How long can people live like this?

But not everyone's life ends that way if they reach old age, not by a long chalk.

And if I've understood you correctly, you're saying you'd refuse treatment if you were diagnosed with something now. While you still presumably aren't elderly (though correct me if I'm wrong), have all your marbles and have some quality of life. That's incomprehensible to me.

I agree. My FIL has said to my 16 year old niece that he needs to be shot rather than go into care home.

My gran lingered to 100 but there was nothing to celebrate. She lived in her own home with a carer and was just a body being taken care of for around 10 years after she forgot us all and herself. I smoke a lot in the hope it’ll get me before that.

Doctors used to withheld or stop treatments for dehydration and UTIs in very elderly patients who wished to die.

Ah of course, that's why the become so prone to dehydration and UTIs!

Dr Ezekiel Emanuel has written some interesting stuff on this. He’s an oncologist and medical ethicist and he’s said openly that past 75 he will refuse a bunch of stuff that could prolong his life, including cancer screening, antibiotics etc.

https://www.bbc.com/future/article/20141021-why-i-want-to-die-at-7

I do find it interesting his personal views are so stark one way yet he’s opposed to assisted dying etc.

I think we need to have a proper conversation about quantity v quality of life. We could start by recognising that it's not a case of keeping people alive at all costs v bumping them off at the first whiff of dependence.

For reasons I don't understand, we don't seem to have a mechanism for people, i.e. the frail person themselves, to have a voice. There's a big gap between DNR and don't medicate to needlessly extend. The person themselves, providing they have capacity, should be allowed to say what they want and for that to stand. If they don't have capacity, then we'd hope for a living will. If they don't have a living will, then I think we'd have to proceed on the basis of best possible treatment.

None of this has got anything to do with assisted dying and we definitely seem to have a problem separating these to concepts, i.e. the difference between assisted living and assisted dying.

I do feel desperately sorry for those having to navigate this trauma at the moment. My husband wasn't so lucky with his own father, who was forced to linger, very much against his wishes (that is the father wanted to die) for a number of years. It was like watching someone be tortured. So painful for all. Nothing to do with burdens. Everything to do with being harmed by unnecessary medical interventions.

As the body naturally slows down and shuts down, the brain stops sending signals for hunger and thirst. Most very elderly or dying people do not feel the sharp pangs of hunger or intense, agonising thirst that a healthy person would feel if they stopped eating and drinking.

You make your wishes known in advance fill out an advanced care directive. Ensure the person you give your health power of attorney to has a spine and is willing to decline interventions on your behalf.

Sometimes this will generate a best interests meeting with social services so it’s important things are properly documented.

I worked in a care home and a resident stopped drinking for three days, he was taken to hospital, he came home and then did it again and died. He was very vocal about wanting f to die and he had capacity. He was aged 57.

How many elderly people do take their own lives? I don't think I've ever heard of a single case. We need to bear in mind that many of the very oldest generation will have had a religious upbringing, and regarded suicide as a sin. The ludicrousness of my mother, a churchgoer, saying to me when she was in her sixties that she wanted to be 'shot' or 'suffocated' (by me) if she suffered the same fate as my grandmother who had vascular dementia. And it's highly unlikely that she would ever have taken her own life, even in the early stages. So to me, the only approach that makes sense is an ADRT requesting no active treatment for infections, no vaccs etc. And for it to be strictly adhered to, not overridden. It should be as much part of life as a will, or POA.

I suppose an older and frailer person might pass quicker using that method than those people that do hunger strikes for political reasons and seem to go on for a good while - for me it's the thirst i'd dread, being really thirsty drives me mad!

When some people with dementia want to die they refuse to eat and drink.

How would you implement this if you had dementia?

Obviously, I can’t be absolutely sure that this is what I would do, but I’ve thought about this for a long time. I looked into health screenings and made an informed decision not to have any screenings.

I used to work in residential and nursing homes when I was young. I often saw elderly people refuse to eat and drink when they wanted to die. They were allowed to die in those days without doctors trying to save them.

Even these days they are allowed to give enough drugs to someone to kill them off provided that it is the pain relief that is the intention, death is a side effect.

Medics are very concerned about being sued / reported so often have a let’s start off low so we do no harm. If a person is effectively dying then is it still harm?

Not all medics tbf I read a sad story where palliative care was going toe to toe with oncology at a dying child’s bedside because she was still in pain despite all the drugs and one lot wanted her sedated. The idea being if you cant take pain from the patient you take the patient from the pain.

Obviously an awful story but I was glad to see some doctors are still willing to fight for their patients rather than the endless arse covering.

Was taken away from my dad, lost some use of his hands so couldn’t open the bottles even if he wanted to.

No option to opt to die even for a person entirely paralysed and losing themself to dementia

Easy to sit and say that! Just like my mum often talks about taking all her benzos and ending it but she never has the balls to do it.

Do you not think that these people don't let their families know that are miserable and don't want to be here? There's tons of posts here from people who are suffering because they've got a relative that's very vocal about not wanting to be here! You've no idea that toll takes on people and how energy sapping that is? Have you ever found it so hard to ring your own mother that it takes ages to psyche yourself up and a stiff drink to be able to do it? Trust me its not fun when they are suicidal and don't want to be here!

The 'poor doctors' coped 50 years ago, and until Shipman I believe were quietly and efficiently still 'coping.'

This is what people seem to either forget or just not understand.

All this “I will refuse x, y or z” is just not realistic. By the time you are at the stage you don’t want to be at, you won’t have the capacity to have an opinion.

“at some point, you’d have to take yourself to hospital where the poor doctors would have to try and make you comfortable.”

No, I wouldn’t take myself to hospital. I would kill myself instead, or if I couldn’t manage that, I would take to my bed and stop eating and drinking.

How could a doctor euthanise someone when they’ve taken the Hippocratic oath? Even if it was legal, it’s harm.

Well that is if you could get proper palliative care in a hospital….

I agree people have no idea what it means to ‘just let the illness take its course’. Some times, it might be the kindest thing to do. Often it is not.

Like you have an infected wound. You don’t want AB. So you’re waiting with an infected wound, in pain, hoping it will become systemic quickly to take you away.
Not what’s I’d see as a peaceful and nice way to go.

Well, we are western, and I personally as a woman would not want to adopt Thai or Indian cultural values in order to prolong my life. Also I don't believe Thai or Indian men are doing much elder care, or child raising for that matter.