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

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I recently started watching Facebook videos and haven’t yet adjusted my preferences for content I want to see. I’ve been bombarded by videos of “feel good” stories. It’s largely about people in the US who have had life changing injuries. So for example, a shot gun wound where they lost most of their face, or someone who has had all of his body below the torso removed because of an accident. In all these cases the person nearly died but was saved by modern medicine.

I want to be clear I am disabled myself (and have a not great quality of life) and I think if people want to have surgeries/treatment they should have them on the NHS and be fully supported by the welfare state if needed. But, is it always ethical to
intervene? And is consent always needed?

I’d be really interested to hear from any medical professionals or people with firsthand experience what they think. Is it possible to put in place something on medical records to say in advance when we wouldn’t want treatment.

My experience is that the NHS/medicine is great at physically saving people but there is very little support for living with the impact of serious illnesses/injury. I assume it’s the same in the US.

YABU-we should always use medicine to save a life

YANBU- it’s more complicated and sometimes it’s kinder to let someone pass

Definitely. It seems to be excellent at acute care in emergencies - which I've experienced and had great benefits from - but therapy or other type of support and treatments for disabilities, especially obscure or rare disorders like mine, are practically non-existent. I think most people who are disabled with chronic illness probably just exist in limbo, and if they get PIP, they are absolutely fortunate.

My dear Dad died a couple of years ago, when life support was withdrawn by doctors 24 hours after he suffered a huge heart attack. His brain had just been deprived of oxygen for way too long. I’m devastated that he died - but although he would never have filled out forms, he would have absolutely hated to have been kept alive by the medics, but be very badly brain injured. I’m heartbroken to have lost him, but it’s a small comfort that he didn’t have to face that. Miss him so much…

Very interesting to understand more how it works in practice. It does sound like often there is intervention to stabilise the patient, without which they would die?

I’m sorry you are also struggling with a rare/not well understood condition. It’s so tough x

I remember reading about the young lad in the States who had the hemicorpectomy - I couldn't get it out of my mind at the time as I hadn't thought surgery like that was possible, survivable, or ethical. But I also remember reading that there had been time for the medical team to discuss with him, and that it was what we wanted when death was the only other option. I don't think it's what what I would want - but how can anyone who has not been in that position really say?

I also wonder if there is a cultural difference between UK and the States, as I can't see this kind of radical surgery being presented as an option in the UK - but I have no idea really.

You sometimes see cases in the courts here when family and doctors disagree about what treatment is in a patient's best interests when patients can't decide this for themselves. I'm not sure if this happens in other countries where finances have a bigger impact on treatment and if it's the insurer who has the final say.

Agree about the algorithms pushing this kind of content - whilst it's good that disability is visible and not hidden, the way these account show up also feels quite voyeuristic. Especially as a lot of them are linked to fundraising efforts to pay for medical bills.

Really sad and thought provoking thread - I am sorry to hear about the difficult experiences other posters have shared about themselves and their families.

I’m so sorry x

Thank you 😊 💖 I keep on keeping on, but it is hard sometimes 😢

I actually had similar with my mum who was quite young, which I think has made me more aware that the unexpected can unfortunately happen. I’m definitely going to follow up on the links to documents shared

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.

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 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 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 bet you weren’t 23 +6,

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 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.

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

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.

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

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.

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.

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.

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.

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

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