or more in a fucking nursing home, tormented by every cough or simply trying to pee.
Don't get me wrong, I'm not planning on bowing out while I'm in moderately bad health, with moderate pain. But when pain management starts to require being doped into incoherence, I'm fucking out of here. With luck, I'll get myself a massive injection of LSD, along with a fatal dose of sodium morphate. I figure at that point, it won't hurt a damned thing to feed my addiction to acid, staying clean for which is a fucking whore and a half sometimes.
DuWayne at January 20, 2009 3:56 PM
DuWayne said "my addiction to acid".
How can you be addicted to acid? Seriously, every time I did it I enjoyed the hell out of it, but when I came down it was like, there no way I'm doing that again any time soon. I've also never heard of it being physically addicted.
William (wbhicks@hotmail.com) at January 20, 2009 4:39 PM
Here you go Eric
Time
(Mason, Waters, Wright, Gilmour) 7:06
Ticking away the moments that make up a dull day
You fritter and waste the hours in an offhand way.
Kicking around on a piece of ground in your home town
Waiting for someone or something to show you the way.
Tired of lying in the sunshine staying home to watch the rain.
You are young and life is long and there is time to kill today.
And then one day you find ten years have got behind you.
No one told you when to run, you missed the starting gun.
So you run and you run to catch up with the sun but it's sinking
Racing around to come up behind you again.
The sun is the same in a relative way but you're older,
Shorter of breath and one day closer to death.
Every year is getting shorter never seem to find the time.
Plans that either come to naught or half a page of scribbled lines
Hanging on in quiet desperation is the English way
The time is gone, the song is over,
Thought I'd something more to say.
Home, home again
I like to be here when I can
And when I come home cold and tired
Its good to warm my bones beside the fire
Far away across the field
The tolling of the iron bell
Calls the faithful to their knees
To hear the softly spoken magic spells.
lujlp at January 20, 2009 5:04 PM
> Don't get me wrong
Yes yes yes, you're a terribly willful young fellow. All the guys here are. Not like that shrinking violet, Eric's mother... (Or almost anyone else who ever lived or who you'll ever meet.)
You're in charge of your process, right? You're going to protect yourself from pain, right?
Sure, sure you are. Zappa had this one song lyric: "It can't hap-pen heeeeeeeere."
> Time
> (Mason, Waters, Wright, Gilmour)
> 7:06
Great Gig in the Sky was a better tune... Though much more challenging to transcribe, I'll grant you.
> it just one more thing to
> make me lose respect for
> my dad
Extended deaths, which are not atypical, do weird things to people. And you never know what's going on in other parts of your family. In many relationships, the balance of authority can be swiftly transposed, leaving someone theretofore disposed to subordination in command with no principles for guidance... (And that includes the kind of macho bluster that stains this message stack.)
1. It's tougher than it looks.
2. The outcome is shitty anyway.
3. The parties carrying the load aren't responsible: It can happen it to everyone and probably will.
and
4. That includes you.
I'm not asking for particulars, but you should at least consider cutting your Dad a break. Death of loved ones is almost psychedelically disorienting, and it's not his fault anyway.
It occurs to me now that the last discernible lyric in Great Gig is "I never said I was frightened of dying...."
Crid [cridcridatgmail] at January 20, 2009 6:15 PM
"Eliminate the estate tax. It's double-taxation."
It is not double taxation. When Bill Gates died, his estate will be created. His estate is totally separate legal entity from Bill Gates. It will have its own tax ID number and conduct affairs just like corporations.
Our tax system is designed to tax when property passes from one legal entity (Bill Gates) to another entity {Bill Gates Estate). For the life of me, I do not understand why people call this double taxation or even unfair.
If you children in their 40s or older need your full estate money to build American dreams, we, as a group, are totally screwed.
Chang at January 20, 2009 6:28 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/01/20/modern_medical.html#comment-1622138">comment from ChangIf you children in their 40s or older need your full estate money to build American dreams, we, as a group, are totally screwed
I work seven days a week and I'm going to need somebody's estate soon if newspapers that run me keep going out of business and we keep giving billionaires welfare.
Amy Alkon at January 20, 2009 6:37 PM
http://video.google.com/videoplay?docid=-5892764967477222715&ei=IIp2SaTlJ6L-qAP04tSpBA&q=pink+floyd+time&hl=en
lujlp at January 20, 2009 6:39 PM
William -
Please, never ever use the phrase physically addictive again. It is a pathologically meaningless phrase and completely inaccurate. Overt chemical dependency does not equal addiction. Addiction is the problem you still have, even after you have detoxed.
As for how one can be addicted to acid, it's all in what floats one's boat. I've used a whole hella lot of a lot of different drugs over the years and very few stuck. I have severe ADHD, which is in part, pathologically defined by dopamine deficiency, which is why people with ADHD tend to have substance abuse problems, especially if they aren't medicated for it - also why the meds are so effective.
The same mechanism that makes me inclined towards substance abuse, also makes me disinclined to overt dependency. I've used cocaine for long enough periods and with enough frequency for most people to become dependent. Never had that problem. As soon as the allure wore off - mainly when the friend I was doing it with started getting way too fond, I had no problem not touching again. Haven't since, in spite of numerous opportunities over the years. Unfortunately, it does nothing for my propensity for addiction though.
Bottom line, I really, really fucking love me that LSD. I love ingesting large quantities. I love incrementally increasing my dose over several days, so I can keep on tripping - went over a month once. And really, it's not just acid. I am overly fond of hallucinogens in general, including a host of highly toxic plants - partly why I had to quit altogether. Been eight years.
DuWayne at January 20, 2009 7:20 PM
Crid -
Jesus your a sanctimonious asshole. Seriously.
Not like that shrinking violet, Eric's mother... (Or almost anyone else who ever lived or who you'll ever meet.)
I'm not going to knock anyone who is afraid to die, afraid of what the end has to bring. People are who they are and a lot of them are terribly afraid of death, or worse, afraid of what death might bring.
But there are plenty of folks out there who really aren't afraid of death. Because of my own stupidity, I have nearly died on more than one occasion. A few times because of really stupid drug choices. Once when hopping a freight car. A couple of times while climbing.
I'm not afraid of death Crid, I'm afraid of pain and I'm afraid of slowly wasting away, wallowing in my own feces and urine. For what? By that point my contribution has been made. Is there something great about suffering? Is there something grand lesson for me to teach someone about perseverance? Is there something noble about making sure my family watches me suffer excruciating pain and dementia? Is some sick and twisted god going to send me to eternal damnation because I said "no thanks, I'll just get off now?"
I've watched loved ones whither and die. Terrified that if they try to end it, their "benevolent" god will send them to hell. After my uncle I befriended and decided to help care for several people with HIV and a few with AIDS. I've buried a couple of them now. I don't have HIV, but given what my biological paternal side ends with, I ain't looking at a much preferable ending. So I will be offing myself, on my terms, before I get that bad off. I live with enough pain now, I'm not going to end that way.
DuWayne at January 20, 2009 7:41 PM
I have a living will. Everyone who could possibly be in a situation to have that final say has a copy and knows my wishes. I do not want to be a vegetable. I don't want to be in pain, and most importantly, I don't want my family to suffer. Emotionally and financially.
My husband doesn't want to pull the plug on me; he's stated that he won't, so I've taken that power out of his hands and left it to a very good friend who will. He knows this and understands why. He just can't bring himself to think about it, much less do it.
Some of my peers think I've gone to extremes to make my wishes known and legally binding, but I have Lupus. I've seen too many people die very painfully from the complications of Lupus and I do NOT want to go out like that.
I do not want my family buried under medical bills either. I would like to leave something for my children and I don't want my husband to struggle financially after I'm gone.
As for the working class not being able to set up a trust- Bullshit. It's not hard and it isn't very expensive. I paid $100.00 to have a trust drawn up. You can also buy all the forms etc.. and do it yourself. Some banks offer the service for free too. If you want to set up a trust, do some research. It's easier than it looks and sounds.
Truth at January 20, 2009 7:46 PM
And everything else aside, I am really looking forward to my last acid trip....
DuWayne at January 20, 2009 7:50 PM
Hey! I got my four front teeth knocked out tonight!
Eric at January 20, 2009 8:30 PM
sorry- by an excited little boy's forehead while he was running around like a ghost with a throw over his head.
This innauguration sucks.
Eric at January 20, 2009 8:33 PM
Are you serious? Did that really happen to you?
Crid [cridcridatgmail] at January 20, 2009 9:05 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/01/20/modern_medical.html#comment-1622154">comment from EricEric, you're not serious, are you?
Amy Alkon at January 20, 2009 9:10 PM
Fucking ouch Eric, sorry to hear that. Beats the piss out of any damage my eldest has done to me.
DuWayne at January 20, 2009 9:24 PM
Serious- I look like a scarecrow from Kentucky. I may be off to Alaska where my niece will fix me up. See- I was too flippant...
PS- Oxycontin = goooooood.
Eric at January 20, 2009 9:37 PM
I prefer percoset, I can feel the blood flowing thru my skull. Does make it feel like the back of my head is missing though
lujlp at January 20, 2009 9:59 PM
> Jesus your a sanctimonious
> asshole.
Don't make it so easy for me!
> Im afraid of pain and I'm
> afraid of slowly wasting away
Yeah... So you'll be bold and courageous and forthright, and when the time comes, you'll....
...Yeah.
I like to quote Cosh: 'Hipsters think that Elvis invented fucking.' A couple decades later, those same personalities discover that death is unpleasant. (No one else happens to have noticed before!)
But Eric's mother was only a sick old lady when she was sick and old, and she probably spent a lot of her old time being not-sick. And before that, she was as young and vital as you are, and she and all her friends were just as appalled by what happens to old folks.
I have energy about this because people are naive and it pisses me off. I've seen a few seniors pass away now, and I'm annoyed about the stupidities that happen because people just don't want to think about it.
I think the Dark Side of the Force needs a better press agent. I want people to have a sensible anticipation of these events. I especially want their inevitability taken into account when people make babies, and not hidden in a fog of machismo and detachment. The end of life is almost never good for anyone.
We should say this out loud, and not be afraid to say it in front of children.
This is the best book I ever read that I could never give to anyone as a gift, especially if I loved them a lot. I don't like you very much, though: Highly recommended. If you hate books, see this at 39 minutes. (The audio is out of sync: Don't be afraid.)
Crid [cridcridatgmail] at January 20, 2009 10:00 PM
Eric, sincerest sympathies.
Now share your drugs, dammit
Crid [cridcridatgmail] at January 20, 2009 10:01 PM
Ouch! My sympathies Eric. It sounds painful as hell.
The more I read this blog, the more I feel like a complete jerk knowing that I have yet written a living will (or any will whatsoever). I need to deal with this asap.
Toubrouk at January 20, 2009 10:55 PM
I'm not going to knock anyone who is afraid to die, afraid of what the end has to bring. People are who they are and a lot of them are terribly afraid of death, or worse, afraid of what death might bring.
I'm not afraid of death.
I just don't want to be there when it happens.
Hey Skipper at January 20, 2009 11:32 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/01/20/modern_medical.html#comment-1622172">comment from EricEric...so sorry to hear that. Feel better.
Amy Alkon at January 21, 2009 12:19 AM
Crid -
You're a sanctimonious ass, because you like to assume that you're the only person that has anything thoughtful to say about anything. Everyone who disagrees with you is just kneejerk - flying off the cuff about everything.
I like to quote Cosh: 'Hipsters think that Elvis invented fucking.' A couple decades later, those same personalities discover that death is unpleasant. (No one else happens to have noticed before!)
Case in point - see above.
I have energy about this because people are naive and it pisses me off. I've seen a few seniors pass away now, and I'm annoyed about the stupidities that happen because people just don't want to think about it.
Me too. Which is why I have a living will. Which is why I've discussed my wishes with my parents, siblings, my partner and close friends, so that I not only know that they know what I want, but so that I know how they're likely to react in the event my end comes before theirs. And low, I've also taken their feelings into account in formulating my own wishes.
And I too have seen a few seniors pass, including my grandfather who went kicking, screaming and fucking terrified. I've been forced to consider my own feelings about my dad getting older and not having the same abilities he had in his sixties. I've had to accept that while he will likely be with us for quite a while to come, at seventy-four he is getting on towards the end. At the same time, in his declining years, my dad has been a profound contributor to my take on death and dying.
I especially want their inevitability taken into account when people make babies, and not hidden in a fog of machismo and detachment.
There is no machismo in my feelings about death and dying. To the contrary, I seek an easy out. It really takes very little courage to avoid pain and suffering. I'd like to think that if there was any good reason not to avoid that suffering, I would push myself through it. But there really isn't and I just won't do it.
If I do my job right, my kids will accept that. Just like I have accepted my own dad's wishes, which aren't all that dissimilar to my own. That's not to say it's easy to accept. I love my dad and have a strong appreciation for the input he provides me and my children. I would love nothing more than to have him around forever, but I accept that that is never going to happen - given the inevitability of his death, I want him to have the comfort and dignity he desires so very much and respect that he may well help himself along.
This is the best book I ever read that I could never give to anyone as a gift, especially if I loved them a lot.
There's a copy sitting on my reading list - dad got a copy for each of us. Handily, it's also on the book list for my forthcoming developmental psych class.
To be clear. I don't dislike you because we disagree. I dislike you because you like to pretend you're the only asshole out there who thinks about things and therefore are the only one who should say something about it.
DuWayne at January 21, 2009 5:30 AM
"I'm not asking for particulars, but you should at least consider cutting your Dad a break. "
Eh.
He went off the deep end and he beat me. And my mom. And my sister.
I get what you're saying. If he was an otherwise great guy/dad I probably wouldn't feel the disappointment. But right now, he can't do anything right in my book.
Probably too many particulars but I just don't want you to think I'm this hard bitch on everyone.
Gretchen at January 21, 2009 7:02 AM
> He went off the deep end
> and he beat me. And my mom.
> And my sister.
Ahah... Never mind, do watcha need to do.
> Everyone who disagrees with
> you is just kneejerk -
> flying off the cuff
Not everyone, you in particular.
Crid [cridcridatgmail] at January 21, 2009 7:49 AM
Thanks everyone for the best wishes- off to the dentist today.
Eric at January 21, 2009 8:41 AM
Damn! Haven't read through all the comments, but Eric's caught my eye, about dying of a bottle o' wine and a Percocet overdose when old age and poor health become intolerable-- what a GREAT way to go!!! I would TOTALLY vote for that approach being legalized!!! Seriously, WHY NOT make death as pleasant and even pleasurable for the terminally ill as possible? It makes no sense to let them suffer when they don't want to!
As it stands, I've got a living will and a DNR order, and my organ donor card all filled out.
Melissa G at January 21, 2009 8:49 AM
I've been fully conscious of my own mortality from the age of 40. In all probability, I'll live to be around 90 (good genes and good maintainance of my body), so since I'm 50 now, I've got another 40 years to go. I think every day, what do I want to experience, what do I want to achieve, how can I take care of my health, etc, etc.
Death is guaranteed for everyone, and if more people accepted this fact, they wouldn't fritter away their lives (I'm a big Pink Floyd fan!)
Chrissy at January 21, 2009 9:26 AM
Our tax system is designed to tax when property passes from one legal entity (Bill Gates) to another entity {Bill Gates Estate). For the life of me, I do not understand why people call this double taxation or even unfair.
Because taxes were already paid on that money (income taxes, capital gains taxes, etc.). Bill Gates' estate is a legal entity for the sole purpose of passing Bill Gates' legacy on to his heirs. It has no other purpose. It's legal chicanery.
And even if it is a transfer from one legal entity to another, why does the tax penalty have to be half? Why is the government entitled to half of the fruits of someone's lifetime? Keep in mind, most estates are not the size of Bill Gates'.
Wait...my trust is a legal entity. When I transferred most of my "wealth" to it, there were no taxes.
Conan the Grammarian at January 21, 2009 9:26 AM
Which I might buy Crid, if I didn't watch you do it with a whole lot of other folks who comment around these parts. Dismissed not because their wrong, but because they couldn't possibly have considered the issue.
But lets address your assumption that my comments are kneejerk responses. You'll notice that Amy writes about a lot of things I don't respond to, discussions of Islam in particular. It's not because I don't find those topics interesting, or even that I don't have an opinion. I don't respond because I wouldn't be able to provide a well thought response.
The only time I enter a conversation, is when I have an opinion that is based on due consideration and tempered by learning about it and discussing it with others. This topic in particular, is one that I have spent a great deal of time on over the years. Dismissing my attitude as kneejerk, is no different than if I were to dismiss anything you say because I think your a sanctimonious ass.
For someone who's prone to making accusations that others are being juvenile, you are quite prone to being quite childish yourself.
DuWayne at January 21, 2009 9:36 AM
"Bill Gates' estate is a legal entity for the sole purpose of passing Bill Gates' legacy on to his heirs. It has no other purpose. It's legal chicanery."
So as Microsoft. Should we give free tax break to Microsoft, too?
"Why is the government entitled to half of the fruits of someone's lifetime? "
All thanks to Democracy you love so much. The people shopping at Wal-Mart are not really concerned about your cry for justice.
"Wait...my trust is a legal entity. When I transferred most of my "wealth" to it, there were no taxes."
Because you are still alive, so it is still one entity under IRS code. The IRS is very patient. Once you are dead, they will send your trust a bill.
Chang at January 21, 2009 9:51 AM
So as [sic] Microsoft. Should we give free tax break to Microsoft, too?
Microsoft is a company selling products (and slowly taking over the world). It is not a legal entity for the sole purpose of passing on Bill Gates' legacy. It doesn't come into being only when Gates dies. It already is in being.
What's a non-free tax break? If you have to pay for it, is it really a tax break?
The people shopping at Wal-Mart are not really concerned about your cry for justice.
The people shopping at Wal-Mart are the ones most negatively affected by the estate tax. When they inherit Mom's bingo money, they'll lose half of it to the government. There go the new rims for the hooptie or the new gun rack for the truck.
Conan the Grammarian at January 21, 2009 9:59 AM
"Microsoft is a company selling products (and slowly taking over the world). It is not a legal entity for the sole purpose of passing on Bill Gates' legacy."
Then, do you think Bill started Microsoft to save the world by selling products? Or do you think he did that for himself or his family? I do not see much difference between his estate and Microsoft.
"The people shopping at Wal-Mart are the ones most negatively affected by the estate tax. When they inherit Mom's bingo money, they'll lose half of it to the government."
Wrong. Thanks to the Republicans, any estate less than 2 million in 2008 will pay zero tax to the IRS. Do you know any bingo pay out more than 2 million?
Chang at January 21, 2009 10:12 AM
Because you are still alive, so it is still one entity under IRS code. The IRS is very patient. Once you are dead, they will send your trust a bill.
Which is why I will sell off my assets to my neice and nephew for a dollar.
I will then max out tens of thousands of dollars in debt and the the IRS have all of it
lujlp at January 21, 2009 10:15 AM
FWIW, here is the core of my advance health care directive:
If I should have an incurable or irreversible condition that will cause my death within a relatively short time, my agents are aware that I desire:
• to withhold or withdraw procedures that merely prolong dying and are not necessary to my comfort or to alleviate pain.
• no nutrition or hydration unless I am able to consume them orally.
• sufficient analgesic to relieve pain, even if doing so will hasten my death.
My agents are aware that I view being diagnosed with permanent and severe brain damage without prospect of recovery no differently than having an incurable or irreversible condition that will cause my death within a relatively short time.
Until one of my health care agents is available, I desire that my attending physician treat me according to my wishes stated above.
In the event of my death, I donate all parts of my body for the purposes identified in AS 13.52.210 without restriction.
Notwithstanding the other provisions of this Individual Instruction, if I am in a hospital when a do not resuscitate order (DNRO) is to be implemented for me, I want the DNRO to take effect after my body parts can be evaluated for their donation suitability.
Hey Skipper at January 21, 2009 10:30 AM
That will change when the Democrats restore the estate tax, Chang.
I do not see much difference between his estate and Microsoft.
Look harder.
Bill can't buy a car or another ridiculously large house using Microsoft's money. He can buy those things using his own money (that's what will be his estate when he dies).
I can buy stock in Microsoft. I cannot buy stock in Bill Gates' personal holdings.
Microsoft is controlled by a Board of Directors. Bill Gates' estate is controlled by Bill Gates (and, after his death, his executor according to the terms of his will).
Steve Ballmer has a great deal to say in what Microsoft does and nothing at all to say in what Bill Gates' estate does.
When Bill Gates dies, his heirs will inherit his estate. They will not inherit Microsoft (except for any shares in Bill's estate).
Chang, this exchange is becoming high-tech torture. If you're the same Chang who has sucked me in before, this will never end. Obviously, you think the estate tax is a great idea. Obviously, I don't. We'll agree to differ.
Conan the Grammarian at January 21, 2009 10:32 AM
Crid - Duwayne is right, he's planning on taking the easy way out. If I'm given the choice, I will too. There are worse things than dying and the thought of being kept alive when I'm a drooling idiot or totally brain dead is appalling. The thought of living in horrible pain with no hope of relief that leaves your brain intact is also appalling. Both my parents have stated similar thoughts. I'm sure I wouldn't like giving the order to pull the plug, but I think I'll be able to if the situation comes up.
Duwayne, I respectfully disagree with this:
"Please, never ever use the phrase physically addictive again. It is a pathologically meaningless phrase and completely inaccurate.".
Very few people become addicted to drugs that they aren't, or haven't been, physically dependent on. The classic example is heroin addiction. It creates extreme physical dependency; so much so that people have died from withdrawal. But beyond the dependency, it is also psychologically addicting. There are very few examples of people who have successfully quit using it if it is available without replacing it with other drugs (alcohol, methadone). There have been people who have managed to stay off of it for a year or two, and then start using again.
William (wbhicks@hotmail.com) at January 21, 2009 11:11 AM
estate taxes. Yes they are set to come back. You still have to have been seriously rich to have your estate get burned by them. There has been much prattle about lost family farms but precious little evidence of an actual lost farm.
And to all above talking about their terminal plans, living wills, whatever; when your time is about up your kids are probably the ones who will have to say yes to carrying out the terms of your terminal plans. They will be in emotional overload and have added to that making the decision to actually pull your plug.
This is much easier to agree to when all is well as opposed to when your mother looks at you and writes on a board (too many tubes to talk) "should I die?"
Jim at January 21, 2009 11:34 AM
William -
I think you are misunderstanding me.
The phrase physically addicting is meaningless, because all addiction is physical at the core. While there are a great many mechanisms we really don't understand yet, because neuroscience is still in it's infancy, we do know some of the physiological mechanisms that are true of all addictions across the board. All addictions, whether it's addiction to heroin or an addiction to shopping, spike the production of the neurotransmitter dopamine.
In short, psychological addiction is just as physical as overt chemical dependency.
The flip side of that is that not all overt dependency must be addiction. While they are quite rare, there are people who for whatever reason use a substance long enough to become overtly dependent, who will not suffer addiction once they are detoxed from it. Which is why I believe that it's important to distinguish overt dependency from addiction.
And I think you are mistaken in the assessment that few people become addicted to drugs they have not become physically dependent on. While there are few who would begin to admit it, there are a lot of people with addictions to marijuana. While marijuana also has the propensity for overt dependence, the withdrawal from marijuana is so mild that it's essentially meaningless.
I have written about this quite extensively at my own blog and in comments at DrugMonkey's blog, an NIH funded addiction researcher. He discusses the false physical/psychological addiction dichotomy here. The posts on my blog are the third and forth down I believe. And for older discussions, just plug "addiction" into the search function at the header (I'd link them but then the comment would get eaten by Amy's spam filter - and there are a lot of discussions to list). (I was going to post a link to just DM's blog, but the spam filter ate it with just two links)
If you go to my blog, you will also find a slow growing list if links on the topic. I would suggest a good place to start is the harm reduction coalition. This is a topic that interests me enough, that I am going to school to become a neuropsychologist with the goal of getting into addiction research. Frankly, I think that our social and political addiction paradigm is fatally flawed and want to become part of the solution.
(and if you wander over, please feel free to join the discussion about eugenics too)
DuWayne at January 21, 2009 11:57 AM
Just an FYI to those out there interested:
Cost of replacing a broken dental bridge: $6,171.00+ "incidentals".
Eric at January 21, 2009 6:17 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/01/20/modern_medical.html#comment-1622354">comment from EricOh, Eric...my sympathies!
Amy Alkon at January 21, 2009 6:19 PM
DuWayne, yes, I had misunderstood you. But then stating 'physically addicted' isn't meaningless so much as redundant. If I'm understanding you correctly now ("psychological addiction is just as physical as overt chemical dependency"), you are implying that it is all physical addiction. Then you state "you are mistaken in the assessment that few people become addicted to drugs they have not become physically dependent on". That seems contradictory to me. Maybe a lot of people are addicted to pot, but I have my doubts. I wasn't aware that pot cause ANY dependencies. I did it every day for a couple a years and the only change over time was that it started to just make me sleepy (which is why I quit). Does your link provide any data on it?
Eric - ouch!
William (wbhicks@hotmail.com) at January 21, 2009 8:33 PM
William -
I am really sorry that I'm not explaining myself very well. Unfortunately, I made a retard move that I had to fix today and am just a bit frazzled. I will be happy to explain it better and provide links to data on the weed, but it will have to wait until after school tomorrow, probably won't get to it until Friday. I will put it up as a post at my blog - it's relevant to another discussion I've been involved in.
DuWayne at January 21, 2009 9:10 PM
> he's planning on taking the
> easy way out. If I'm given the
> choice, I will too
You won't be given the choice. Almost nobody is.
And to the degree that we do have that choice, almost nobody exercises it. (Or select your own favorite graph, then find your own place on it.)
(more)
Crid [cridcridatgmail] at January 21, 2009 11:34 PM
About five years ago there was this super-popular novel called The Corrections. Every member of a grown family gets a piece of the satiric narrative, each showing pathos and weakness in turn. The father's story is the one I recall as most poignant: He tumbles into pitiful neurological illness, despite promises to himself to hit the exit at just the right moment.
If this was just the fantasy of a single author, that would be great... But LOTS of people have this illusion about how they'll protect themselves through suicide. People have always had this fantasy.
But doing that is not in our nature. And there's substantial evidence that it doesn't belong in our nature... Human beings are supposed to struggle. Two of the most charming figures from public life in my adulthood are named Michael. They do not whine.
Anonymous blog commentary has profound limitations, but it often gives penetrating and disturbing insights into the human soul... People get on here and offer casual, bus-stop daydreams of self-importance and courage as if they were superhuman spirits. There's just no limit to the braggadocio presented. In these ramblings, it's imagined that huge patterns of human feeling --whether of children toward parents, or of women toward men, or of voters toward government, or of distant souls toward the object of their prayer-- can simply be discounted and countermanded by the commenter's explicit, inarguable certainty.
And now we have The Big D itself: Commenters are confident that the experience of everyone who ever lived just doesn't apply. They'll handle death better, because they're tougher and smarter.
I doubt it.
Crid [cridcridatgmail] at January 21, 2009 11:36 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/01/20/modern_medical.html#comment-1622395">comment from Crid [cridcridatgmail]Very eloquent, Crid.
And as for this: They'll handle death better, because they're tougher and smarter. I doubt it....especially watching Cathy Seipp battle cancer and eventually die, I know I'm a total pansy about being sick and hurting and dying. That's why I'm very interested in ways of offing myself peacefully rather than living on in suffering, and also, why I have documents demanding that I not be kept alive as a human turnip.
Amy Alkon at January 21, 2009 11:52 PM
Crid, your first graph actual supports my point. The suicide rate rises dramatically with age. Consider how many people die of heart attacks and strokes, or other things that aren't extremely painful, in other words, things that wouldn't cause someone to want to off themselves. Maybe I won't be given a choice, maybe I won't die of something that make me want out before I dies naturally. In fact, those possibilities are quite high. Given how many people do die of things that wouldn't cause them to want to commit suicide, why would the suicide rate rise so dramatically? In fact, your graph almost certainly doesn't include all of the doctor assisted death that happens in states where it's illegal.
What makes you think this has anything to do with having courage, self importance, toughness or intelligence? Amy has it right about being a total pansy. I DON'T WANT TO SUFFER. Does that sound like braggadocio? does that sound tough? What makes you think I'm (or other people of the same opinion) discounting anything? I won't off myself if I have cancer and there is even a slim chance of survival. If's there's constant horrible pain and no hope of recovery, then I and a lot of other people will take the easy way out.
William (wbhicks@hotmail.com) at January 22, 2009 7:01 AM
To add to William's response, those numbers also wouldn't include those who commit suicide by default, i.e. being removed from lifesupport/refusing life saving medical intervention. Nor does it take into account people who would commit suicide, if only they were able. People who are too incapacitated or are actively restricted from doing so. And it also ignores a phenom that has fairly recently surfaced - suicide by "accidental" dosage mistakes. I haven't the time this minute, but will try to find the article after school.
Graphs are a great thing, but they certainly don't tell us the whole story.
I am not full of bravado on this one. Quite the contrary, I have watched enough people whither and die slowly, that I am petrified of it happening to me. I am not fond of pain. I am not interested in wearing adult diapers. I don't want to forget the names of my children or grandchildren (should any come along). I don't want to live with significantly diminished capacity.
All of those things terrify me far more than death does.
DuWayne at January 22, 2009 8:16 AM
> The suicide rate rises
> dramatically with age
...but they're still a tiny fraction of those who come to suffer and suffer terribly.
Not only that, take a look at the ones who most often choose this exit: White guys! The ones who, in popular understanding, have been given the easiest pass through life's travails. And as it happens, I'd wager that it's white guy commenters who've been most vociferous about it on this page. Why the disproportion?
Some will presume that it's white guys who built our civilization anyway, who've been given the least solace of excuse-making across their lifetimes, with the strongest habit of taking steps when confronted with difficulty.
But we should consider the possibility that white guys might just be pussies, scared little weasels who've never before suffered as a matter of course. (The nature of pregnancy alone changes the math of this for women. As they pursue the fullest expression of their human form, they know things will be unpleasant for them. Historically, childbirth was a great way to be killed or maimed.)
Listen, living as a sentient animal has problems. But whether its food or sex or death or even intelligence, nothing good comes from pretending you're not a bloody, breathing thing.
Your smugness is a duple.
First, that it just so happens that everyone who ever came before you since the dawn of time (including Eric's mom) was cowardly, thus implicitly deserving of the horrific fates which this planet assigns randomly but certainly.
Second, that in these hours of youthful confidence when the battle seems so distant as to actually not exist, you boast in front of the chattering townsfolk about your wartime prowess, encouraging them to do the same.
It's just not for real.
Crid [cridcridatgmail] at January 22, 2009 8:34 AM
So by your admission, the people most likely to choose suicide over pain and suffering are, like me, white and like me, terrified of the pain and suffering. Though I question the point of taking such a nasty attitude about people who choose this out.
What is noble about living through the pain and suffering that so often accompanies the end of life?
First, that it just so happens that everyone who ever came before you since the dawn of time (including Eric's mom) was cowardly, thus implicitly deserving of the horrific fates which this planet assigns randomly but certainly.
What the hell gives you the idea that I am disrespecting anyone else's choices? I haven't said anything that would begin to imply that I have anything but respect for the end of life decisions of others.
The only person here who has taken a disrespectful tone about anyone's choices, is you Crid. You're the one who seems to think it the height of cowardice to take an easy out. You're the one criticizing people who wish to commit suicide instead of following the path of noble suffering.
Second, that in these hours of youthful confidence when the battle seems so distant as to actually not exist, you boast in front of the chattering townsfolk about your wartime prowess, encouraging them to do the same.
First, it's not so distant. Yes, I expect to have a great many years left. But I watched my uncle die of AIDS almost fifteen years ago. I have watched five friends die of AIDS since. I watched my grandfather die just two years ago. All but two of them suffered horrible, drawn out deaths. The other two suffered plenty towards the end, before choosing to take advantage of OR death with dignity act.
And I have been coming to terms with my seventy four year old father moving ever closer to the end of his life. I am dealing with the emotional impact of my greatest super-hero in life, losing his ability to do so many things that were once nothing to him. I am dealing with the emotional impact of his own desire not to wait until he is suffering to die naturally.
Nor am I encouraging others to make the same decisions I am. I don't care what others choose to do in relation to their end of life experience. While I would prefer not to watch loved ones suffer for an extended period of time, I respect their desire to hold on. I honestly don't understand that desire, but it's not my desires that matter under the circumstances.
Yes, it really is for real. I will admit that my desires may change over the years I have left. But I sincerely doubt that will be the case.
DuWayne at January 22, 2009 9:10 AM
Crid, do you have any numbers to back up your assertion the the one's who commit suicide are a tiny fraction of those who suffer and suffer terribly? I don't think most people do suffer terribly. A lot die from heart attacks and strokes. A lot just have their bodies give out.
My father in law will be in that group soon. He's not in much pain, but he's fuzzy minded from lack of O2.
First we're full of braggadocio,now we're pussies, scared little weasels. Make up your mind Crid.
Where is anybody encouraging anybody else to do the same?
"First, that it just so happens that everyone who ever came before you since the dawn of time (including Eric's mom) was cowardly, thus implicitly deserving of the horrific fates which this planet assigns randomly but certainly." What the hell are you trying to say here Crid? That because we're cowardly we deserve to suffer?
What makes you think we're smug? And WFT is a duple, besides something indicating 2 of something?
Have anybody here pretended they aren't a bloody, breathing thing? Or that we shouldn't have problems and that we'll take the easy way out if we have any hope?
How about this one Crid "hours of youthful confidence when the battle seems so distant as to actually not exist"? I turn 50 this year. I'm not old yet, but I feel the creeping decrepitude that is aging. My heart's gone AFIB twice. The first time the doctor told me it is a life threatening condition. The second time they wheeled me into a hospital because when I tried to stand up I almost passed out. Or the time I got hit my a car riding my bike. I saw it coming and couldn't get out of its way. You don't think I thought about death then?
One of the things I'm most ashamed of is when my daughter's kitten died. I had taken it to the vet and he told me that it was 'time to put the kitty down'. I didn't have him do it because I wanted my daughter to see him one more time. It suffered horribly the last few hours. I wouldn't want to put a person through that, not for hours but months, and I wouldn't want it for myself. Everyone in my family has stated that they don't want their body kept alive if their mind is gone. My parents have stated they don't want extraordinary measures done to keep them alive. They both have made it clear that they don't want to be kept on life support if they aren't going to get better. Does it sound self important to follow someone elses wishes?
Is it that hard to admit that maybe we've spent time thinking about these thing, that this may not be a whim, tossed out casually?
The only person who sound smug here is the one who casually makes sweeping statements about people he doesn't know.
William (wbhicks@hotmail.com) at January 22, 2009 11:02 AM
William -
I strongly suspect that Crid's attitude has little to do with the reality of what we are actually talking about and everything to do with his distaste for me. I tend to be rather assertive about some of my positions on things and have an admittedly arrogant certainty about some few things that he seems to find rather offensive.
He calls it the braggadocio of youth. I call it the courage of my convictions. What I find most ironic, is that he waxes poetic about how anonymity provides empowerment to those who would brag thus. He posts anonymously. I most certainly do not. I like to be informal, but clicking on my name will take you to my blog where my full name is listed.
And I just dare you to try and find another person named DuWayne Brayton - same spelling. Anonymous I am not.
DuWayne at January 22, 2009 1:38 PM
> What is noble about living through
> the pain and suffering
I didn't say it was noble, I said what we're hearing is a daydream that has little to do what what will happen to you, or how you'll feel about it when it does.
> do you have any numbers
See the book mentioned above.
> First we're full of braggadocio,
> now we're pussies
Well, that's what makes it braggadocio. Truly stoic people don't bother with bluster.
> I turn 50 this year.
Likewise.
> everything to do with his
> distaste
The topic has been discussed before. It's not all about you. Our anonymity is that we'll never meet or hold each other accountable for principles we discuss.
Crid [cridcridatgmail] at January 22, 2009 4:16 PM
Crid, still don't know why you would consider it braggadocio. We're not being boastful or bragging, we're admitting that we aren't brave.
I'm well aware that you can't tell what a soldier will do until he's been under fire. I don't think this is in the same category. I've been in enough pain before that if I had that to look forward to for the rest of my life, I would have wanted to end my life then. Even terrible pain is bearable if you know it won't last. Your position reminds me of the various witch hunts that have occurred. People have been tortured to give up the names of other people, and if they would, it would all end - the pain and their lives. Eventually, they would give their tormentors what they wanted, just to end it. If their life was so precious, why not just keep enduring it? Do you really believe that there isn't anything worse than death?
William (wbhicks@hotmail.com) at January 22, 2009 6:03 PM
> Do you really believe that there
> isn't anything worse than death?
Did I say there wasn't? Can you recite that part where I said that? Or are you extrapolating?
It's bluster because you're pretending to have it all figured out, it's really very simple for you, you'll just get out when the getting's good.
Crid [cridcridatgmail] at January 22, 2009 7:43 PM
Crid, you didn't say it, I was extrapolating.
How can you say that what I say is bluster if you do believe there are worse things than death? I'm not pretending to have it all figured out any more than you are. You sound like you're certain you would stick around if faced with something worse than death. How would you know any more than I do? You act like you're an expert on people, and like you know us better than we know ourselves.
William (wbhicks@hotmail.com) at January 22, 2009 8:47 PM
I didn't say it was noble, I said what we're hearing is a daydream that has little to do what what will happen to you, or how you'll feel about it when it does.
No, what you said is that people who take the easy out are pussy little cowards. Your fucking words. So there must be something preferable to suffering through it, instead of taking the easy out.
So what exactly is it? If not nobility, then what? Why are you accusing people who choose to out of the suffering pussies?
It's not all about you.
That's not what you said several comments up. But whatever Crid.
Go on believing you're the only thoughtful person around here, the only one who could possibly have a valid point or opinion. I think you're just full of shit. Except when I agree with you. Or on the rare occasion you make a valid point I hadn't considered. OTOH, it's quite possible to full of shit and right at the same time.
So no, on second thought you're just full of shit.
DuWayne at January 22, 2009 10:20 PM
And you know something else? Your smugness is fucking duple too.
DuWayne at January 22, 2009 10:22 PM
Our anonymity is that we'll never meet or hold each other accountable for principles we discuss.
That would be your anonymity. While you and I will never meet or hold each other accountable, I am accountable for the principles we discuss here, because I am out here in the open. People I actually know can find these conversations without much difficulty. People I actually know have read my blogs, knowing that I wrote them. People I know have found them offensive on occasion, other people I know are already aware that I'm an asshole and don't sweat it.
I've been held accountable. There are people who chose not to hire me, because of my position on gay marriage. There are people who chose not to hire me because of my position on religion. At the time these came up, I was busy enough not to care. At the time my business was sinking, I doubt they had the money.
I've offended my mother, who's very firm in her Christianity, pro-life and against gay marriage. I made it clear that I love her quite dearly, but loathe some of her positions. We don't talk about those topics and get along fine. Yet I suffer scowls from some of her friends and occasionally random attempts by some of her other friends to re-convert me.
I assume that I'm going to be held accountable for what I say here, nearly as much as I am held accountable for saying things to the people around me. In fact I want to be. I'm not always thrilled that I lose it and get rather nasty, but I live with the consequences, just as I do when I lose it with the people around me. On the other hand, I also manage to foster the occasional tough discussion with people around me and that makes it worthwhile.
It's only anon for you, because you're anon. I'm not. I'm standing here naked for the world to see - for good or bad.
DuWayne at January 22, 2009 10:49 PM
Why is it always about extrapolations and "sounds like"? When you post comments, don't you work to say exactly what you mean? Do you want to be held accountable for anything else?
I think it's bluster or bravado because it's so simplistic, and these are some of the most complicated sequences of events imaginable. Almost by definition, we're talking about the most intricate project you'll ever be a part of: the conduct of your life across the rest of your days. But in forums like this one and far too many others, it gets reduced to "I'll just kill myself", as if that solved the problem, was likely to happen, or should be automatically acceptable to others.
Look, the theme of Amy's post is spot-on. I'm not into suffering. Pain doesn't usually improve people, especially at the end... It just hurts. I think Kervorkian got a raw deal, OK? I think too many doctors (especially young ones) view medicine as a sporting puzzle that distracts them from the essential business of helping lives go well.
But there's no point in running so hard from pain, because pain will find you anyway!
The book mentioned above for statistics on painful death (the Nuland, not the Franzen novel) was something I happened to be reading between scuba lessons. The theme of the book is "Man is an obligate aerobe ." It had extra resonance because that was exactly what the scuba instructors were teaching: "You gotta keep breathing." The diving guys were not being smartass or ironic.... Almost every problem that can happen underwater can be solved if you take a breath and think about it. So if you can't take a breath, you're in trouble anyway. (You DID personally check your O-rings and tank fill, right?)
Death is what happens when a critical tissue no longer gets enough oxygen to function, which will happen to your brain shortly thereafter. No oxygen. How many ways do you think that can be made pleasant? How do you imagine that suicide helps you avoid this fundamental truth? No oxygen.
Well, let's sketch out the suicide of your dreams. The day begins with a quick jog, a latte, and a series of encounters with family, friends and lovers. After a light lunch of fresh vegetables, its three sets of tennis and a few hours of Proust or Shakespeare before a sensible dinner. Then it's off to a Knicks game, a Broadway show, or Opera at the Met before returning to the hotel for an hour of vigorous sex with an affectionate supermodel. You send her on her way after a glass of Cabernet, read one last poem, and then blast your braincase all over the room with a luger, leaving enough corpse for the kids to come and identify.
(Your parietal lobe, scattered now across that little bench for luggage, can't get oxygen from the air directly.)
Could it go any better? And after experiencing that vitality, would you still wanna do it?
Again, I think people were meant to struggle, by nature if not by God. Poor people are in pain all the time, but they don't kill themselves. Too much of our nature, too many impulses are in a pattern that says go-go-go. Sometimes that means fight-fight-fight and sometimes it means flight-flight-flight, but either way, its all about being alive.
Any approach that makes you tamp down that spirit is going leave you in no better shape than a mortally ill person anyway. No opera or supermodels for you...!
If, when a time of desperate illness comes, you really wanna do that in a thoughtful manner, being respectful of the boundaries of the lives of others, then I won't judge you harshly... No decent person will judge you harshly. But meanwhile, let's not be glib, OK?
And before making babies, let's always remember we're bringing them to the planet for a typical death, too. (Talking tough about suicide makes it easy for casual parents to ignore you.)
The last rock star for whom I felt any personal affection was Cobain... But let's face it, he was a terrible prick.
Crid [cridcridatgmail] at January 22, 2009 10:56 PM
Why is it always about extrapolations and "sounds like"?
It's not, but when you accuse people who choose suicide over torment, it's quite reasonable to assume that you don't approve.
I think it's bluster or bravado because it's so simplistic, and these are some of the most complicated sequences of events imaginable.
No one is saying that it isn't complicated, least of all me. I have to head out to see my therapist and go to work for a couple hours. When I get back I'll be happy to attempt to explain my thinking on this and why I think about it in the terms I do.
But what it all boils down to is quite simple. No matter how difficult the route is, once we get there it's not complicated at all.
I like to discuss the more complicated, abstract aspects of any discussion. But I have been trying to balance that with the necessity of brevity. You're one of the people who convinced me that long comments aren't really appropriate for this sort of venue. So if I really must get long winded, I post at my own blog. Otherwise I try to keep it down a bit.
But you're right, this is a complicated issue and deserves more.
DuWayne at January 23, 2009 6:07 AM
Crid, I find this highly ironic "Why is it always about extrapolations and "sounds like"? When you post comments, don't you work to say exactly what you mean?"
Why do I extrapolate? I'm not the only one doing it; you just won't admit it (besides that, everybody makes assumptions about what other people are thinking, based on their knowledge of the person, their own prejudices, and knowledge of what people are like). If you would be less vague, we wouldn't have to guess what you're thinking. That's what I find so ironic, if you're working to say exactly what you mean, you're either incompetent at it or you don't have a clear idea to begin with.
What about this bullshit Crid - "Well, let's sketch out the suicide of your dreams. The day begins with a quick jog, a latte, and a series of encounters with family, friends and lovers. After a light lunch of fresh vegetables, its three sets of tennis and a few hours of Proust or Shakespeare before a sensible dinner. Then it's off to a Knicks game, a Broadway show, or Opera at the Met before returning to the hotel for an hour of vigorous sex with an affectionate supermodel. You send her on her way after a glass of Cabernet, read one last poem, and then blast your braincase all over the room with a luger, leaving enough corpse for the kids to come and identify."
Again, I have to make a guess as to your thought processes. I could only write such crap if I thought the other person planned to off themselves if they got a hangnail or stubbed their toe. You think that I'll end it when I'm feeling good enough to do any of that? You think I take it this lightly? I've stated clearly that ending it is a last resort, something to be done when there is no hope and continued existence is agony.
The suicide of my dreams is me laying in a hospital bed, unable to get up. I've been told I have at most a month to live. I'm fluctuating between being in a haze from the pain when it's been too long since the last meds, and being in a daze from the meds. Loved ones come and go and I struggle to recognize them because of the haze. During one of those interminable days, a doctor comes in and after he's talked to me so a while, I finally realize that he's asked if he can do anything for me. I ask him to please make it stop, make it go away. And he does.
You keep repeating that pain will find us, that it is our lot to suffer. No shit, Sherlock. I didn't need you to explain that to me, and I doubt anybody else here did either. You think that at the end, when there is nothing to live for, we'll keep on trying until our bodies quit. You think I have a fantasy that I'm different, that I'll do what other people won't. You're wrong. Yes, some people do struggle till the end. Some people don't. I don't think I'm different from other people, and I know that people have breaking points.
William (wbhicks@hotmail.com) at January 23, 2009 7:07 AM
First I would like to clarify, that while I have chosen not to be anonymous, I don't mean to disrespect those who choose to be. My reason for doing so, is that it forces me not to say anything that I wouldn't want the people I interact with offline to see. While the nature of the internet is such that I can still presume a certain anonymity, I must assume that anyone choosing to look for me online is going to see what I have to say, wherever I happen to say it. It helps keep me real. But I also understand that anonymity is necessary for a lot of people to be free to speak their mind. I'd rather they speak with anonymity, than not speak at all.
Into the breech then.
First I will admit that while I operate under a belief in the strength of my resolve, I have no illusions that my resolve is an absolute that will certainly carry me to the end. I am very arrogant, but I'm not that arrogant. Just like I can't Know what I would do if presented with the necessity of taking the life of another human being, I can't know what I will do at the end of my life until I'm there. What I can do is make a very confident assumption of what I would do, based on the whole of my life experience.
I Know, for example, that I have no underlying fear of death. I have come close to dying on more than one occasion and while I want not to die, that is because of things left undone – not due to fear of the end. On two particular occasions, I actually believed I was going to die. I didn't just give it up for lost either time, but accepted that my struggles were futile and looked into the breech with a sense of peace and grace. The only reasons I struggled at all, were that my dying would inconvenience others and that I didn't want to be remembered as an idiot that died from recreational drugs.
Unfortunately, I also Know how I deal with exceptionally stressful situations. Last year a women standing on a corner in front of me, waiting for the light to change so she could continue on her way to pick up her daughter, was shot in the leg. The bullet was meant for someone else, but fucking idiot shooting from moving vehicles don't have the best aim. I was downrange from the shooting.
Most of the people around her were in a panic. I will admit that I was fucking terrified and in no small amount of shock. But my upbringing won the day and in complete autopilot, I calmly knelt down beside her and clamped my hands solidly around the wound and applied a great deal of pressure onto the wound. I then allowed people who knew more than I, to direct me. What I was conscious of, was the desire to run like hell, in case the fucking morons came back by. But I did what I Knew I had to do, well enough that the subconscious impulse over-road my conscious fight or flight impulse.
From that experience I have confidence in my belief that I can do what needs to be done, even when I don't want to do it. I also endure the shame of knowing that my thoughts were of terror, not once turning to the safety of my family, who I was on my way to meet and who would be coming through at any moment. I wasn't even particularly conscious until I realized that the police officer who was washing my hands down with antiseptic cleanser was trying to talk to me.
I also Know what it is to watch people I love suffer immeasurable pain and die. I loved my uncle quite dearly. We became very close towards the end. For him, I was a surrogate for the son's who had forsaken him. For me, he was a remarkable teacher about the feats of human endurance and sheer will. He should have died years before he did. But he had a mission to fulfill and forced his body to comply so he could create a legacy that would endure and help ensure that other people wouldn't suffer the same stupid fate that he suffered. And I had no small measure of compassion for a man who at the very end would often call me by the name of his youngest son, who was my age and looked a lot like me. I loved him for the love he still bore for a child who had wounded him as deeply as anyone can hurt another.
But at the end, I just wanted him to fucking die already. His suffering outweighed my desire to continue with his presence in my life. I would much rather he had died months before, before the agony and drugs to curb just a bit of that agony had taken most of his coherence. I hated to visit him at the end. It was all I could do to force myself to visit. Given the choice I would have stopped altogether. But I knew that my visits brought him some measure of comfort. That those last visits from the son he came to firmly believe I was were critical to helping him pass. But my daily hope was that today would be the day.
At seventeen years of age, I decided that I would not force my loved ones to endure that horror on my behalf.
Over the years since, I watched other friends die. Every time I was there reinforced my desire not to force my loved ones to experience my suffering at the end, if suffering would be my end. Just last night I had coffee with a close friend and we talked about his experience as primary caregiver for his dad, when his dad was dying of cancer. We discussed the pain his dad was in and his feelings of shame, because more than anything, he just wanted it to be over.
I love my dad. There is no one in this world who I would rather emulate, than my old man. He isn't perfect by a longshot. We have our fundamental disagreements. But there isn't a man alive or dead who I admire more than my dad. A few years ago he was helping me work on the house I was living in, when I asked him to do something that required going a few steps up a step ladder. I can't describe my feelings when he explained that he just couldn't manage to work off a ladder, even a few steps up. In less than two months we'll be celebrating his seventy forth birthday.
My dad is in exceptional health for a man his age. I am confident that he will be around for a good long time to come. But he is coming towards the end of his life and given his importance in mine and that of my son's, I am forced to prepare for it now. And as much as I love my dad, as much as I want him to be around forever, I know that I could not endure seeing him in the same condition as my uncle was. As much as I love him, I am glad that he will not endure that – even if doing so would give us all a little more time with him.
I have had to deal with a great deal of pain and trauma with my family. I'm just not going to get into that here, because it involves very personal issues of people who aren't me, but dealing with my partner has been hell on earth. And dealing with the fallout with my kids is possibly the greatest challenge I have ever had to face.
It's no small measure of arrogance on my part, but I have goddamned well earned the confidence that I have in my convictions I have on this issue. Not bluster and braggadocio. Not simple, thoughtless bullshit. While my actions at the end may well be different than I believe they will, I have earned the belief that they won't be.
DuWayne at January 23, 2009 11:21 AM
Here's a factor to keep in mind: do your nearest relatives AGREE with your directives?
My dad signed a living will. My mother ah...didn't put it into effect for nearly 2 years after he became permanently hospitalized. Now, I don't blame her for the first year or so, the doctors were still feeding her bullshit hope, but after awhile it was pretty obvious it was just stringing him along. She finally agreed to "pull the plug" after insurance refused to pay any more and she would have gone bankrupt paying $24k for him to stay alive per month.
I know darned well that she would do the same to me, were I in that state. Unfortunately, I don't have anyone else I can give that directive to. The rest of my relatives are gits.
As for suicide, I do have to admit that if you are in a good enough place to be able to do it yourself, you probably won't want to. But it's hard to figure out where the best "jump-off point" would be. When can you still manage to kill yourself before the dementia gets too bad? Damned if I know. But assisted suicide isn't legal in most places, and god knows getting doctors and "family" to "let you go" is a bitch, so...
Jennifer at January 23, 2009 11:26 AM
Here's a factor to keep in mind: do your nearest relatives AGREE with your directives?
Not only do they agree, as the youngest, I have the authority to carry out all of my siblings directives. If I should go before they do, they've empowered others in the family with that authority. Unfortunately, we have a sister who doesn't want our wishes carried out and have made plans accordingly. She will have no authority to stop anything. (She's also the only one who would fight our dad's wishes that whatever estate is left when both he and my mom are gone, should go to a particular library's genealogy department. There are specific items that we will get to remember him by, beyond that we've made sure that the rest won't be squabbled over.)
As for my own directive, one of my nephews has the authority. I barely know him, but he knows what my wishes are and has committed to making sure they'll be followed through. We all came to the conclusion that it just wasn't fair to put these decisions into the hands of our respective kids. There are others with the authority, but of course family making the decisions is best. And unless she's the only one left, my stupid sister can't interfere. given her age and lifestyle, she probably won't be.
And two of my brothers and I have included in our directives instructions that cannot legally be carried out at this time. But I'm hopeful that given time the laws will change and make it possible for them to be followed too.
DuWayne at January 23, 2009 3:18 PM
"But it's hard to figure out where the best "jump-off point" would be." Jennifer, you've named the issue nobody has an answer for. It would be hard for me to make that decision. I only hope that I would go though with it while I could. There are doctors that help people do it. I'm not say a high percentage do, but it happens. These don't get reported suicide, so it stays under the radar.
William (wbhicks@hotmail.com) at January 23, 2009 5:55 PM
OK. Next time I'll say "twofer" instead of "duple"... But you guys are still smug on both sides.
Crid [cridcridatgmail] at January 23, 2009 6:33 PM
And you're the height of humility Crid?
DuWayne at January 23, 2009 6:54 PM
Not humility, physical beauty.
Look, we don't get to choose....
Crid [cridcridatgmail] at January 23, 2009 7:52 PM
Wish I'd seen this:
"If you children in their 40s or older need your full estate money to build American dreams, we, as a group, are totally screwed."
Chang, you're just a thief who wants the Fed to take people's money and give it to you or your favorite program.
You might not have noticed the financial mess the country's in. Half of my 401K is gone, and you want more? It was not the sole action of the people that did this. In fact, without Federal meddling, it couldn't have. The suggestion that Congress would do better with Joe Blow's money than Joe's family is simply nuts. Get medication, and keep your grasping hands to your own wallet.
You know, there's a delicious irony here though. Chang, if you want your own family to prosper, your ideas make it harder for them. Maybe you should tell them about it so they can appreciate your leadership on that issue.
Radwaste at January 24, 2009 5:50 PM
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