January 30, 2014

"I don’t want to be morbid, but I just want to remind you that you have control here."

"We can turn the device off at any time. (It is your device and your life.)"

Script prepared by a doctor, for use speaking to a patient, quoted in a NYT article titled "A Decision Deferred: Turning Off the Pacemaker."

50 comments:

Heather said...

I don't want to be morbid but I'm leaving a gun on the night stand. It is your choice to shoot yourself in the head.

CStanley said...

Between this and the recent case of the Texas pregnant woman, it seems as though the legal profession has some catching up to do with biotehnology. Why don't advanced directives routinely address these things?

MikeR said...


"I don’t want to be morbid, but I just want to remind you that we have control here. We can turn the device off at any time."

PB Reader said...

Oh. Personal responsibility. How quaint!

Yes, you can turn that TV off.
Yes, you can turn that computer off.
Yes, you can turn that phone off.
Yes, you don't have to answer the phone just because it rings.

Ignorance is Bliss said...

We'll put the control right here on the nightstand in case you decide you want to turn the device off.

Last words of the doctor.

I wonder if there's anything good on TV.

Last words of the patient.

Revenant said...

How is leaving the *patient* in charge of whether he lives or dies an example of "death panels"?

Scott said...

"I don't want to be morbid but I'm leaving a gun on the night stand. It is your choice to shoot yourself in the head."

I think that's actually one of the ways they do assisted suicide in Switzerland.

tim in vermont said...

Colonel, we will leave this lugar on the desk and be back in five minutes. No pressure.

Scott said...

Doctors throw pacemakers on their geriatric patients for any little arrhythmia anymore. Turning one off is no guarantee of a hastened death.

madAsHell said...

I don't know if I believe this article.

My Dad had a pacemaker, and we questioned the doctor after my father made several pronouncements to the effect of:

"When an old soldier wants to die, an old soldier wants to die".

The doctor said the pacemaker wasn't going to interfere with death. Of course, Dad stopped getting out of bed, and died of pneumonia.

Footnote:
If you want to get a laugh at a family gathering, just holler "When an old soldier wants to die!!"

Rusty said...

Revenant said...
How is leaving the *patient* in charge of whether he lives or dies an example of "death panels"?

Who mentioned death panels?

It isn't.

Basil said...

It's still an example of the death culture, where life is devalued and one is encouraged to stop being a (presumed) burden on others.

The culture of life is to value life and to willingly assume the burdens of old age and illness for ones self and family. However, for the government, old people and the sick are a problematic expense to be eliminated, not nursed, loved and cared for.

n.n said...

A doctor should not advise his patient of an option which is self-evident. In order to make the numbers work, or at least to create that illusion, the population control protocol will need to change with Obamacare.

RecChief said...

Self IPAB!

n.n said...

Basil:

A burden from conception to death. Although, they do stage a good act between birth and death to maintain a false impression. The Left's intelligent design schemes are notorious for causing misaligned development.

Ignorance is Bliss said...

Rusty said...

Who mentioned death panels?

The Professor, as one of the tags.

Which is not a statement that this is an example of a death panel, only that someone interested in that topic might also be interested in this post.

Inga said...

n..n,

Do you really not understand that end of life decisions that may include the possibility of suicide or assisted suicide are contemplated by people across the spectrum politically? I've read accounts from conservative commenters here on Althouse that have indicated they do not agree with prolonging life artificially for themselves or their family members when faced with a prolonged period of suffering. It's not just a leftist thing. I think perhaps you may be too young to have personally experienced such a situation with a family member.

FullMoon said...

Would that (suicide by "off button" negate a Life Insurance policy?

RecChief said...

@FullMoon
most insurance policies have a 2 year suicide clause. Meaning, in the first two years of the policy, if you commit suicide, the contract is voided. After that....

Also, as an agent, if the potential client brings up the idea of suicide, you're supposed to stop the interview right there. Reputable companies anyway.

Long story, but I sold life insurance for a short while, inherited a client from a guy who left he business. The client had purchased life insurance about 18 months prior. he would call me every few weeks to ask what the policy date was. After the first 2-3 calls, I figured out he was trying to calculate when the clause would end. So I called his ex-wife (the beneficiary) she didn't seem to care. so I called his parents (the contingents) the mother didn't really care, just wanted to know how much the policy was for. The dad though, took it seriously. Before I left the business, the young man had gotten some help because of the father. Don't know whatever happened to them, but it seemed like things were turning out well.

m stone said...

I actually agree with Inga, although politics have no place in the discussion.

This is actually an easy single decision---one made by the patient himself. It's not even a question of assisted suicide because an MD simply presents options.

One of our terminal family members was told she need not even take her meds BUT was informed which ones she really should take to avoid pain.

In far too many other cases (other diseases), there is no "on-off switch" and the decline follows no regular path, often horrible. I don't believe even a health care proxy can authorize anything more than stopping extreme measures. It is getting to those extreme measures that can last a very long time. That is another discussion altogether.

Michael K said...

A family friend, about 40 years ago, had a pacemaker implanted but hated it. Eventually the doctors agreed to remove it. He died about a week later. True story. Early pacemakers were more trouble than at present but it was a bit extreme.

LilyBart said...
This comment has been removed by the author.
Inga said...

I so agree With LilyBart. Government should most certainly butt out of people's personal decisions.

Inga said...

LilyBart? Where did you go?

Scott M said...

Battlespace prep.

CStanley said...

I have a veterinary patient with a pacemaker. I thought it was a little extreme but it was her owners' choice- and truthfully I'm glad they went for it because she's a lovely little dog.

And she is little- about a 16 pound mixed breed. Which means that the device is implanted under her skin just above her sternum. It freaks people out when they don't know her medical history.

n.n said...

Inga:

Read what I wrote again. Then discern the difference between my two comments in context. We agree in principle, but not in practice. Frankly, many of our differences arise in practice, in the actual details of implementation. I will only allude to the most controversial topic and leave the specifics for another thread.

carrie said...

Research has shown that doctors are wrong about half the time about who is dying and when death is imminent. Research also shows that a healthy person's view of what he thinks he would be willing to live with is different than what sick people thinks they would be willing to live with--disabled people are happier than healthy people expect. It also turns out that with most people, the sicker they get, the more pain, physical limitations, etc. they are willing to accept. Quality of life is subjective and a doctor advising you to die because your qualify of life isn't good is most likely basing that advice on his own personal views on qualify of life. Unfortunately, a young doctor or a healthy doctor will probably have a different view on quality of life than a patient who is struggling with a serious health issue. The biggest concern is that you will be allowed to die, or encouraged to die, by a doctor whose quality of life views do not match your own.

carrie said...

Research has shown that doctors are wrong about half the time about who is dying and when death is imminent. Research also shows that a healthy person's view of what he thinks he would be willing to live with is different than what sick people thinks they would be willing to live with--disabled people are happier than healthy people expect. It also turns out that with most people, the sicker they get, the more pain, physical limitations, etc. they are willing to accept. Quality of life is subjective and a doctor advising you to die because your qualify of life isn't good is most likely basing that advice on his own personal views on qualify of life. Unfortunately, a young doctor or a healthy doctor will probably have a different view on quality of life than a patient who is struggling with a serious health issue. The biggest concern is that you will be allowed to die, or encouraged to die, by a doctor whose quality of life views do not match your own.

traditionalguy said...

So should the rhythm giving heart electronics have a "sunset" date built in requiring a new decision to keep it on another year?

And who has the scanner codes? Does the NSA or Putin have them on satellite Death Ships?

No wonder the Death Panels are staffed with "Medical Ethicists."

Marshal said...

The issue isn't whether people have the right. The issue is whether it's appropriate for the NYT as the town crier for leftism to nudge the culture into thinking embracing death is the correct decision.

One day it's your decision and it's inappropriate for anyone to interfere. Some day down the line you're selfish for making the decision differently than the culture thinks you should. It'll certainly be shocking if those nudges get stronger as that money spent keeping you alive could be otherwise be spent on a thousand federal employees. Shocking.

CStanley said...

I think that type of discussion is ethically correct in some contexts but not others. If it is part of the initial explanation of pacemakers, fine. Beyond that, not fine- because inevitably some patients will feel that the doctor is specifically giving them this information as a hint.

Bob Boyd said...

One time, years ago, when my sister and I were both home from school, we were driving my mom's car.
I pulled the automatic garage door opener off the sun visor and said I'd heard these things will screw up a pacemaker. Then I said hey see that old guy on the sidewalk? Let's see if he has a pacemaker. And I pointed the thing at him.
My sister screamed NOO! and grabbed it away from me.
I laughed at her and got called an asshole.

The Godfather said...

I don't think it's new news that a pacemaker can interfere with accomplishing a decision to die naturally. It seems to me that I've heard that for years.

I think what the quoted language is intended to mean is that if you, the patient, decide that you want to let go, the fact that we've installed a pacemaker won't prevent you from exercising your autonomy; if you ask us to, we'll turn it off.

I have no moral objections to allowing people to make such decisions. I do, though, object to the death cult of people (like Kevorkian) who encourage people who are not dying to commit suicide, instead of helping them to deal with their depression, sorrows, defeats, etc.

cubanbob said...



carrie said...
Research has shown that doctors are wrong about half the time about who is dying and when death is imminent. Research also shows that a healthy person's view of what he thinks he would be willing to live with is different than what sick people thinks they would be willing to live with--disabled people are happier than healthy people expect. It also turns out that with most people, the sicker they get, the more pain, physical limitations, etc. they are willing to accept. Quality of life is subjective and a doctor advising you to die because your qualify of life isn't good is most likely basing that advice on his own personal views on qualify of life. Unfortunately, a young doctor or a healthy doctor will probably have a different view on quality of life than a patient who is struggling with a serious health issue. The biggest concern is that you will be allowed to die, or encouraged to die, by a doctor whose quality of life views do not match your own.
1/30/14, 4:36 PM "

Very astute comment. As my late paternal grandmother use to say "life is just as sweet at 80 as at 18" and she was not in good shape for most of the years I remember her.

Inga said...

Exactly Godfather, Kevorkian and some of the groups that assist in assisted suicides are a bit creepy in their enthusiasm. I think that it should be between a doctor and his patient or a doctor and his patient's chosen surrogates.

Rockport Conservative said...

My own dear mother was 89, had been a heart patient for years, had a pacemaker/defibrillator when she became deathly ill with a staph infection and her body began shutting down. After a few days of being filled with fluids which were only invading her tissues because her kidneys had failed, and she was in great pain in many ways she said, "no more, no more." Her cardiologist came in and with tears in his eyes; with her 5 daughters holding hands and praying around her, and shut down the device. We expected her imminent, I mean any minute death. It was 7 miserable days later before that wonderful, enlarged, wounded heart stopped beating. So when a doctor say we can turn it off, it doesn't mean you are going to die immediately.

Inga said...

Rockport Conservative, I've seen many elderly chronically ill patients in you mother's condition. Not all, as a matter of fact very few are given a peaceful gentle death. Most need support in the way of pain meds, anti anxiety meds, meds to dry up secretions in lungs and elsewhere and oxygen, oral suctioning, etc. What your mother's doctor did with your permission was merciful.

Revenant said...

Culture of death = not artificially prolonging your life?

If you die before you can get a pacemaker installed, that's God's will... but once it is installed, leaving it on as long as possible is God's will? God's a fickle little minx sometimes.

Revenant said...

Would that (suicide by "off button" negate a Life Insurance policy?

Depends on the policy, since not all policies refuse to pay out for suicides.

Jim S. said...

The patient should say, "Can I turn yours off?"

Titus said...

Today at work I learned about machine learning techniques including The Random Forests Algorithm.

And...I saw Helen Mirren in a parade surrounded by drag queens winning the Hasty Pudding Award.

Thank you Cambridge for being so fucking fab.

tits that text mine.

Titus said...

I am totally into decsion trees now.

Statisticians are cool.

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David said...

"We expected her imminent, I mean any minute death. It was 7 miserable days later before that wonderful, enlarged, wounded heart stopped beating. So when a doctor say we can turn it off, it doesn't mean you are going to die immediately."

I am sorry it happened this way.

My wife and my mother were luckier. The Docs were willing to give them morphine, quite a bit of it. It did not kill them outright but surely it hastened death and made the final hours of the process far more peaceful.

David said...

"Depends on the policy, since not all policies refuse to pay out for suicides."

Nearly all life insurance have suicide clauses. However, they are not exclusions of payment upon death unless the death by suicide occurs early in the term of the policy. One or two years of suicide exclusion is the norm.

Inga said...

Where does one draw the line the administration of huge doses of morphine and euthanasia? Doctors have quietly been hastening death for years now, long before Obamacare. I recall one case in which 10mg.of morphine was ordered to be given every half an hour in an elderly dying patient.

Laura said...

Why prepare a script if not for the death panels?

Laura said...

Nurse Ratched never reports the doctors, especially the ones whose orders she likes.

Inga said...

Laura,

What an incredibly stupid statement. The orders are legal and accepted protocol. Evidence that they were given are on the med record, on the doctors order, in the patient's chart. What is there to report?? The state is aware of these types of orders, hospices use them all the time. The families want their loved ones to not be in pain and if the med is held by the nurse because of depressed respirations the families sometimes have a fit and call the doc to report nurse.

This isn't new, these doses of morphine have been ordered by doctors and given by nurses for years, long before any imaginary death panels. Why don't you address your concerns to David, above, he was relieved his Mother's and wife's doc ordered big doses of morphine.

Don't comment on something you have no earthly clue about, it makes you sound very ignorant. Sarah Palin level stupid.