Notice a Change in Tone?

[GravitySucks]

I wasn't thinking morphine in lethal dosage, just that I've seen it releave the anguish and pain of not being able to breath.

 

[Turbo29]

I have read about the problems with lethal injections by the states that still use capital punishment and have always wondered why they don't just simplify the process and use carfentanil. Based on what I have read about the opioid crisis, it appears to kill people almost instantly.

I was just at the veterinarian's office two weeks ago to have one of my cats put down. This is the 7h time I have had to do this in my adult life and I was present every time for the whole procedure. They didn't all use the same drugs but not one of them got it wrong. Why can't they seem to get it right with humans?

 

[pb4uski]

Often we treat our animals more humanely than people. Sad.

 

[W2R]

[...]None of us get out of here alive, we should give some thought to how we would rather go.

(Bolded emphasis mine)
For me, suicide is out of the question. I'm tough and would rather try to handle it and maybe survive, than to just give up and off myself.

My family's coat of arms has a saying on it that translates to "Fight to the Death". That was the subject of SO many jokes about family interactions when I was a kid. But honestly, that is the way I am made, it is in my blood, and I would rather go out fighting.

I do not think making an informed decision is suicide .Do you consider People who refuse chemotherapy when they are stage 4 as suicide ?

I do not judge the decisions of other people and will leave that discussion up to you or others. But as for me, as I said above, I would rather go out fighting.

 

[ER Eddie]

If quality of life is gone, I'm in pain, and there's no reasonable hope of recovery, I'm out. I know what's on the other side. I'm not afraid of death. I'd rather do without prolonged unnecessary suffering during the last couple weeks, if I have a choice. I'd do it for a dog I love (have a couple of times), and I'll do it for me, too.

It's different if there is chance of recovery, though. If the odds are 20% survival, I'd give it a shot, even though I hate the idea of being on a ventilator.

 

[Tadpole]

If your advanced directive for medical care says you do not want to be kept alive by artificial means, does that include ventilators?

 

[LARS]

god I wish I'd never stumbled onto this thread. Ugh.

 

[swakyaby]

If your advanced directive for medical care says you do not want to be kept alive by artificial means, does that include ventilators?

Yes.

 

[Amethyst]

I think the main reason is that animals' relatives can't sue afterward.

Often we treat our animals more humanely than people. Sad.

 

[Amethyst]

"Ending your life on your own terms" is not an infrequent theme on this forum.

god I wish I'd never stumbled onto this thread. Ugh.

 

[donheff]

I am of mixed mind on this one. My medical directives advise DNR if I have a terminal illness, I may need to add DNI if that isn't already implied. Not knowing much about it, I would have thought intubation was fine for some critical (normally non fatal) trauma or illness but, the more I read about if for this virus the less I like the idea. An ICC pulmonary doc in NYC said the rate of death at his hospital for intubated CV patients was 86%. Couple that with extended recovery for old folks (I'm 71) and I am inclined to say O2 and repositioning, CPAP if available, but no ventilator.

 

[blueskyk]

I am of mixed mind on this one. My medical directives advise DNR if I have a terminal illness, I may need to add DNI if that isn't already implied. Not knowing much about it, I would have thought intubation was fine for some critical (normally non fatal) trauma or illness but, the more I read about if for this virus the less I like the idea. An ICC pulmonary doc in NYC said the rate of death at his hospital for intubated CV patients was 86%. Couple that with extended recovery for old folks (I'm 71) and I am inclined to say O2 and repositioning, CPAP if available, but no ventilator.

+1
For me, part of thinking all this through and discussing it with DH is to help him navigate the situation. It’s blisteringly difficult to make these calls for a loved one and often, decisions are endlessly second-guessed by the decision maker. It can be a great comfort to know you decided in accordance with their wishes.

DH and I have discussed the quality vs quantity issue well, to death.

IMHO it takes equal courage whether you’re in the fight to the bitter end club or the death is (ultimately) inevitable and refuse treatment club or the drink the kool aid club.

Regardless, much misery can be minimized by being in the formally documented and thoroughly discussed club.

 

[braumeister]

I am inclined to say O2 and repositioning, CPAP if available, but no ventilator.

By the time you get through tattooing all that detail on your chest you'll probably be dead from ink poisoning.

 

[donheff]

By the time you get through tattooing all that detail on your chest you'll probably be dead from ink poisoning.

The impression I get in the coronovirus case is that patients are conscious (and in breathing trouble) when the ventilator decision is made. I would expect to make my wishes known (and share them with DW) if I head to the hospital because of breathing problems. I'm in very good health so the odds are good that even with hospitalization I would do well. But, once I get bad enough for a vent, the Bayesian analysis says I drew a bad hand and should fold.

The difficult thing for me is figuring out what my routine advanced directive should say. If I am terminal and can't communicate, no question - DNR, DNI. But what about other situations like a traffic accident or problems during surgery? It feels like we are left in the dark with little info and no medical guidance on what makes sense. I have read that countries like Sweden don't put patients over 80 on ventilators absent a few specific situations. Maybe I can incorporate some of that thinking. Still, it would seem the medical community could outline a few general models for people with various attitudes toward these issues. Sort of like model portfolios based on self assessed risk profile.

 

[ER Eddie]

If your advanced directive for medical care says you do not want to be kept alive by artificial means, does that include ventilators?

Yes, but I believe there's a clause in there that requires there to be no reasonable chance of recovery. So, in this instance (CV-19), it wouldn't kick in, because there's a roughly 20% chance of recovery when you're put on a ventilator. It's meant to apply to situations where things are basically hopeless, not to preclude the use of life support under any circumstances.

At least that's how I hope it works!

I'm sure it depends on the individual directive and how it's worded. I probably need to pull mine out and check the fine print. I wouldn't want to be denied life support, if there's a decent chance I can pull through.

"Ending your life on your own terms" is not an infrequent theme on this forum.

Yeah, we're an independent bunch.

In a way, it's another form of retiring early.

 

[Turbo29]

I think the main reason is that animals' relatives can't sue afterward.

I was talking to a doctor once and asked, "Why do doctors clean the skin with alcohol before giving a shot to a human when I've never seen a veterinarian rub a cat, dog, or horse with alcohol before giving them a shot?

The doctor replied, "Animals don't have lawyers."

 

[MarkiePippo]

My father at 90 is in a Nursing Home and has the virus. He has expressed multiple times that he does not want to be intubated. He was living independent for the most part till a series of seizures that wiped out his ability to do that. Now he has much more pronounced dementia issues. We have a DNR in his file. So far he is doing fine with little or no symptoms. But he is on Oxygen. If they put him on a ventilator it would kill whatever quality of life he has left.

 

[jcgc50]

Am I noticing a change in Tone or just coincidence.
NPR gave an hour to interviewing a palliative care physician who was saying basically maybe you should think if you want to be kept alive. Andrew Coumo saying only 20% of intubated patience get off the respiratory alive. The numbers I read a few weeks ago were saying 40 to 50% recovering.
At a 40% I told my health proxy I don't want to be tortured an extra week and would prefer massive morphine dose to a ventilator. At 20% she no longer argues with me.
I'm welcoming a change in the discussion. The system soft sold some actions that led to decisions when I was DWs proxy and she never did forgive me. None of us get out of here alive, we should give some thought to how we would rather go.

The first 3 minutes of this episode of This American Life podcast discusses that very thing and it is thought provoking. https://www.thisamericanlife.org/700/embiggening

 

[SoReadyToRetire]

God, what a depressing thread. I know it's necessary to think about this sort of thing, but depressing nevertheless.

 

[ivinsfan]

My father at 90 is in a Nursing Home and has the virus. He has expressed multiple times that he does not want to be intubated. He was living independent for the most part till a series of seizures that wiped out his ability to do that. Now he has much more pronounced dementia issues. We have a DNR in his file. So far he is doing fine with little or no symptoms. But he is on Oxygen. If they put him on a ventilator it would kill whatever quality of life he has left.

I hope he is doing better today...

 

[audreyh1]

My father at 90 is in a Nursing Home and has the virus. He has expressed multiple times that he does not want to be intubated. He was living independent for the most part till a series of seizures that wiped out his ability to do that. Now he has much more pronounced dementia issues. We have a DNR in his file. So far he is doing fine with little or no symptoms. But he is on Oxygen. If they put him on a ventilator it would kill whatever quality of life he has left.

Wow, best wishes for your dad! Is he in a being kept in isolation at the nursing home?

I have been thinking about DF On hospice who also has a DNR on file at nearest hospital. Oxygen OK, ventilator no way.

 

[Emerson11]

No ventilator for me

The prospect of living a long life with the debilitation resulting from time on a ventilator is more frightening than the prospect of death. The impact on family and society is also on the "no ventilator" side.

 

[Bongleur]

"This DNR declaration has two mutually exclusive sections which instruct your course of action:
Section 1: If I am infected with the disease known as COVID-19.
Section 2: For any situation where I am not infected with COVID-19."

 

[ncbill]

It's best to write a health care POA where you grant the broadest powers possible to your health care agent & make sure you discuss beforehand what you want done rather than try to address every specific situation in writing.