Don’t Torture Mom & Dad

A doc’s eloquent plea:

It’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go. Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health. … With unrealistic expectations of our ability to prolong life, with death as an unfamiliar and unnatural event, and without a realistic, tactile sense of how much a worn-out elderly patient is suffering, it’s easy for patients and families to keep insisting on more tests, more medications, more procedures. … When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” … At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. … A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.” (more; HT Amanda Budny)

Our urge to use medicine to show that we care costs more than just spending more for mostly useless treatment. It often literally tortures our loved ones.

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  • Miley Cyrax

    “Our urge to use medicine to show that we care costs more than just spending more for mostly useless treatment. It often literally tortures our loved ones.”

    Yeah, but how else can I signal that I care about my parents while passing the costs (more tests, more medications, more procedures) of my signaling onto the rest of society?

  • Stephen

    Our mistreatment of the very old will go down in history as one of the monumental failings of our era, right next to our impossibly bad agricultural practices.

    To me the major hurdle is “death as an unfamiliar and unnatural event.” When I was younger I had always hoped old age came with a revelation that allowed death to seem more like the natural occurrence that it is. Now I see that nothing is that easy. Perhaps death-readiness can be taught? Death-Ec in highschools?

    Also, is there no conflict between railing against excessive end-of-life care and hoping for a singularity breakthrough? These seem like inclusive interests.

    • Gulliver

      Perhaps death-readiness can be taught?

      I’ve always wondered why so few people who are in a position to do so plan for ensuring their end-of-life care is discharged in accordance with their wishes. I also find myself wondering how much power next-of-kin have to override explicitly prepared patient wishes. I have the good fortune to have a family that I know will respect my wishes and not oppose my living will, so I’ve never had to worry about them overriding my documented wishes. But I wonder if that’s a problem some people face.

      Also, is there no conflict between railing against excessive end-of-life care and hoping for a singularity breakthrough?

      I suppose it depends at least somewhat on whether one is railing against excessive end-of-life care imposed by family or chosen by the patient.

    • rationalist

      What do you mean by “hoping for a singularity breakthrough”? Do you mean life extension?

      The word singularity really has lost its original meaning; people seem to be using it to refer to an entire cluster of loosely associated memes.

      • Stephen

        I meant singularity in the superficial meme sense but breakthrough was meant to imply extra-long or post-biological life.

        Probably better to just rephrase: It seems on one hand Robin is against life-extending tech, and on the other hand he is pro life-extending tech. Is it just a difference of degree? How do we cross the margin between high marginal cost life extension and low cost life semi-permanence (em life, etc.) without growing pains that can sometimes look like torture?

        It sounds like the argument in this post is that we need to get better at dying, but the larger narrative of this blog has more to do with avoiding death.

  • http://juridicalcoherence.blogspot.com Stephen R Diamond

    Chalk it up to Christianity, with the “sanctity of life” and the sinfulness of suicide.

    But then, religion’s a good thing, right? What you describe is the “morals” it instills.

    • http://fearfulfortress.com/ feathers

      And therefore medical spending on the old is lower in religious vs. secular countries?

      • fburnaby

        You’re right that seems to contradict Stephen’s complaint. But then again, medical spending correlates strongly with wealth in general, which correlates negatively with religiosity, does it not? I’d be surprised if the inverse relationship between religiosity and health spending would survive, if controlled for wealth.

  • Anonymous

    Out of curiousity, to what extent do you extend this principle? Do you consider it to apply even if the old people in question would want all possible measures?

    • http://juridicalcoherence.blogspot.com Stephen R Diamond

      I don’t know that it’s clear that the relatives rather than the dying person is at fault for continuing treatment. Sometimes it seems that a belief in the afterlife has made them more vulnerable upon facing the reality of impending death. (This strikes me as a near/far phenomenon.) At other times it’s a matter of perceived moral duty.

      Here was have much worse that waste: torture, whether self-inflicted or family-inflicted–market failure. Warranting policies where medical care is rationed.

      • Anonymous

        So, to get to the relevant part of your answer, you don’t want the old people to go through it even if they have made clear that such is their chioce? That their desire to live is so great that they want any possible gamble in order to survive?

      • Gulliver

        @ Stephen R Diamond

        Here was have much worse that waste: torture, whether self-inflicted or family-inflicted–market failure. Warranting policies where medical care is rationed.

        If you end the life of someone trying to stay alive, that’s known as murder.

        Unless you believe their life belongs to you, in which case you could rationalize deciding that they are not allowed to experience pain in their efforts to remain alive. The problem is that once you’ve assumed that power, you’ve also assumed the power to decide for someone else what pain they may endure to stay alive at any time in their life, not only the end of it. In fact, once you’ve assumed the power to dictate to others what they may suffer because “I define X as torture and torture is wrong, so I’m morally justified in denying you from experiencing it”, you’ve assumed the power to decide anything anyone may do in life from a body-piercing to S&M play, from a hard workout to self-flagellation.

        It is an extremely poor excuse for rationing medical care. If you simply do not want terminal patients to become a drain on medical resources, you are far better off arguing for such policies on purely utilitarian grounds than thin justifications for policing moral self-treatment. If you truly believe people should not have the right to choose to endure suffering, then de facto you do not believe their life or body belongs to themselves, and therefore that they are in fact property. I suspect you will encounter rather significant resistance to assuming that power.

      • http://juridicalcoherence.blogspot.com Stephen R. Diamond

        Gulliver,

        If you truly believe people should not have the right to choose to endure suffering, then de facto you do not believe their life or body belongs to themselves, and therefore that they are in fact property.

        Along with religion, a grasping, capitalistic outlook is what’s responsible for people trying to hold on to life for too long. These people see their lives as their property and ending their lives as tantamount to suffering theft or at best bankruptcy. (Thus the people most scared of “death panels” are the same ones outraged by taxation–people obstinately attached to what’s “theirs,” whatever its form.)

        The issue, of course, is resources. I wouldn’t try to stop someone from torturing himself, but to devote expensive resources to self-torture, denying others those same resources where they’d be beneficial (or even neutral)—but for the beneficiary, unaffordable— is something else.

  • http://hertzlinger.blogspot.com Joseph Hertzlinger

    A debate between the Robin Hanson who wrote the above and the other Robin Hanson may be of interest.

    • Robert Koslover

      Well, I find the views of the two essays to be reasonably consistent.

      • http://juridicalcoherence.blogspot.com Stephen R Diamond

        “My husband has said, on numerous occasions, ‘Choose life at any cost,’ ” Peggy says.

      • Robert Koslover

        I don’t find Robin’s earlier “Choose life at any cost” remarks to be inconsistent with what Robin wrote above. Rather, I believe he was exhorting us to do that as a personal choice for ourselves, as opposed to enforcing excessive care upon another suffering person. For the former, and to put it more poetically, consider Dylan Thomas‘ “Do not go gentle into that good night.”

      • Robert Koslover

        Apologies, but my link to the Dylan Thomas poem above evidently takes one to some kind of lunatic-fringe website, which for unknown reasons happened to have posted that good poem (and which also became the #1 hit for it on Google!) Please, instead, use the following link if you are interested in reading the poem: http://www.poets.org/viewmedia.php/prmMID/15377

    • Scott

      Robin Hanson would not consider prolonged life to be torture; he’d choose it himself. It’s only torture for old people who don’t want to choose life at any cost.

      In a more evocative metaphor, what BDSM enthusiasts do to each other for pleasure would fit squarely under “torture” for most.

      • Gulliver

        @ Scott

        In a more evocative metaphor, what BDSM enthusiasts do to each other for pleasure would fit squarely under “torture” for most.

        If torture is always wrong, then it must be nonconsensual. If torture includes consensual suffering, then it is not always wrong. If torture is always wrong and includes consensual suffering, then enforcing its prohibition is enforcing the morality of one group or person on the lifestyle choices of everyone subject to the enforcement. In terms of social autonomy, if its moral to outlaw BDSM play, then it’s moral to outlaw sodomy. But of course many, myself included, would consider such prohibitions to be oppressive.

        High five on the Escher Mobius Strip I avatar image! Mine’s harder to see, but it’s an partially unfolded tesseract. Go extra dimensions :-)

      • http://juridicalcoherence.blogspot.com Stephen R. Diamond

        Robin Hanson would not consider prolonged life to be torture; he’d choose it himself. It’s only torture for old people who don’t want to choose life at any cost.

        Wait a minute. While it’s true that something isn’t torture merely because it’s very unpleasant, it can’t be torture unless it’s unpleasant. How can Hanson reasonably assume that these old people find the promise of life insufficient to warrant suffering when Hanson finds it sufficient–so much insufficient, for those others, that it amount to torture?

    • http://juridicalcoherence.blogspot.com Stephen R. Diamond

      A debate between the Robin Hanson who wrote the above and the other Robin Hanson may be of interest.

      Here’s another Hanson

      I like that one’s positions better:

      Expand the Food Stamp program so that everyone is entitled to generous, free weekly allowances of fruits and vegetables. … Or how about mandating that companies that employ 25 or more workers provide on-site exercise rooms or tax-free benefits to cover gym membership?

      • http://hanson.gmu.edu Robin Hanson

        You have been warned about violating OB rules on comment frequency, and have not responded or changed your behavior. Congrats on being the first ever person to be banned from commenting further on OB.

      • Damon Stephens

        You have been warned about violating OB rules on comment frequency, and have not responded or changed your behavior. Congrats on being the first ever person to be banned from commenting further on OB.

        That’s simply an outright lie. My god you’re a desperate one for a corrupt son of a bitch.

  • jonas

    What if we spend this estimate of money that we are spending too much on medicine (just for showing that we care), not on people instead that take care and are in engagement with the people we care about? probably showing that we care just feels worth the money we spend.

  • richard silliker

    Death has become a vicarious experience for many people and they are lacking. The mass is to much for them.

  • Gulliver

    @ Stephen R Diamond

    Gotta reply down here as our thread-tree reached its limit.

    Along with religion, a grasping, capitalistic outlook is what’s responsible for people trying to hold on to life for too long.

    I’m not nor ever have been the least bit religious; but I have a strong survival instinct and I like being alive a lot. There’s nothing superstitious or theoretical about it.

    These people see their lives as their property and ending their lives as tantamount to suffering theft or at best bankruptcy.

    My life belongs to me and absolutely no one else. In that strict sense of the word, my bodily life is indeed my property, the most important property I own. A body is a living thing. A person is a living thing who owns his or her self.

    See definition #4:
    http://en.wiktionary.org/wiki/property
    The exclusive right of possessing, enjoying and disposing of a thing.

    (Thus the people most scared of “death panels” are the same ones outraged by taxation–people obstinately attached to what’s “theirs,” whatever its form.)

    First of all, “death panels” are nothing more than a Republican strawman. Second of all, equating taxation and body-sovereignty is another strawman.

    The issue, of course, is resources. I wouldn’t try to stop someone from torturing himself, but to devote expensive resources to self-torture, denying others those same resources where they’d be beneficial (or even neutral)—but for the beneficiary, unaffordable— is something else.

    Indeed, and that is a reasonable argument. I think you’ll get further with it than you will with arguing whether a person belongs to herself or is owned by other(s).

  • Lord

    There is also a problem with the medical community that thinks in terms of procedures and treatments rather than comfort and ease which is often what is desired but much more difficult to obtain.

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  • http://www.uweb.ucsb.edu/~criedel/ Jess Riedel

    It’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go. Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health…

    It’s certainly plausible that people prolong the suffering of their family members in order to signal/demonstrate-caring/etc. But if we’re looking for objective decision making, wouldn’t you expect that the burden felt by those taking care of the patient to be a stronger a bias? Who is more likely to lie to themselves?

  • http://www.pacrimjim.com PacRim Jim

    My denial mechanism is functioning just fine, as nature intended, and it’s reminding me that I’ll live forever. What, me worry?

    • richard silliker

      Just in case you are unsure of how long forever is. It is until you die.

      lol

  • http://www.isteve.blogspot Steve Sailer

    Why not just freeze Dad’s head?

  • Ari T

    I strongly agree with personal experience regarding this.

  • CH

    This post hits really close to home. My grandmother, a very active woman who raised chickens and pigs and grew vegetables, fell and broke her hip. She picked up a nasty infection in the hospital. Eventually the decision had to be made: insert a feeding tube or not? My mother, after consulting with her pastor, had the tube put in. My grandmother spent another year completely bed-ridden and in incredible pain. Then she died.

    All of their advanced care prolonged her unhappiness. When I was growing up, my church taught that using feeding tubes or respirators is “playing God.” Now for some odd reason not using a feeding tube or respirator is “playing God.”

  • http://lukeparrish.rationalsites.com/ Luke Parrish

    I wonder if medical professionals could be persuaded to recommend cryonics on the grounds that it encourages the acceptance of death (where “death” = a state in which the patient no longer feels pain). It occurs to me that it could save a lot of suffering. Even cases where cryonics is not chosen, simply having that option on the table could result in a reduction in anxiety (since the choice to not engage in cryonics would be a choice to come to terms with death) compared to never considering it to begin with.

    • DSimon

      That would be awesome. There’s a practical barrier, though; how would the cryonic procedure get paid for? Health insurance won’t cover it, and only the quite well-off would be able to afford paying for it outright instead of with a life insurance policy purchased in advance.

      • http://lukeparrish.rationalsites.com/ Luke Parrish

        I’m guessing that cost is not the real issue. If it were, you could appeal to insurance companies to substitute cryonics for more expensive aggressive medical treatments at the end of life. (Note for example that medication for assisted dying is a covered benefit in Oregon.) It would make good business sense, as cryonics is less expensive than pursuing aggressive treatment. However first you would need to get doctors recommending it. For that to happen, you need them either recommending it as a medical method of increasing the patient’s long-term survival chances, which I see as unlikely to fly (on its own) any time soon, or recommending it as an alternative to reduce suffering and cope with anxiety about death.

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