TW: death/injury When is it kinder to let someone die?

It is interesting that people are saying they don't want saving after a massive brain injury. I used to say the same. Recently someone very very close to me suffered this, and was expected to have no quality of life. They were kept alive. Brains are so unique. Despite huge trauma, this person is now walking, talking and enjoying life, not very long after the event. I won't give any more details. However, it has made me rethink what I vocalise about my own wishes, should anything similar happening to me.

Also, doctors don't know in advance how a person will do. They can judge probabilities but there are always outliers. I know an ICU doc with a story about an 18 year old, high speed head on car crash, no seat belt. Presented at ICU with absolutely catastrophic head injuries, to the point receiving physician hesitated to commence attempting treatment. To everyone's surprise he was still alive the next day, but prognosis was terrible.

He walked out of hospital and went to university. Granted, that's an extreme outlier, a "once in a career" story, but it happens.

Wear a seatbelt.

Well if I’d have written after 80 that you can commit suicide with professional assistance, it would have been outrage all round - just look at the recent assisted dying bill!

Yes so why desperately prevent illness in the extremely old - they do though!

I think barbiturates are the easiest way to go. I’d agree with you though. In the Netherlands in order to get help to die you should be in unbearable suffering. It’s a subjective definition obviously as we all have different thresholds but Ibthink it’s appropriate.

I haven't read the full thread yet, but I also think about this a lot.

We spent 6 months in hospital after a car accident (100% caused by a negligent driver).

My 5 year old son (now 12) was rendered paraplegic in this accident and I am permanently disabled and in chronic pain. There was a time that I (and my son) wished that we had rather died, although we're currently in a place where we are happy to be alive.

But the time spent in the rehabilitation hospital was horrific. Some children had near-drowning accidents and the lack of oxygen to their brains left them unable to do anything by themselves. They lay in bed all day, moaning and staring at the ceiling.

We live in a 3rd world country and this was in a private hospital, so the parents are paying for the care of their babies, which includes feeding tubes and being turned over now and then. What kind of a life is that?!

I know a family whose baby was deprived of oxygen at birth and the hospital admitted fault. They were paid out quite a bit of money, but it's in a trust and gets doled out as the trust sees fit. It only covers medical equipment and doesn't take into account that the parents have had to change their lives and careers to fit around this and all three (mum, dad and son) have zero quality of life. They joke that they are the poorest rich people around, but I know they are miserable.

I don't know what the answer is, I really don't. All I know it that there is no god. Surely if there was a benevolent god, he would not let these things happen?

Nice recommendations are done on qualys- quality adjusted life years, how much life benefit is gained for how much cost. It has zero role in any decisions we make acutely as to how or who we treat (heart attacks strokes major trauma etc).

It's role is predominantly in determining if drugs or equipment should be funded for a specific condition. Most commonly cancer drugs as they cost a fortune and can sometimes only at best offer a couple of months of extension of life (so needs to be a national decision on how best money is spent). Sometimes v rare diseases with no treatment (motor neurones/Huntington etc) that have horrific quality of life will be given a vo ahead even if minimal benefit for a high price as there's no alternatives/humane reasoning etc

en.wikipedia.org/wiki/Quality-adjusted_life_year

The guilt is unreal either way. Half why I'm awake at 4am on my AL. There's not many we palliate at arrival (thinking huge trauma car crashes etc) we will give hours of pouring blood products in in theatre to give the surgeons time to try to stop the source of the bleeding but sometimes its just not enough and despite all our efforts they pass away anyway (their hearts go into cardiac arrest and we have repeated attempts to shock it back out but it doesn't always work

That's no longer the case, if someone is compliant with medication and has good social support etc they can definitely be listed

Yes. Anaesthetist and icu Dr and I often think that. There's a lot of icu care that is frankly pretty awful to induce and I wouldn't particularly want myself. Similarly having done a stroke job or worked in neurosurgery, there's many people that live in vegetative state almost that i would never want myself

It's called an advanced directive where you can write a list of things you would and wouldn't want if you lost the ability to communicate and even just rough ideas of I wouldn't want to spend months in icu with a tracheostomy and have a v poor quality of life at the end of it. You just need it to be witnessed and signed then give to gp and hospital to record it. I haven't registered mine yet but its an ever growing list on my laptop

The other thing u really really wish people would do is talk to family about what their wishes are as at least 90% of the families I talk to have absolutely no idea as its deemed taboo. At least with my parents from talking work to them I have a v good idea of "don't ever do that with me" even if the idea is awful

Everyone should have lasting power of attorney so that others can make health decisions on their behalf. Don't pay a solicitor a fortune download it from the office of the public guardian website and get it witnessed by friends of neighbours and submit it for about 80quid each (one for health one for finance).

I've often thought we do a lot of treatments in medicine just because we can, not because we necc should and that's what motivates me to be v explicit in my wants as I don't want to live in a v dependent state. But then every now and then you get a total miracle patient and you see why we do do everything

Everyone needs to consider dnar orders, cpr is utterly brutal and an unpleasant way to go, and doesn't work in most instances. I utterly hate it when working in cath lab and you have an out of hospital arrest come in in someone thats 90+ with many health conditions, its horrific to do and you know it has no chance of success

Theres lots we can do in medicine and I think we are becoming quite American in our defensive practice now. Things for eg like decompression craniectomies - removing part of the skull to allow the brain to swell after a stroke or traumatic brain injury etc i mentally struggle with as there's a big study showing if you do it, far more survive but far more survive at the vegetative end of the spectrum in minimally conscious vegetative type conditions which personally I'd rather be dead from. But obv we have no idea when going into the surgery whether the individual will be one of the lucky ones or not

That’s because organs are a precious resource and they do the want to "waste" it on someone with low chances of recovery/high chances of rejection.

Even now schizophrenia bars you from the organ recipient list.

I know because I had a first episode psychosis at 27. Classic timed onset for female schizophrenia. The doctor told me they thought that was what I had but that they wouldn’t put the diagnosis because it will bar me from life opportunities such as organ transplants.

They apologised profusely and said however if they see me again, or anyone else again it’s likely to get changed.

Thankfully never had another episode. But that did shock me. Even if I do have schizophrenia and it does come back one day I am a valuable member of society. I have friends, family, children, work, own a business, contribute to society.

I think if there's hope of life treatment should be attempted. It's too hard to predict how well people will recover.
The exception is when it's extremely elderly or terminal people who will likely only live a few months longer and endure significant/unbearable pain.
Otherwise I think treatment should be attempted as guessing at the outcome could result in people dying who could have actually lived more fulfilling years.
It's too hard to decide what quantifies poor quality of life too, for example to some severe facial disfigurement/inability to speak would make life unbearable, others might feel life is very much worth living still.

And both of my parents died before reaching 80. The idea that we should not worry about this until we are in our late nineties is niave.

No, but i was weaned off heroin and called "a miracle of modern paediatric care " by the professor at King's College hospital NICU, who pioneered these places and treatment. I was 28 weeks and 2lb so small enough, thank you.

I have "only" got high frequency hearing loss as a result of my early birth, but i think my prematurity was a possible contributing factor to some of my susceptibility to my current health problems.

A very small number of people live till 95. The median age for women to die is 84.

Its very hard. In the past Doctors would leave babies to die who were born very early as it was thought they would have no real quality of life. We no longer do this.

According to this, babies born at 23 weeks have a 55% chance of any disability but only a 15% chance of severe disability. At 24 weeks it’s 39% and 8%. https://cahs.health.wa.gov.au/Our-services/Neonatology/Resources/Library/Birth-of-your-baby-at-23-to-25-weeks

I find this topic so interesting, especially after working in intensive care for many years. I did a masters degree in healthcare law and ethics and my dissertation was on whether a person had the right to demand treatment, even if the doctors disagreed. There are so many factors to consider when deciding on what treatment to give people.

Essentially doctors have to decide if treatment is in the best interests of the patient. To work this out, they look at quality of life, burdens of treating/not treating, patient’s wishes. Sometimes considerations need to be made about wider society such as using scarce resources that others need (such as an ICU bed), family considerations, costs of treatment.

Sometimes it is not clear what the best interests are and if medics are not sure, they treat and think later. Generally it is seen as better to accidentally save someone that didn’t want to be saved, rather than letting someone die that wanted to live.

I could write thousand of words more and go on about ethical principals and the realities of the healthcare system and tell you some real life stories, but I’d be here all night!!

There’s loads of books out there that you would find interesting. Go and buy yourself some books and dig deeper into the issues, it’s absolutely fascinating. I can recommend “The value of life. An introduction to medical ethics” by John Harris.

Is the shotgun example the women who tried to take her life and was given a face transplant? I saw a ‘feel good’ video that documented what happened, and at the end the woman said she was glad to be alive. I wasn’t sure if that was for the cameras though, and it wasn’t clear how her brain had been affected.

I bet you weren’t 23 +6,

I was one of the born too soon babies 43 years ago. If I'd not been saved, my parents would never have adopted me

😢😞

I think we keep too many people alive- the old, the born too soon, the near fatal accidents. Just because we can, doesn’t mean we should.

When I’ve had enough of life, I’ll want to die. I won’t be getting a flu vaccine at 95 (if I’m here), I would t want one if I had dementia, but they bloody give them. Crazy.

I agree - this group of people is for obvious reasons less likely to vote or be able to advocate for themselves and is just easier for politicians and the rest of society to ignore.

It's why the care sector is such a mess - no one wants their taxes to go up or their inheritance to be affected in order to pay for it, and the people who it affects the most are least able to speak up.

I suppose doctors and nurses are there to preserve life, so in some of the instances you've mentioned, medical professionals will want to intervene to save those people's lives.

My DH told me that if he ever was to be in a vegetative state (I'm sorry if that isn't the correct term), then he'd want me to put a pillow over his face.

My mum had cancer, and died very quickly - no drawn out period of suffering. She was pretty healthy considering and it happened in a matter of days. I was with her for the whole of her last night on earth, and after seeing her suffer so much on her last night, I was relieved when she went. Then came the reality, smashing me like I'd been physically beaten, grief and feelings of guilt that I'd actually whispered into her ear to 'Just go to sleep and be at peace'. I couldn't stand seeing her in so much pain.

I think I would want to be saved at all times, unless I had something like Locked In Syndrome, or I was in extreme pain.