I’m incredibly grateful that medical aid in dying is an option and that one can have agency not only in how they live but also in how they die.
I had someone close to me opt for it. They were greatly suffering and had no chance of their condition getting better. Having a planned final date allowed us to say farewell and thank each other for all the great moment we shared without feeling ominous. The last phone call I had with them will stay with me forever.
I've been grateful that a couple of loved ones were able to choose to end their suffering. Both times, it was a sad, but very rational decision. I do wish there was a lot less stigma about it. People said some genuinely awful things to my aunt about her choice before she passed especially.
It must be hard to say one last permanent goodbye.
on the bright side, at least you don’t need to worry about “i wish i told them __ before they died.” It’s a good way to have closure i suppose.
Unfortunately not everywhere. In France the parliament is passing half-assed laws to praise all kinds of religious authorities and call it progress.
Luckily we have our neighbor countries that are way more civilized than we are.
It's a mercy we allow our pets.
No reason we shouldn't allow it to ourselves.
Pets are legally property. You may love your pet, but it’s not human.
The risk with allowing humans to do this is that it’s possible for someone not of sound mind to come to this conclusion.
>The risk with allowing humans to do this is that it’s possible for someone not of sound mind to come to this conclusion.
It seems like lots of people think you can just go to your doctor and be prescribed a cocktail of death because you feel down today. That's not what assisted death programs are like, at all.
There's waiting periods, evaluations by independent doctors and psychiatrists, interviews, etc. to determine your capacity and understanding of the decision. Someone who is not of sound mind is not getting approval for assisted death.
Anyone sufficiently determined enough is going to find a way to die, regardless of what laws or programs are there. These programs don't change that, and they aren't meant to.
> Someone who is not of sound mind is not getting approval for assisted death.
For many of us, this is a classic catch-22 as requesting such approval demonstrates the lack of a sound mind.
>requesting such approval demonstrates the lack of a sound mind.
This is wild to me.
I watched my father, who had a life expectancy measured in months, live in unbearable pain 24 hours a day. And you believe that him wishing to end that nightmare demonstrates a lack of sound mind? The sound decision, in your opinion, is to suffer in pain, knowing that there is no treatment nor cure coming, just pain for some number of months until death's release?
I find it particularly cruel that you (seemingly?) think that he should have had to continue to suffer. And, by extension, myself and the rest of my family, should have had to continue to watch him suffer.
(Before we get too far into it, I will say upfront, there's not much in way of argument that will sway me from this opinion. I am certainly open to hearing your opinion, though.)
tell me you haven’t been around old suffering people without telling me. I literally think your comment is crazy. Like batshit crazy.
Go into a nursing home in the U.S. sometime and walk the halls. Tell me if you think the majority of those people are waking up with something to look forward to? Some of them are sitting in their own shit for hours because the nurses are too short staffed. I’d rather be dead than sit in my own shit for hours while being in chronic pain, and abandoned in a nursing home.
There are other reasons to choose death too of course. But i digress. I’m not in the mood to make an exhaustive list.
If you’re old and in okay-ish health, and have _something_ to look forward to (hobby, seeing grandkids, reading, etc), then it’s a different story.
When I volunteered at a nursing home an attendant complained to me about a guy who wouldn't make the effort to go shit but expected staff to dig it out for him. Why bother choosing to live if you don't find it worth even that much effort.
IMO it's purely a liability debate. The other concerns are philosophically interesting but on a practical basis mooted: anyone of sound or almost anyone of unsound mind and two nickels to rub together can reliably off themselves without asking anyone for approval.
People who aren't of sound mind can come to this conclusion regardless of the law. Giving people who are of sound mind a way to control their death with dignity (and in a minimally burdensome way for those who they leave behind) is the point.
No, the actual risk is that there are larger bureaucratic barriers to treatment than to the assisted dying programme, so it's easier for somebody suffering to die than to get treatment, when effective treatment is available and (in the absence of those daunting bureaucratic barriers) preferable.
Assisted dying is a horrifying, but probably overall good idea; however, we need to reform our medical bureaucracies before it's something that they can ethically provide.
And on that note, it always amazes me we have plenty of people dying of depression or anorexia, conditions they have for many years and their treatments don't work (in these cases) and yet they are not offered psychedelic therapy because it's still forbidden in many countries (it's changing, slowly). I'm not saying it's a panacea - far from it - just if someone is not responding to other treatments or the treatments is making things worse (like the risk of suicide goes up for some antidepressant medications) then why not try a different option. As you say, bureaucratic barriers.
> someone not of sound mind
We are already risking someone not of sound mind owning a gun or operating heavy machinery and ludicrous speeds in public places.
Do we really think the benefit doesn't outweigh the risk in case of medically assisted death?
Why isn't it considered a risk that someone not of sound mind might decide on a course of action that causes them to live in agony for months with an incurable condition? Why is the argument always "what if a particular death is bad?" and never "what if a particular staying alive is bad?"
What constitutes a sound mind?
Isn’t this what we have psychologists for ?
Surely you don’t think an 18 year old claiming to be endlessly suffering due to failing a math test sound enough to terminate his life?
Yes, it is indeed a risk. It is much better to only allow people "not of sound mind" to kill themselves the way they currently do - via brutal, goresome, and unexpected methods, which also often endanger others as well.
/s
A centenarian relative did this. But it's not actually legal where they lived. So instead of doing it properly, it was done by withholding food and water and they slowly faded over the course of a few days.
It is absolutely insane the way we do this stuff.
I understand why people are concerned about medically assisted death, but this is the sort of thing that happens without it.
I've also seen elderly people whose time was past (very old, bed-ridden, lost their partner) go into into what's basically hunger strike in the nursing home. They said "I'm not really hungry today", eating very little, getting thinner and thinner until the end.
It's now legal here, but family, religion and tradition can be obstacles to assisted dying.
In case you don't want to leave that way, you have to prepare ahead of time. There's different legal means in different countries, e.g. advance directive covers the case where you can't decide yourself anymore.
I think doctors have always pumped people full of painkillers to the point of death long before it was legal. Who would know?
Besides with modern technology it has become debatable what death is. You can plug someone to a machine and keep their heart going for years.
I've heard lots of stories of that being done, anyway. Oh, that much morphine is dangerous, but they're in a lot of pain....
I wasn't aware that Oregon had a "death with dignity" program for terminally ill people. It was enacted in 1997! Do other states have similar ones?
I'm a huge proponent for assisted suicide in general, even if you're not terminally ill. Regardless, these types of laws are a step in the right direction.
The NYT recently did an interesting review of Canada's program: https://www.nytimes.com/2025/06/01/magazine/maid-medical-ass...
I read that article a few weeks back - it was a great read. Incredibly complex topic both legally and ethically, but I thought they did a good job with it.
> Wonnacott had met Paula once before, and he found her to be a fairly accurate narrator of her own medical history.
This line reminded me of a lecture from my Psych 101 class back in college:
There are three "views" of ourselves
1. Reality
2. What we wish we were
3. Where we think we are
If 2 and 3 match but are far from 1: we are happy but "delusional"
If 1 and 3 match but we are far from 2: this is VERY often found in people who have depression.
And, ideally for long term happiness, 1 and 3 are close together and 2 is a "reasonable" distance away or close to 1 and 3.
Between the timber wars and assisted death, it was a hell of a decade. They introduced statewide vote by mail I believe around then as well.
It's had it ever since the Kevorkian blowup 35 years ago, I think.
>Regardless, these types of laws are a step in the right direction.
What direction would that be?
> What direction would that be?
Providing people with options on how/when they leave this world and making suicide less taboo. You could say most technically have this option already but I think it's more humane if we provide reliable methods to do so via medical professionals. Leaving it up to individuals can be messy and violent.
On the cultural side, I guess I'd like to see less sanctioning of suicide so that we don't make people's lives more complicated for merely expressing their desire to do so (e.g. getting the police called and being held for days)
All of that to say that death is sad regardless of what time you leave and I'm not advocating for people to do it. Just that we should have the option like any other healthcare service with guardrails of course.
The status quo is that the people who are most able to avail themselves of non-medical means tend to be the ones least in need of it. A healthy, able-bodied person can pretty easily off themselves in all sorts of ways. A person no longer able to care for themselves will find it impossible unless they can somehow secure the cooperation of a helper.
Non able bodied people can commit suicide via dehydration within a couple days (longer if they are healthy), provided they can avoid getting treated for it.
Yes, other states have it you can Google for a list.
Hah, yeah, I could. I guess it was more of an invitation for people to discuss specific state programs and their experience with them (e.g. if they had relatives who used it)
I don't know why people are so for it. The process is "cruel and unusual" when it's done to criminals but the same process is fine when you request it.
My understanding is that the death penalty process is kind of a hack job and can't be done properly because no medical personnel will participate in it due to the Hippocratic oath. This is not a concern in consensual euthanasia.
There's also an issue with the death penalty process seemingly requiring suffering, as evidenced by the lack of use of inert gas which appears to be painless considering accidents with poorly-ventilated spaces where people unknowingly pass out (and sadly those who go help them suffer the same fate). Even in states where the "gas chamber" is a thing, cyanide is used instead of just inert gas despite it making the post-execution cleanup process safer (so would make sense even if you did not care one bit about the suffering of the condemned).
Even if the death penalty was perfectly humane, there are so many other considerations that this comparison is clearly in bad faith. The GP doesn't understand why the state murdering people is a different consideration entirely from doctor assisted suicide?
Absolutely, I'm not defending the death penalty in any way. But even if you do support it, my response tries to bring up how bad and intentionally cruel the current implementation is.
The OP wants to know why the same process using the same drugs is described as full of suffering in terms of symptoms for criminals, but blissful when used for assisted suicide.
(And I'm not in favour of the state killing criminals or terminally ill people).
But it's not "the state killing terminally ill people". It's terminally ill and suffering people asking for help to end their lives and their suffering.
The situation is completely unlike the death penalty, where it's about punishment.
> The process is "cruel and unusual" when it's done to criminals but the same process is fine when you request it.
You seem to be saying that as this is inconsistent. I'm curious why do you think that is? Whether someone agrees to have something done to them or not is a crucial factor in whether doing said thing is OK.
Is it unreasonable for you to imagine any of the following scenarios?
* A person believes that choosing to die is different than having that forced upon you
* A person disapproves of assisted suicide and capital punishment?
* A person approves of assisted suicide and capital punishment?
* The process is quite different for criminals vs voluntary medical participants?
etc etc?
Seems to me you're twisting things pretty hard to find a false equivalence.
I'm not convinced that the process is that different, medically.
But it demonstrably is. Unless you think medicine is just injecting stuff?
How the health professional accompanies the subject is a major aspect of medicine. So some uncaring prison personnel carrying out an execution vs a caring health professional, a terrifying process vs acceptance/calm/accompanying is wildly different, re: "the medical process".
A careful surgical procedure on a toenail is wildly different to someone torturing you by taking your toenail.
It's a different chemical cocktail, but more importantly consenting to it makes a bit of a difference in terms of how it registers morally.
>The process is "cruel and unusual" when it's done to criminals but the same process is fine when you request it.
Yes, of course. This is a concept called "consent", and it drastically changes the context and morality of various situations.
Because I am practically alone in having avoided addiction, felonies, poverty, becoming handicapped, and/or morbid disabling obesity over the course of my life I have become the "responsible adult" in my family.
Over the last six years it has been my responsibility to oversee the end-of-life care for three people: my paternal grandfather and grandmother, and maternal grandmother.
My grandfather died at home of congestive heart failure. He spent a week on hospice in a medical bed in the living room staring at the ceiling, barely conscious due to the morphine and pain, pissing and shitting himself, as he slowly suffocated to death.
My paternal grandmother lingered for two weeks in the hospital due to an embolism after falling and breaking her hip. Again, two weeks bedridden staring at the ceiling barely conscious due to the morphine and pain, with a machine breathing for her, until diffusion/perfusion stopped enough that no mechanical or pharmaceutical intervention could oxygenate her blood enough and she died.
My maternal grandmother was the worst. Having fought off COPD for the last 20 years it finally became too much. After a year of coughing fits that led to torn muscles and spine/rib fractures leading to her being in a near-constant state of opioid-induced stupor the oxygen and albuterol stopped working and she very slowly and painfully drowned to death. She had been aware of her impending death for about two years and constantly expressed her desire to die on her own terms, but she had made the mistake of moving into an assisted living facility. So she spent the last few years of her life in a recliner hooked up to oxygen as the albuterol treatments got more and more frequent until the point that she would have to wake up every couple of hours 24 hours a day to do them, with coughing fits between them to the point that she would paralyze herself due to neck or back pain and spend six weeks on pain killers, unable to urinate or defecate or dress or eat without assistance, as it became harder and harder to breathe until she mercifully slipped into unconsciousness and died.
We already have medical aid in dying, it's called "giving a little more morphine every time the patient starts gurgling in order to 'soothe their pain'".
In a just world the patient has the choice to accelerate the process.
All men must die.
I will not die suffocating to death as I stare at a blank ceiling, blasted out of my brains on drugs, while a TV blares in the background to cover up the sobs of my family.
In my late sixties I am going to start going to the doctor complaining of back pain, stockpile enough Percocet to kill me, and when the time comes (with good fortune many many decades later) I am going to settle my accounts, write a note with some directions, have a party, and say goodbye.
That's why I'm "for" MAID.
I've always found what cats do admirable. I have never had to bury a cat. Once their time comes, they simply wander off, never to be seen again. It just feels like the right way to go.
The question of choice/agency is probably at the heart of the difference. One, the state is taking someone's life against their will. The other is allowing someone to exercise their own agency to end their own life.
Well, the death penalty is certainly a different discussion since the government is deciding to take your life. I don't support it, personally.
Assisted suicide, in my view, is more like an escape hatch for people who don't want to participate any longer regardless of how much "potential" they may have. Making it available for terminally ill patients is good, but it misses the mark for people who struggle with more "invisible" illnesses like ones in their own mind or lifelong ones like a physical deformity.
> The process is "cruel and unusual" when it's done to criminals but the same process is fine when you request it.
Because consent matters.
Many things work this way, they're wonderful or useful or helpful when you request/consent to it, but are despicably evil when done against your will.
Children are incapable of consent. In the same way, people who are having big mental burdens are not capable of consenting to this. It’s a system as ripe for abuse as allowing children to consent to sex.
I’ve had my dark moments, but I learned to deal and I’m sooo glad I didn’t end it.
You know, you always hear about people who survive a suicide attempt often find out after they’ve jumped that they really didn’t want to die! It’s an irreversible choice, and something about realizing that changes people.
>You know, you always hear about people who survive a suicide attempt often find out after they’ve jumped that they really didn’t want to die
You don't just walk into a building and say "I would like to die please" and then get assistance on the spot.
The two people I know who chose assisted death both had to go through various evaluations (over a period of several months) to determine that they thoroughly understood the decision they were making and that they had the mental capacity to make the decision.
The comparison to a child 'consenting' to sex is completely nonsensical.
Of course that’s not how it works. People will doctor shop. If one doctor rejects them, they go to the next and learn the right things to say to get the doctor to say yes. It’s just ripe for abuse.
What they really need is help, not death.
Someone who is determined enough to go through several years of doctor shopping to kill themselves will find a way to kill themselves whether there are assisted death programs or not.
I agree that those (hypothetical) people need help. Though, to be honest, I'm not really convinced this is a real issue. Some of these programs have been around for multiple decades, and I've not seen any evidence that there is a pattern of abuse. Let alone the programs being apparently "ripe for abuse".
Disallowing assisted death programs is not help, though. It is a punishment to people who deserve a death of dignity instead of months or years of unbearable suffering.
If abuse of the medical system is a concern of yours, I feel like a much more prominent cause ( millions more preventable deaths) worth fighting is over-prescription of opiates. That's just my opinion, though. (And, for all I know, you're already fighting that fight too. If so, godspeed)
You are sharing an important perspective. 1 in 20 people die from assisted suicide in Canada today. You can't tell me the process is sound every time. That's a huge number.
It's false dignity, and false compassion. Dignity does not come from control over one's life, and it does not come from the absence of suffering. Dignity comes from being made in the image and likeness of God. If anyone reading does not agree, well, that's fine, but I feel compelled to say it that someone might read it.
How many people will we lose to despair that could have been helped? I say this both as a Catholic and someone that has suffered and recovered from mental illness.
MAiD is not available for people whose only condition is a mental illness [1]. I'm saying this not for you but for anyone who may read this, particularly non-Canadians. It's not about "despair".
[1] https://www.camh.ca/en/camh-news-and-stories/maid-and-mental...
Yes that is the official stance. I do not believe that is being followed on the ground and is in any case a temporary condition. In 2027 it will be officially available with only a mental health issue.
I had a lot to say to this comment. I think your comment is gross. But it will just end up in a debate about god, so I'm editing it out.
However:
>How many people will we lose to despair that could have been helped?
Assisted death is not something reserved for mental illness, and it's dishonest to frame your comment like it is. Terminal, painful diseases are the leading reason for assisted death. In fact, many assisted death programs do not consider mental illness alone to meet the criteria of acceptance.
The whole point of these programs is that there is no other help possible. Except, maybe, enough drugs to make the person basically dead anyways. Which, in my opinion, is not "help".
I'm leaving my other comment despite your edits, as I believe it represents an answer to an important question.
Nothing in my comments is dependent on assisted suicide being available or not for any purpose or another. I am arguing against it in all cases to be clear.
>I am arguing against it in all cases to be clear.
Yes, reading your other comment, I now understand that you truly believe that suffering is a good thing and that, if you had it your way, my father would have had to be bedridden, in extreme agony, for several more months than he had already suffered. A cruelty beyond imagination.
We will never, ever agree on this, so I wish you a good day.
This is an age-old question. All I can do is share the Catholic perspective on this which you may or may not like or agree with.
God allows suffering to bring about a greater good, His plan. He endows us also with free will, which sometimes means we make choices that cause suffering for ourselves or others. Free will doesn't mean all or even most suffering in a given life is because of our choices. Sometimes it is though.
Satan's playbook is all about denying these things, denying the cross, denying redemption. Satan is the one whispering that life isn't worth it, that it would be easier to end it, come down from the cross.
For a even better discussion of these things, I always recommend Life is Worth Living which is an old program hosted by Bishop Fulton Sheen. It is as relevant today as it was when he recorded it. Many of the episodes are on YouTube.
EDIT: many seem to be taking this as an anti-painkiller stance which it is not. Reducing pain until natural death is a great kindness.
I think that’s an entirely reasonable stance to take if I can reframe my anguish as in the case where I’ve been dumped and am feeling sad. But if my heart is dying and my life can only be prolonged through great and endless suffering, I think choosing death is entirely reasonable, and demanding that someone live a few more miserable weeks is cruel. And I don’t think those parables about Satan considered the difference between those two situations. What lesson is there to absorb to become a better person?
If tomorrow I invented a machine that could keep us all alive indefinitely but also required us to be immobile and in great pain, who would choose that outcome?
Not against reducing pain for terminal patients - I made an edit above because it seems I was unclear on this point.
Many of us don't believe in god, Catholic or otherwise, and so we shouldn't have this point of view enforced upon us.
Me borrowing your car is also very different, morally speaking, depending on whether you agreed to it or not.
I think it should be an option for the terminally ill but nobody else.
There are people who are suicidal who don’t feel they deserve help and feel that assisted suicide is an option for them. We should not give them that option. Instead, we should spend that effort as a society helping them deal / get better.
I don't think this option is given to people who feel suicidal, so that's a moot point.
Also, people who find suicidal often will find a way, legal or illegal. This is about terminally ill people, and about not making things harder for them, or getting their loved ones in legal trouble.
I am the OP. Surprised to see this at the top of HN.
Best to you OP.
I always think of the Five Remembrances:
I am of the nature to grow old. There is no way to escape growing old. I am of the nature to have ill health. There is no way to escape having ill health. I am of the nature to die. There is no way to escape death. All that is dear to me and everyone I love are of the nature to change. There is no way to escape being separated from them. My actions are my only true belongings. I cannot escape the consequences of my actions. My actions are the ground upon which I stand.
“All lives are the same length, Lazarus. They're all just one moment long. It’s the moment we’re in. The rest is memory or imagination.” — Dora, in Time Enough for Love by Robert A. HeinleinHope you throw a giant party before seeing yourself out. Like a wake that you get to attend.
Well, as much as I'd love to tie one on today, my drinking days are over. I'll probably smoke a bit of weed though. That, and chill with my loved ones.
I am surprised to see it here too. I find it unkind.
Not that you need to hear it from me, but you will be remembered and missed.
Inappropriate / unkind, perhaps. I did make at least one solid friend over it. She saw the post on here, emailed me, and I ended up talking for over an hour with an understanding person who has lots in common with me and gave me some things to think about. I could have done without the email from someone else who said that "people in Gaza are suffering worse than you and they aren't doing what you're doing, so get mental help."
The absurdist humor of my impending demise making the front page of hackernews and being debated by the denizens thereof is not lost on me.
What's unkind?
Well, sharing someone's deeply personal post on here could be seen as unkind or inappropriate. I get the sentiment; I can agree with it to a point. If someone else wrote a similar thing on their blog, I wouldn't submit it here without asking. But I also think frank, honest, and open discussion of this sort of thing is a net good, which is why I published my post, and why I don't mind it being here.
https://news.ycombinator.com/item?id=44251900 just thought I would leave this comment here in case it makes you reconsider. Don't let sunk cost fallacy make you commit to something so permanent just yet if it turns out this therapy is within reach after all. Either way... Good luck. Hug your loved ones tight.
I seriously wonder why a state (France in my case) preggers to have people jumping from buildings on into a train than to have them terminate their life peacefully.
I know that when I have Alzheimer or ALS out similar stuff I will commit suicide, quickly. I will have to prepare early to have some poison or jump into a train (something I would like to avoid to not traumatize the driver).
Why not simply helping me when this is what I want, in the name of who knows what.
> I know that when I have Alzheimer or ALS out similar stuff I will commit suicide, quickly.
One of the common features of dementia is that you don't know you have it. It is just that everyone else around you seems to start behaving weirdly while your own reality is unchanged. It is both a blessing and a curse, but it does mean you may not ever have that moment where you can make the choice.
My mother has been bedridden for a year, completely helpless, on a daily drug regimen, recognizes nobody, would absolutely not want to continue living in this state, but is no longer capable of making that choice and so will stay in this condition for potentially several more years until she finally dies. It's a horrific final chapter.
I thought about that too, and was hoping for a diagnosis before I am incapacitated.
I actually wondered about a dead man switch, where poison would be released into the bloodstream if I do not acknowledge that I am fine. This would also manzge comas and lock-in. Technically it is quite complicated though.
I pity you, and this is exactly the reason I want to quickly end it so that my family does not suffer for a long time.
The Netherlands has a legal death man switch. You're able to consent to, and set up euthanasia early on in your diagnosis with the intention to die at a later date when it gets worse.
I don't know the exact numbers but in practice it's basically worthless because the doctors at hand end up in an ethical catch 22. This person that was sound of mind might have consented to euthanasia, but now they're not sound of mind anymore.
This is a weird catch 22 TBH. If someone makes anticipated choices because they will not be able to do that later and this is denied, then why allowing this in the first place.
It looks like a botched law, same as we have in France (and I thought we were the worst - not even because we do not have the laws but because the law is completely hypocritical)
> "A few months ago, a friend sent me a link to a university doing clinical trials using stem cells to repair the heart. It seemed really promising. Unfortunately, they are in Germany, and they only accept German residents. So that wasn’t an option."
It's not that tough to gain German residency. There's even a "Freelancer Visa" that gives you a residence permit. If you pay an immigration consultant a few thousand bucks, and don't have a criminal history, it can be done rather quickly.
Maybe I’m a statistical anomaly or maybe I just don’t know the baseline occurrence rate for this stuff but I have 3 close acquaintances two of which are this persons age or younger with similar symptoms (tachycardia, though to a lesser degree) going on. Is there data on the incidence rates for this stuff and has it been increasing since 2021?
Not tachycardia, but I had frequent heart palpitations for a few months after contracting Covid the first time in late ‘21. Did not notice anything in subsequent times. Maybe it was a placebo effect, as I had knowledge of Covid’s effects on the heart, maybe not.
I doubt it was placebo. I had the same for about a year after a wild-type covid infection in early 2020.
Turns out there is multiple publications associating tachycardia and other heart symptoms with long covid. https://pmc.ncbi.nlm.nih.gov/articles/PMC8356730/
The medical profession has got much better at finding these sorts of anomalies. Whether that is good or not is an open question.
> I’ve explained my reasons more fully to people who are close to me, but they basically boil down to the fact that an organ transplant requires a full commitment to the process, and I’m not willing to make that commitment.
I can't imagine being that indifferent to life. I would give all I could to live just one more day if I were in that position.
From the post: "I want to live [...]"
I am saying this completely honestly, with no sarcasm:
I truly hope that you never have to experience (or witness a loved one experience) the kinds of illnesses/injuries/diseases that would make someone consider assisted death. It is a blessing that you can't imagine the situation. Because the situations that make you consider assisted death are awful.
The heart transplant will have them live in a state of uncertainty, most likely having to use a defibrillator until a suitable heart is found, if it is found. It is risky, with many points of failure. As such, a certain death of their own terms might be more valuable than a chance of a life with the certainty that they will have to go through the suffering that has already driven them to disable the defibrillator mixed in with some more risk and pain. It would be a rollercoaster ride for the hungover, except they don’t know id they will get to step off. And the loved ones get to watch on from the side lines. Even with all that, it is tough to imagine not opting for the transplant, but this should just serve to help you empathise with pain they are going through.
I think the same as you, but I recognize that those in such circumstances now are literally experiencing horrors beyond my comprehension. However bad you think it might be, it would have to be unspeakably worse, which for some, it evidently is.
Can I ask you how old you are? Because at my age (50s), I've pretty much experienced what life has to offer and made peace with my mortality. I'm in no hurry to die, but I could die any time and not feel shortchanged.
Nobody knows what would they do in extreme circumstances until they end up in those circumstances.
Perhaps the question is how much misery are you willing to tolerate to prolong your life for how long?
Certain treatments take weeks to recover from while giving you months, years, even decades of life expectancy with good quality.
Other treatments of late stage terminal cancer only give you a few more weeks in the hospital.
my life is miserable even though im not sick. i would not qualify for assisted suicide. what does that mean? but if i got a terminal illness i would. so my life is motivated by the idea that i will someday achieve something that will make it worth it… and if i became terminally ill then i would no longer be able to achieve that goal… so i should end it. maybe i should reorganize my life so that i am not miserable. im not sure thats possible. i had a little early retirement before and i was still miserable. i am miserable dealing with people in this country. everyone is petty, mean and ready to stab you in the back
I'm completely ignorant on this topic, but if the defibrillator was shocking him so frequently, but he has survived having it turned off, doesn't that imply the patient was being shocked far too frequently? I can't imagine that has a positive effect.
So the issue here is that overly rapid beating (Tachycardia) in the lower two chambers of the heart (Ventricles) can be harmless, but left alone it can lead to dangerous heart rhythms (Such as Ventricular Fibrillation aka VFib) and arrest. The cardioversion is there to prevent it, but it's true that the fast beating of the Ventricles (VTach) is most likely to resolve without killing you.
Still in a patient like him it will eventually lead to VFib and then death, so you implant a device that prevents that cascade. There are settings for these devices about the threshold of when and how to shock, but ultimately it's still going to err on the side of caution because any sustained VTach is dangerous.
> Another slim possibility is a heart transplant. I am not interested. I’ve explained my reasons more fully to people who are close to me, but they basically boil down to the fact that an organ transplant requires a full commitment to the process, and I’m not willing to make that commitment.
Seems a little strange to not want to try to commit to the requirements for transplant and instead just die.
Perhaps they (arguably justifiably) fear the trauma that further interventions will bring.
I think this view is needlessly reductive and lacks compassion and understanding for their suffering. Not every problem should be approached with an engineering mindset.
This is at least the second time I've heard someone say that the defibrillator implant shocks are so bad, they would rather be dead.
If the defibrillator has any kind of warmup period before it fires, I wonder if that interval could be used to send a signal to the patient, e.g. to their phone.
The most “usable” form of this would be to allow the patient to agree or disagree to the shock (maybe defaulting to agree if no response is given in time); this would place the agency in the hands of the patient and allow them to be mentally prepared. Missing that, at least a couple seconds of warning would be better than nothing.
(Disclaimer: I don’t know much about these devices or the latency requirements between detection of an abnormal condition and treatment; these suggestions only work if the heart can tolerate a few seconds of delay. It seems plausible since the detection itself is based on monitoring of heart rhythms over some period of time, but I am not an expert.)
I can only speak for myself, but, assuming it's feasible to implement as you describe, that sounds awful. In full auto mode, unpleasant experiences happen, but at least without specific anticipatory distress. I don't see that you alleviate the overall existential state (of the possibility of shocks constantly looming over you forever) by offering individual instances of temptation to choose comfort over lifesaving intervention.
Now the unpleasant experiences become something that I'm doing to myself, and that my animal brain in the moment has the power to prevent. Every intervention becomes a test of my willpower: I know that I need this, I know I don't want to do it in the moment... What's the harm in rolling the dice this one time, in exchange for avoiding just this one painful episode? The parallel that immediately comes to mind is "well, just this one cigarette won't kill me..."
I'd much, much rather pre-commit than have to face that aversive decision time after time and day after day. Knowing that my life is on the line if I'm caught in a moment of weakness. That calculus is much too important to me to leave to the whims of my reactive brain.
Maybe that works for you, but in the case of the article, the random shocks were bad enough to make him literally choose death over the shocks…
I for one think we should probably not be hooking up pacemakers to bluetooth and deciding whether or not to administer shocks based on wireless communications.
I never thought about the uncertainty of it all. If the shocks are very painful and can come at any moment, without notice, they must be terrifying. The author of the article describes being fearful of even trying to sleep...
It’s literally like those experiments that test the effect of electric shocks in rats for avoidance of something, and there’s a control group of rats that are just shocked randomly. The randomly shocked rats become highly stressed and neurotic.
I agree with the other comments but one thing that’s also missed is that by accepting a heart transplant you’re likely also taking a heart transplant from someone else. It is incredibly altruistic to be honest enough with yourself about what you’re willing to live with.
People aren’t a science experiment. At some point they have had enough and it’s something we should respect.
Yeah, my thought on reading this line was that dying also requires a pretty irrevocable commitment. I can't make this decision for this person and its ultimately going to be the kind of decision that defies so-called rational analysis but I was caught by the inconsistency in this particular piece of reasoning.
Slight oversimplification, but dying is a one-time commitment, and the transplant requires continual commitment (or re-commitment) over a very extended period of time (the rest of his life).
again, and this may really just be sophistry but it deserves acknowledgment, I wanna zoom in on the phrase "the rest of his life"
Let me be clear: I understand the difference and I agree with you. The reality is that a transplant would probably be a lot of work and suffering and I can definitely understand opting out of it. All three of the grandparents I actually got to meet ended up doing this same math and getting the same result: sometimes life-extending care isn't worth what you have to go through to get the extension of life. I guess what I'm interested in playing with here is the language we use to abstract the reality, and how it doesn't really hold up once death is accepted. Treatment is a commitment. So is dying. Treatment will go on for the rest of his life. Without treatment, dying will go on for the rest of his life. A lot of the things we do and ways we look at things assume that dying is
1) very far off 2) to be avoided at all costs
If either of these things becomes untrue the calculus we do to determine reasonable courses of action goes flying out the window. Neither of these things is true for this person, but it's true for all (for a given value of all) of us trying to talk about it and I see throughout the thread this interesting disconnect that basically boils down to people saying "You can't kill yourself! You'll die!"
The dying happens with either course of action. The transplant is in addition to it, not an alternative.
Everybody dies. It's not something to fear, if you have come to terms with it.
I just want to chime in here.
Getting a heart transplant doesn't necessarily mean buying yourself 40 more years. Could be 5, 10, 15. If I recall correctly, the average is around 10-15 years.
You also have to be on immunosuppressants for the rest of your life, with all the added risks that come with that (infections, cancer, organ damage, etc.).
>Seems a little strange to not want to try to commit to the requirements for transplant and instead just die.
You just have different values than the OP. I have values different from yours as well that would have me turn down a transplant... and it's not that I wouldn't want to live longer. There are just some measures I'm unwilling to take.
This is not a matter of values. It’s more like you can only be sure what you would do in a situation when you are actually in it. There are plenty of people who claim “if I was in situation X I for sure would do Y” but will reevaluate this when they are actually in it.
They'll do what when they're actually in the situation?
They will take another look at the available options and pick what they think is the best option. This may be different from the one they proclaimed they would take.
How do they determine which is best?
The same way you determine anything in your life. You make tons of decisions every day based on the situation.
Np, I actually have values. It's difficult to believe, most of the people around you apparently have none. First off, my own organs are spare parts for those in my family who are younger than I am... children, nieces, nephews, etc. They're never to donate to anyone in a generation older than them (lateral's sometimes ok). And I wouldn't accept donor organs from someone not in my family. I've got other people to think about than myself, so staying alive at any cost (financial or moral) isn't a consideration at all. Not saying I wouldn't hesitate if facing the end, but I've thought about this alot over the years and I've already made the choice.
My take from reading the blog post is that this person is understandably disappointed, scared and traumatized by past treatment failures. He described being scared to even try sleeping, always fearing the next shock or heart attack. Also some of the treatments seem to have been exploratory or "just in case", and then failed. That leaves a psychological scar.
It's very difficult for someone who hasn't experienced this (like me and, I guess, you) to put themselves in the other person's shoes. I think I can understand the decision he's making, and it doesn't seem to me to have been taken lightly.
Well said, I think you put up a reasonable answer. And at some level their situation will not change, they still will have heart problems while waiting and may go through all that to not even get a transplant
I get it but can't a transplant actually work well for him ? I've just read the statistics and they seem really decent. Perhaps he "needs" anti depressants and go for a transplant. It's not clear to me he is in a completely lucid state of mind - he is saying himself he thinks he has PTSD, plus he has a bunch of stuff to live for it's not like he hates life - he just hates this shitty medical mess he is in. However, it looks like his family is on board with him going through with this so what can I say.
A transplant always is a life altering change. You'll be on immunosuppressants for the rest of your life which has a massive impact on your quality of life - and that's _if_ you get a transplant before you die.
I have no idea how I'd react in that situation - but I can understand people who'd rather not. Especially considering that you might not want to take one of the few organs from a person who might be willing to fully commit to that.
When reading the rest of his posts, I think you are right to ponder how his mental health is negatively impacting his outlook. He seems to be more ready to accept death than I'd expect, given how young he is. I wish him and his family the best; an unimaginable situation.
I always ask not to be snarky but because our culture seems fixated on living forever: what’s so bad about dying?
I would be horribly sad about missing my kiddos' milestones. It's an absolute joy watching them grow up.
But if my health made me feel like I was going to miss them (or worse: derail them), then I would be forced to admit it wasn't for the best for me to keep going as is. If I was sure that was the case, it would be easy.
Conversely, it's easy to examine "from the outside" someone else's situation and say they should keep on going. I'm not so sure I could endure what TFA describes either, especially since it's probably hopeless, and especially after watching my own father sit dying for days in a hospital after his heart attack while the doctors poked him to make him move to show my mom he was still alive. It was gruesome and he died anyway.
I can’t speak for anyone else, but it feels like there’s more to do. More to learn, to see, to visit, etc…
When you’re ready, you’re ready, but people should have the option of continuing if they want.
Nothing is bad about dying, its a part of life, but his insistence on giving up despite a major medical option remaining feels illogical even though they may have good reason to not want it.
If you're a big fan of doing nothing forever, I'm sure it's fine.
Better than getting shocked all day or feeling shitty after a transplant because of the drugs you have to be on forever.
I get what you're saying, but continued existence has to be balanced against the quality of said existence. If it's agony, pain or extreme disability that prevents enjoyment of life, life seems less compelling.
Same as before you were born. How traumatic was that?
The Bardo time? Pretty fucking traumatic, at least first one I can recall was. Practice makes perfect. Why do you think so many kids are afraid of the dark? And why do you think that infantile amnesia exists to begin with?
I wonder if those implanted defibrillators would be more manageable if they gave you (say) a 15 or 30 second audible warning so you could prepare yourself?
Perhaps they would, but I would guess that you would still get scared when hearing the warning instead of the shock it self.
For example if you would get stabbed 15 seconds after hearing a beep I think you would develop pavlovian like response to the beep itself.
Counterpoint: a warning may not avert the fear but still be beneficial in cases where the person needs to prepare themselves to avoid a sudden fall/etc.
Could see it very useful if you're driving. Might even save other peoples lives in the case of a crash.
What if it had the user press a button to trigger the shock? Would it help them prepare for it?
What are you going to do once you get the warning?
As someone else said, mentally prepare, put down items you are carrying, maybe lay down on the floor?
As someone who has been shocked by the ICD, lying on the floor seems like a bad place for it, since the floor is a hard surface. You're gonna jolt and spaz and scream. According to my GF, the screams are quite terrifying. One of the orderlies or admissions people (I cannot remember which) at the ER laughed once when it happened to me. I don't think he was being a douche; more likely it was the whole unintentionally laughing at inappropriate times thing that happens to a lot of us, including me. Once the shocking started, the first thing I would do is lie back in my recliner in case there were more. Surprisingly, I don't think I've ever been shocked while vertical. It's always been in the chair, bed at home, hospital bed, or stretcher. I have no explanation for that; maybe a medical nerd knows if there are reasons why you're less likely to be shocked while vertical, or if I've just managed to beat the odds on that one.
I ran into a stat recently that gave me pause. Medical air in dying, what canadians call "MAID", is now a significant cause of death. It's roughly 1 in 20 of all canadian deaths. That is far higher than I would ever have expected.
https://www.canada.ca/en/health-canada/services/publications...
>>> In 2022, there were 13,241 MAID provisions reported in Canada, accounting for 4.1% of all deaths in Canada.
i don't think it's honestly that startling. extrapolating that number gets you to a total of 323k deaths, probably under a percent of canada's complete population based on their 2021 census population of about 37 million.
in 2021 there were 305k deaths in 2023 there were 326k deaths, and we learned that one sixth of MAID requestors died before they were deemed eligible or ineligible
and 70% were in pallative care
a lot of people die slowly and painfully, and a lot of people think long and hard before making that request.
It's almost certainly better for the vast majority of humans to die on their preferred schedule from something that wont cause them to suffer. The old joke goes:
"I want to die like my grandfather, peacefully in his sleep with no pain, unlike his passengers who all died screaming and in agony"
Most "natural" deaths are just various forms of suffering. You decay while still technically alive, your body stops working, your brain turns to pudding despite your physical fitness and healthy life.
Why WOULDN'T more people choose to die peacefully, if they don't have religious or moral problems with suicide?
I would expect, in an imaginary utopia, that the vast majority of non-accidental deaths would be by choice.
The alternative is laying in an expensive bed for an indeterminate time while a doctor pumps you so full of opioids that you are barely you anymore anyway. Or like my Memere, you die by choking on your own vomit, alone in your home, with everybody coming to see you for your birthday in a few days but miss you, because you die first. She probably would have preferred to schedule it.
it's terrifying to me all the medical cases that cannot be adequately treated with the current state of medicine.