jollyroger's picture

    Life, Liberty, and The Pursuit of Happiness includes the right to die.Living wills should include a "pull the plug" clause, beyond simply "Do Not Resuscitate".

    By jollyroger on Fri, 08/24/2012 - 3:34am |

    "No fuckin' way". The nurse had asked of I wanted to be resuscitated if my shit went south while they were fixing my broken neck. She was surprised. "Really?" "Really, no heroics. They always work out badly "

    We only rarely are given the gift of choosing the better end, and more often fate and an archaic system of laws that enshrine an outmoded mandate against suicide condemn the terminal sufferer to extended agony. So deep is the hold of the old priest ridden theocratic regime, that in all but a few states one choosing to exit is condemned to slapdash and frequently painful methods, despite the advances of medicine that put within technological reach an assisted death with dignity.

    More poignantly, even *one who has made essentially the same decision as that which surprised my nurse, may find herself trapped in a prolonged nightmare because she can no longer effect her own release and the laws conspire to prevent assistance from the most logical source (her doctor). Thus we are left to the merciful intervention of our closest loved ones, with terrible consequences to them, both psychic and legal.

    If you do not own your own life, and thus the right to end it, you own nothing. Only the stale echo of a regime that once made suicide a cause for eternal hell fire enforced by the priests' possession. of the key to the hallowed cemetary, prevents us from demanding this elementary and elemental right.

    Fuck Yahweh, his messengers, prophets, shills, scribes, and hustlers.

    Freedom. Freedom to live, and freedom to die.

    *She was very beautiful

    Comments

    She was very beautiful.

    by jollyroger on Fri, 08/24/2012 - 4:20am

    That's weird. There was a wedding pic before. First time I was ever busted for hotlinking. See asterisked link.in post body.

    by jollyroger on Fri, 08/24/2012 - 5:05am

    correction- they got that one too. Yo, G. (or similarly sophisticated savant) How'd I get busted, and for what?

    by jollyroger on Fri, 08/24/2012 - 5:08am

    http://graphics8.nytimes.com/images/2012/08/24/us/MERCY-1/MERCY-1-articl...


    by PeraclesPlease on Sat, 08/25/2012 - 6:03am

    Well, sure, if you are not evading the paywall like I do cause I save my 10 free visits for Krugman 's blog which can't. be reached by anonymouse. Fuck pudge sulzberger.

    by jollyroger on Sat, 08/25/2012 - 3:22pm

    once is enough...

    by jollyroger on Fri, 08/24/2012 - 4:22am

    Confusion could arise because medical personnel are unclear if you didn't want aggressive measures taken because you thought the bad outcome might mean permanent paralysis after your surgery or if you did not want a shock delivered to your heart if an abnormal heart rhythm occurred during surgery.

    If the spinal cord was damaged during surgery and paralysis was the result, life might seem of no value. If a cardiac arrest occurred during surgery, defibrillation can be applied to correct the rhythm. If a heart blockage caused the problem, the vessel could be opened with a stent or even bypass surgery. You could leave the hospital mentally and physically intact. That may be one issue that needs clarification for hospital staff.

    If there is no living will with a do not resuscitate order that lists what things you do not want done, hospital staff may ask questions that seem intrusive, but they want to get clear in their heads what you are saying. But, I'm telling you what you already know from a legal standpoint.


    by rmrd0000 on Fri, 08/24/2012 - 8:38am

    Hmmm. It may have implicated issues of greater complexity than I considered at the time, proving once again that it's better to be lucky than smart.

    by jollyroger on Fri, 08/24/2012 - 9:40am

    I have to add a little something. Well, maybe a lot of something.

    Earlier this year I was also asked if I wished to be resuscitated if things went south for me. Actually, things had already gone south -- I was in the ER of the tiny local hospital with kidney failure. I was asked the question by a nurse in that ER. I was asked by the paramedic in the 75 mile trip by amber-lance to the bigger hospital and I was asked by a nurse in the big city ER as well. I was so out of it, I couldn't connect with what they were trying to say.

    It wasn't until my son showed up and said, "Ma, you're about to be pushed off a cliff. Do you want a parachute or not?"

    "I want a parachute!" I said.

    I lived anyway. wink ... Shift+R improves the quality of this image. Shift+A improves the quality of all images on this page.

    The thing is, I think how a person answers this question depends on how well they have handled the shit sandwiches life has handed out to them before. It builds up over time until one pretty much knows, internally and instinctively, how much more they can take. Does that make any sense?

    And also; survival of the lucky, not the fittest, is what that whole evolution thing is really based upon.
     


    by wabby on Fri, 08/24/2012 - 10:31am

    Ma, you're about to be pushed off a cliff. Do you want a parachute or not?"

    I'm not sure how much of this is an actual quote or a metaphor. I think 99% of people would say they wanted a parachute irregardless of how they handled shit sandwiches in their life if this is the question. But its not. The questions are so much more complicated and most people in the condition you describe aren't capable of dealing with the complexity. Sometimes they're not even capable of answering that question.

    My mother was visiting her father when he had a heart attack. The paramedics worked on him for an hour on his living room floor just to get him stabilized enough to get him into the ambulance to get him to the hospital. As my mother sat there watching.

    He spent the next ten days in intensive care, tubes in the arm for water, nutrition, and drugs. Oh yes he had good insurance as a retiree of the Bethlehem Steel back in the day when steel companies were rich. He got the paddles most everyday, some days more than once, to kick start his heart. He never regained sufficient consciousness to speak though he did open his eyes a few times.

    When he finally died the insurance company got a bill for 60 thousand dollars. My mother said the hospital tortured him. She wished he had died on his living room floor. Within six months both my mom and dad had filled out detailed end of life forms with their doctor to try to make sure that never happened to them. That was about 40 years ago and they have updated them and made sure each of their new doctors have a copy on file.

    25% of medicare dollars are spent on people in the last year of their life. That's 2% of beneficiaries. We desperately need to have a serious discussion of end of life issues. Its not something that can be discussed while on a stretcher in the emergency room and its a much bigger and more complicated question than, "Ma, you're about to be pushed off a cliff. Do you want a parachute or not?"


    by ocean-kat on Sat, 08/25/2012 - 3:59pm

    This brings into focus the great weakness of living wills which I was trying in a clumsy fashion to highlight. A true " parachute " would include a living will clause:"get me the fuck outta here" if such and such conditions prevail, eg. the situation you described above. The "DNR" instructions are too limited.

    More to the point, in my own case I should have the right in case I case I awoke with nothing but the ability to blink once or twice, to say if I blink twice, pull the plug. With that option I would have agreed to heroic measures just in case everything worked out well afterwards but if it didnt work out well I would have no way of getting out under current law.

    by jollyroger on Sat, 08/25/2012 - 4:24pm

    Yes, living wills are just part of the discussion. I'm in favor of assisted suicide with appropriate checks and balances. I'm sure that many cancer deaths 50 years and more ago would be more honestly described as death by morphine overdose mercifully administered by the doctor.


    by ocean-kat on Sat, 08/25/2012 - 4:37pm

    Precisely h/t DoubleA

    by jollyroger on Sat, 08/25/2012 - 4:56pm

    Interesting article. I  had a similar experience with my grandmother. We cared for her in my parent's house until it was impossible. She could not make coherent conversation, had no conception of time, could not use the bathroom, could not change her diaper etc. Dementia to the point that her sole human attribute was anger. Fortunately she had kidney failure and she began to refuse dialysis, not in words of course she couldn't communicate. She had to be strapped down for the dialysis or she would rip out the needle. She would fight and rage against the straps until she was too tired and her arms and legs got black and blue marks where the straps were. My parents and her brother convinced the nursing home doctors to stop the dialysis and she died a few days later.


    by ocean-kat on Sat, 08/25/2012 - 5:37pm

    strictures against assisted suicide either by way of conscious request or via instructions cuts the wrong way. My DNR was informed by the limitation. More poignantly, my father, who always kept a stash of morphine pills in case he wanted to get out of trouble, deferred hospitalization for a throat biopsy because on a prior visit to the hospital he had awakened to find himself straped down to a gurney and realized that in a similar circumstance he would have to rely upon a loved one (probably me) to fetch and administer his bottle of relief. He died on the weekend between the cancelled Friday biopsy and the re-scheduled Monday. He was a guy who thought this.he through. With an option to a legally assisted exit, he might have tried treatment, but denied that. he refused.

    by jollyroger on Sat, 08/25/2012 - 5:52pm

    One big part of the problem is that many doctors can no longer define "first do no harm." It's a principle that's basically become obsolete, especially in our ICU's. Much medicine is at a stage where the patient/family is basically given this choice if they were truthtful: "we can make you feel a lot sicker and live or we can let you die." Where making the person feel well is not one of the choices. Many treatments that "save lives," even those as simple as intravenous antibiotics, given often enough and/or long enough, end up ruining body organs rather quickly, ironically bringing on death anyways, and not without pain and torture.

    I learned all about dialysis up close and personal, family. I would judge it not really the worst of the worst that can happen to you, but your mileage may vary. During one of her last of many life/death  crises, many of which she won (I would estimate she "won" something like another a decent decade from medical intervention, but add on another half decade of torture) Art Buchwald's story was in the news. He refused dialysis, though his doctors said he would die within weeks without it. He went into hospice, and lived there quite a long time before he died, it was something like a year, they wanted to kick him out or he was kicked out  and let back in again, because he wasn't dying fast enough, I don't remember the exact particulars. In any case, I think it was painful for her to hear the story, that you could make this choice, she was probably wondering about her own choices. Unfortunately by that time she was robbed of speech and usually on a ventilator as well.

    I don't believe anyone can rely on a living will alone to serve their intent well. It's likely that whatever it is that happens to you is not covered in it exactly, the scenario not imagined when the writing was done. It usually has to be interpreted as to intent by someone else.


    by artappraiser on Sat, 08/25/2012 - 6:26pm

    One's thoughts turn to Hemingway and Hunter Thompson. Dementia is the great horror, for then we may be in intolerable pain, yet forget which end (hint: The round one) goes in mouth. Reaching around to pull a statistic from my research department I believe the differential between men's and women' s successful v. attempted suicide is pills v. firearms.

    by jollyroger on Sat, 08/25/2012 - 6:33pm

    Yes, a living will is the start of the discussion we need to have on end of life issues not the end point. My parents did the best they could to try not to get trapped in the system. But I agree with you, flowerchild and others that its not guaranteed to be enough.

    My grandmother got a good decade of life with dialysis too. Its when the dementia got too bad for my parents to care for her in the home that things went south. I don't know why she was fighting the dialysis. Did she want to die or did the dementia leave her unable to make the connection that this unpleasant experience was keeping her alive? By that point she was unable to communicate enough to answer that question.


    by ocean-kat on Sat, 08/25/2012 - 7:20pm

    Physicians are trained to preserve life. In an era when we are discussing people getting vouchers to cover health care that don't cover all the expenses, we have to be careful about encouraging physiatrist-assisted termination of life. The first responder physician should be ready to go full speed ahead to save a life.

    Perhaps a subspecialty of Terminal Care/Euthanasia  may arise from the current subspecialty of Anesthesiology/Pain Medicine. These physicians has a ready knowledge of the actions of anesthetics and pain medications and be more able of  properly administering terminal pharmacology. The fact is that the body fights for life and done improperly medications to "put people to sleep " can lead to convulsions, release of body fluids,etc.

    The development of a group of physicians trained to provide a necessary service. I would like to see the other M.D.s being obligated to make the referral. How the referral could be is obviously up to debate.Perhaps a set of criteria that ranks how likely a person receiving aggressive care is likely to have a good outcome. The downside of this approach is that it will rise the specter of "Death Panels".


    by rmrd0000 on Sat, 08/25/2012 - 10:12pm

    Parenthetically, the margin between a "therapeutic " and fatal dose of heroin is dangerously narrow, perhaps indicating a future category of medical heroin to join medical marijuana. Less facetiously, I am informed that it is far better than morphine as an analgesic, plus it is a euphoriant.

    by jollyroger on Sun, 08/26/2012 - 12:23am

    o/t I got several shots of Morphine when I first came into the hospital and I don't get what the big whoop is.

    by jollyroger on Sun, 08/26/2012 - 12:26am

    Really? I will never forget the only time. In college, had such severe intestinal pain continually increasing in intensity through like 18 hours, screaming pain, getting louder every minute. I really would have done anything to have it stop, including die. At the ER, the doc gave me one shot of morphine, he could see that I needed it and couldn't even examine me without it, and the pain went vamoose--like within 5 minutes.. magic! There was nothing so heavenly as to be free of that pain and to drift off  soooo relaxed, no high can compare, before or since, nothing can compare. Free of the pain at last! (Don't remember if they gave anything else, never really needed a diagnosis, don't remember if I got one, because I slept a day and it never came back, was probably food poisoning or an object I swallowed with food or a stone or something?)


    by artappraiser on Sun, 08/26/2012 - 12:57am

    Not so much about the pain-it didn't get me high (and let's just stipulate that I know a thing or two about the topic..) Now one time I had a root canal level toothache but couldn't get it done for a few days, and I found that a cocktail of romilar, hash and acid did the trick. Still felt some residual pain, but in someone else's body PLUS I was seriously high.

    by jollyroger on Sun, 08/26/2012 - 4:40am

    To be fair, as categories go, I like uppers, not downers. It's probably related to my serotonin receptor surplus (150% of normal per P.E.T. scan) Don't like smoking opium either.

    by jollyroger on Sun, 08/26/2012 - 4:49am

    Or, maybe the receptor surplus is the result of the 400+ acid trips...hard to say.

    by jollyroger on Sun, 08/26/2012 - 5:02am

    Actually most of the time suppression of breathing is the major problem. If you support respiration with an oxygen mask or ventilator the respirator suppression can be reversed with an injectable antagonist that corrects the problem. If the lack of oxygen because of slowed breathing has effected the brain or other organs, then you may have a real problem.


    by rmrd0000 on Sun, 08/26/2012 - 1:35pm

    One's mind is drawn ineluctably to.Quentin Tarantino.slamming a syringe of Naloxone into into Thurman's chest.

    by jollyroger on Mon, 08/27/2012 - 1:23pm

    My dearest Jolly... I am not an advocate of suicide, assisted or otherwise. It's probably because I'm a natural born optimist and if there is one molecule of hope floating in the universe that things will get better, I'm all for giving that one molecule a chance.

    Yet, I am not indifferent to Mr. Wise's dilemma and understand completely his motivations. I understand there is such a thing as no hope left at all. Mr. Wise probably thought there was no hope left at all for his wife, so he did what he did.

    If this was the case, and I was a juror at his trial, I'd give him a pass.

    And I really think there should be more states that give a person leeway if one wishes to take that path. The stigma of an action like suicide/assisted suicide doesn't really have a legitimate place in a generic moral code because it is so very, very personal.

    I also think this is one of those combustible issues, like abortion, that fires up all sides for what is basically a religious tenet.

    But, enough about what I think.

    The tricky part of a situation like this is figuring out if it was assisted suicide or plain old murder. Is that a lawyer job? Or a police investigator job? I don't know. But, I do know that there has to be some kind of definite division between the two actions (there oughta be a law) so one cannot be excused for the other. Like I said: tricky.


    by wabby on Fri, 08/24/2012 - 9:51am

    That is so right on, well stated

    if there is one molecule of hope floating in the universe that things will get better, I'm all for giving that one molecule a chance.


    by Resistance on Fri, 08/24/2012 - 10:13am

    I'm pretty clear that in this instance we are talking about assisted suicide, albeit perhaps "freelance". Myself, as I have elsewhere detailed, I am pathologically optimistic with a clinical basis for the orientation. I suppose the optimism operated on my own case to dismiss the likelihood of a misadventure.

    by jollyroger on Fri, 08/24/2012 - 12:26pm

    I am not as clear on this as you seem to be. From what a witness has said, it seems Mr. Wise intended to kill his wife and then himself, but the gun jammed and, pfft, there went his plan. No, assisted suicide on it own is not clear to me at all. Neither is outright murder. A suicide pact would be an angle I could argue for since apparently they were quite a private couple. 

    Like Mr. Day might say, I haven't seen the entire file.


    by wabby on Fri, 08/24/2012 - 1:11pm

    I call it freelance assisted suicide because Mrs. Wise had a living will but the living will under our present legal structure does not extend enough for a doctor to assist with the person's wish in an active fashion. I rule out murder because Mr. Wise acted without "malice" which is an essential element of the crime. (A-man, don't come at me on this -I'm fudging a term of art into it's philosophical meaning)

    by jollyroger on Sat, 08/25/2012 - 3:16pm

    It seems Mr. Wise had no faith in the Living Wills. Which may be why there is a question of him turning the gun on himself.

    I do agree he acted without malice. I would even suggest it was with compassion.


    by wabby on Sat, 08/25/2012 - 6:14pm

    more than compassion-love. Go back to the article and look at the wedding picture. (bear in mind I say this as a "five-time-loser"...no three strikes rule for marriage ...)

    by jollyroger on Sat, 08/25/2012 - 6:49pm

    I do not have a Living Will because of going through a similar situation with my father as ocean-kat's mother did with hers. I don't have a lot of faith in their usefulness.

    I do, however, have a Medical Directive on file at my doctor's office. My general practioner knows my wishes. So does my family. The problem for me arose at the ER. It was late in the morning on a Sunday and information from the dr.'s office was unavailable to the ER staff. I think the staff at both hospitals tried to get some kind of response from me in their best effort to do what I wished. I would have liked to accommodate them, but, like I said, I was kind of out of it. I think my son was trying to shock me into a response. It was not a metaphor.

    All this proves jolly's point. As they are written now, Living Wills are basically crap. Either they are ignored or the result falls too short or too far of the intent.

    Maybe the .2 Living Wills could include an assisted suicide clause. This definitely needs discussion even though most people don't want to. Just too icky, I reckon.

    Or, there's always Soylent Green.

     

     


    by wabby on Sat, 08/25/2012 - 6:25pm

    It's good to see two other people who think living wills are not all they are cracked up to be. If someone starts yammering about how important they are, I just secretly have this kind of roll-my-eyes reaction and feel like saying "oh really, just wait and see." Feeding tubes are really nothing, chances are you might want one some day for a short time, and recover quite nicely; same for ventilators. They signify nothing one way or another, really. On the other hand, as far as that DNR order, well, there's a lot of people with them praying in their hospital beds right now that their heart stops so they can die, and it isn't happening for them.


    by artappraiser on Sat, 08/25/2012 - 6:37pm

    Hence my addition of the expletive for emphasis clarity in replying to the nurse's question.

    by jollyroger on Sat, 08/25/2012 - 6:52pm

    Einstein's take (serendipitously brought to us by an Op-Ed in today's Times ): "As he lay dying of an abdominal aortic aneurysm in 1955, he refused surgery, saying: “It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantly.”

    by jollyroger on Sat, 08/25/2012 - 8:44pm

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