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On Death & Dying
- Thread starter Michael Scally MD
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Machine learning has a lot of uses for automating things humans would otherwise be tasked to do, but in terms of classification they are rarely as accurate as a human can be. As complex as the interconnections might be, they are essentially glorified statistical models. It doesn't take a lot of deviation in the data set, deviation a human is far more likely to detect, to throw them off.
IMO it is never appropriate to apply a statistical model by itself to an individual, and in this case the conclusion of the program could produce a machine's version of confirmation bias. In effect, if it says you're going to die and you believe it, you will proceed under that assumption and may decline potentially life saving treatment.
This then becomes another data point both for the model and for the medical industry, a data point confirming the model's dubious simulation results. As the saying goes, simulation is like masturbation: the more you do it the more you believe it's just like the real thing. It's not like the real thing. Lots of people beat the odds.
The scarier element of this is the very high probability insurance companies and/or governments will eventually use these kinds of models to determine who gets gets the potentially life saving treatment, and who gets hospice.
The images here of Holly Butcher don’t convey what’s happening inside her body. Ewing’s Sarcoma, a form of bone cancer, is killing her. At 27, Butcher was facing the end of her life. Before she died, Butcher wrote a letter explaining what she was experiencing. When she died last week, her parents published her letter.
“It’s a strange thing to realize and accept your mortality at 26 years young. It’s just one of those things you ignore. The days tick by and you just expect they will keep on coming; Until the unexpected happens. I always imagined myself growing old, wrinkled and grey- most likely caused by the beautiful family (lots of kiddies) I planned on building with the love of my life. I want that so bad it hurts.
“That’s the thing about life; It is fragile, precious and unpredictable and each day is a gift, not a given right.
“I’m 27 now. I don’t want to go. I love my life. I am happy.. I owe that to my loved ones. But the control is out of my hands.
...
Vita
Member
It's a shame life can not be taken from those that hold no regard for it and given to those who cherish it.
Godlee F. Assisted dying: it’s time to poll UK doctors. BMJ 2018;360. http://www.bmj.com/content/360/bmj.k593.abstract
Doctors’ organisations provide crucial leadership, cohesion, a community, resources, and support for their members. They also speak for the profession; their positions on ethical issues are therefore of great importance to national debate. The BMA and the key medical royal colleges remain opposed to assisted dying. So too do the American Medical Association, the American College of Physicians, and the American Academy of Family Physicians, despite assisted dying being legally available to 58 million Americans in six states and the District …
English T, Ribeiro B. Should doctor assisted dying be legal? BMJ 2018;360. http://www.bmj.com/content/360/bmj.k562.abstract
It could help terminally ill people in pain who want control over how they die while protecting vulnerable people, says Terence English, but Bernard Ribeiro worries about a negative effect on the doctor-patient relationship
Doctors’ organisations provide crucial leadership, cohesion, a community, resources, and support for their members. They also speak for the profession; their positions on ethical issues are therefore of great importance to national debate. The BMA and the key medical royal colleges remain opposed to assisted dying. So too do the American Medical Association, the American College of Physicians, and the American Academy of Family Physicians, despite assisted dying being legally available to 58 million Americans in six states and the District …
English T, Ribeiro B. Should doctor assisted dying be legal? BMJ 2018;360. http://www.bmj.com/content/360/bmj.k562.abstract
It could help terminally ill people in pain who want control over how they die while protecting vulnerable people, says Terence English, but Bernard Ribeiro worries about a negative effect on the doctor-patient relationship
Our dog’s brain tumor had worsened to the point that she was restless at all times and often walked in circles. She had mostly stopped eating and was partially blind. Like so many pet owners, our family finally decided to intervene rather than having “nature take its course.”
Akeela, our beloved boxer, had had her share of medical problems over the years, including a ruptured liver tumor and surgery for a parathyroid adenoma. But after the age of 12, she developed both a severe hormonal abnormality known as Cushing’s disease and a brain tumor that caused seizures.
Our girl dutifully kept going, willingly taking a very large amount of medications. But by this past September, her symptoms, which were probably caused by the spread of the tumor, had worsened.
The veterinarian took one look at Akeela and said, “This is not a happy dog.” We had to concur. The very traits that had once made her so distinctive — her joy, her displays of affection, her constant monitoring of the house — had waned.
My wife and two adult children and I held a family meeting. After some discussion, we agreed it was time to put her down and selected a date and a venue — our home. ...
But what did Akeela’s end say about my own practice of medicine?
In contrast to veterinary practice, the medical profession has long forbidden the notion of speeding death. The Hippocratic oath, which dates to Greece in the fifth century B.C., states that a physician must not “administer a poison to anybody when asked to do so nor … suggest such a course.”
...
If suffering was so obvious and not reversible, and there was a way to provide immediate relief, was my reflexive refusal to assist in the dying process always the right thing to do? And if the patient, fully understanding all of his or her options, was asking for death, didn’t this make him or her more worthy than a dog, whose suffering could only be assumed?
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If you ask people how they hope to die, you will usually hear two kinds of answers. Some people want to go very quickly, for example, through a sudden massive stroke, preferably in their sleep. Others would rather have a couple of years to come to terms with the prospect of death: a gradual decline from cancer, perhaps, with time to fulfil their last cherished wishes, put their affairs in order and gather their family around them for the end.
I would have given the second of these answers myself in the past, mainly because both my parents died suddenly (my father from a heart attack; my mother from a pulmonary embolus). It seemed very cruel for their lives to be cut-off so abruptly, with so much undone and unsaid. Now, I am no longer sure about my answer.
I have seen other relatives and friends decline in slow and miserable ways that seemed worse than dying suddenly. I also experienced a cardiac arrhythmia a couple of years ago, when a black curtain came down in an instant, rendering me unconscious in presumably the same way as it does in quick deaths. It was not pleasant, but nor was it particularly unpleasant.
Apart from knowing the distress it would cause to people close to me, this manner of death is the one I would possibly opt for now, if given the choice–although a pacemaker has significantly reduced the chances of this happening.
In reality, of course, there is no choice in such matters. …
hurricane
Member
Doc I had no idea you had those cardiac issues. I can certainly sympathize and I hope you're doing well.
Hope you had a great holiday season.
Regarding the question I want to go out quickly. Although I'm hoping that won't happen for awhile.
It's in God's hands. Had to throw God in there Doc. LOL.
I am fine. I am not the person of the post! Thanks. Happy New Year.
Damn , I was gonna start talking about turning 59 
in February but I think I"ll just keep it to myself ... FORGET I SAID ANYTHING !!
NEXT SUBJECT PLEASE>>>> ~OGH
in February but I think I"ll just keep it to myself ... FORGET I SAID ANYTHING !!NEXT SUBJECT PLEASE>>>> ~OGH
hurricane
Member
You look damn good for 59 brother!!Damn , I was gonna start talking about turning 59
NEXT SUBJECT PLEASE>>>> ~OGH
hurricane
Member
Sorry Doc. Sometimes the elevator doesn't reach the top floor. OK most of the time. lol. I'll blame the stroke. Just glad the kids got the wife's brains.
Damn , I was gonna start talking about turning 59
NEXT SUBJECT PLEASE>>>> ~OGH
Both of my parents passed this last year , 7 months apart . Both in their early 80"s . It really does change your perspective and outlook on life bigtime .
Now Im thriving for a fitter Ogh , looking at e-bikes right now . More cardio brother....
hurricane
Member
Sorry for the loss of your parents big guy. Cardio is definitely on my list of things to do for 2019. I'm not getting younger myself and I really need to take care of my heart.Both of my parents passed this last year , 7 months apart . Both in their early 80"s . It really does change your perspective and outlook on life bigtime .
Now Im thriving for a fitter Ogh , looking at e-bikes right now . More cardio brother....
Haven't even been in the gym much. I take the dog for hikes and crack out alot of push-ups and pullups at home. Only hit the gym 2x a week.
I've finally realized being 290 is taking a huge toll on my body.
250 is my goal. Going to be hard but I'm doing it for the family.
Good to see you around brother. Happy New Year.
How Americans die has fundamentally changed with advances in medical technology and the ways diseases are treated. For centuries, death commonly occurred in one’s home with care provided by relatives and community members. Yet since the 1960s, the hospital and intensive care unit have become places of passage as people approach the end.
In this week’s New England Journal of Medicine, we report that home has become the most common place of death among Americans dying of natural causes for the first time since the early 20th century, while deaths in hospitals and nursing facilities have declined. https://doi.org/10.1056/NEJMc1911892
Our analysis of data from the Centers for Disease Control and Prevention and the National Center for Health Statistics also showed striking differences in place of death according to who you are and what you die of: individuals who are nonwhite or those dying from diseases other than cancer are less likely to die at home than those who are white or those who die from cancer.
These findings are encouraging. But they can also have a dark side, illustrated by Margaret Peterson, who helped her husband, Dwight, die at home in Illinois. “My experience was positive in the sense that my husband succeeded in dying in his own damn bed, in his own damn house,” she wrote in response to a query that one of us (H.J.W.) posted on a Facebook group for caregivers. “It was negative in the sense that the medical management we needed, such as subcutaneous or intravenous morphine, was not available. It was terrible.”
Sworder
Member
Yeah, let's make you in charge of who is allowed to live...
On a Sunday evening in July 2018, my 81-year-old mother raised a small red glass to her lips. In it was a mixture of water, grape juice and 10,000 milligrams of Seconal powder, a massively fatal dose of a barbiturate most commonly used for insomnia. She was sitting up in a hospital bed in her Washington, D.C., home, bathed in warm early evening light and wearing a thin white nightgown.
She had spent the weekend calling close friends and loved ones to say goodbye, and chatting and passing time with me, my sister and all her grandchildren. A matriarchal figure, always vocal in her opinions, she took the time to dispense some final grandmotherly advice. “Don’t drink too much in your first year of college.” “Stop worrying so much about applying to college.” “No more tattoos.”
Finally, there was nothing more to say. Surrounded by family, she seemed composed and unafraid, ready to shed the anxiety, pain and humiliations that come with terminal lung cancer. Without the slightest hesitation, she drained the glass and lay back on her pillows. Within a minute, her features softened and her eyes closed. She fell into a heavy sleep, her breath audible. It wasn’t long before her breathing slowed, and then stopped.
Phoenix - Randall Jacobs of Phoenix died at age 65, having lived a life that would have sent a lesser man to his grave decades earlier. His friends called him RJ, but to his family he was Uncle Bunky, a.k.a. The Bunkster. He told his last joke, which cannot be printed here, on May 4th, 2020.
Uncle Bunky burned the candle, and whatever else was handy, at both ends. He spoke in a gravelly patois of wisecracks, mangled metaphors, and inspired profanity that reflected the Arizona dive bars, Colorado ski slopes, and various dodgy establishments where he spent his days and nights. He was a living, breathing "hang loose" sign, a swaggering hybrid of Zoni desert rat, SoCal hobo, and Telluride ski bum.
A prolific purveyor of Bunky-isms such as "Save it, clown!" (or "Zeebo" if he was in a mood), he would mercilessly tease his "goombatz" nephews with nicknames such as "mud flap" and "style master." Just days after his beloved cat Kitters passed away, he too succumbed to "The Great Grawdoo", leaving behind a vapor trail of memories and a piece of sage advice lingering in his loved ones' ears: "Do what Bunky say. Not what Bunky do."
For all his chaotic energy and hysterical charm, he had a gentle soul. A night out with Bunky could result in a court summons or a world-class hangover, but his friends and family would drop whatever they were doing to make a trip out to see him. His impish smile and irreverent sense of humor were enough to quell whatever sensibilities he offended. He didn't mean any harm; that was just Bunky being Bunky.
When the end drew near, he left us with a final Bunkyism: "I'm ready for the dirt nap, but you can't leave the party if you can't find the door.
He found the door, but the party will never be the same without him.
In lieu of flowers, please pay someone's open bar tab, smoke a bowl, and fearlessly carve out some fresh lines through the trees on the gnarliest side of the mountain.
