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Re: What does it mean to die?

PostPosted: Tue Feb 13, 2018 11:34 pm
by chimp
i guess the truth is that we don't know what would happen to many of the people we define as legally brain dead if we just waited several years with them on artificial ventilation. perhaps some minority of them would recover some function but i think there's a real limit to how much could be regained in the context of anoxic injury where brain tissue is just dead due to lack of oxygen. probably most would die of intercurrent infections, pneumonia etc. goes without saying that the resource cost would be huge but perhaps society would be fine with that

Re: What does it mean to die?

PostPosted: Tue Feb 13, 2018 11:49 pm
by dusky
life is a continuous sequence of dying selves

Re: What does it mean to die?

PostPosted: Tue Feb 13, 2018 11:53 pm
by JohnK
Our intensivists push for a quick withdrawal when it’s obvious there won’t be any meaningful recovery, but it’s obviously an incredibly hard decision for a family member to make because they don’t want to “kill” their loved one before a miracle (that’s unfortunately never going to happen) happens. Had a lady not too long ago who was 42 with zero history go into v fib arrest and I think it was like 20 minutes until ROSC. EEG showed theta coma and we tried to explain everything to the family but they just couldn’t do it. They elected to have her trach’d and a feeding tube placed in her stomach. So she just lies there with a look of discomfort on her face and has random involuntary movements of her extremities and it’s just the most pitiful thing. And she’ll go to a long term care place where nurse:patient ratios are not 2:1 or even close and she’ll get contractures and pressure ulcers or pneumonia or some other infection and she’ll die anyway. And it’s really sad and you can’t blame them for not wanting to “give up too soon” and asgflgjdjkhld it’s just the worst and I hate it.

Re: What does it mean to die?

PostPosted: Tue Feb 13, 2018 11:54 pm
by JohnK
I don’t know why I’m posting in this thread without reading the article. I’m an asshole. Sorry.

Re: What does it mean to die?

PostPosted: Tue Feb 13, 2018 11:57 pm
by Spoilt Victorian Child
I think brain death is just a concept useful in helping people to make a terrible decision. It is obviously not the same as actual death, which initiates a process of decomposition, and doesn't need the word "brain" appended to it.

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:05 am
by antoine
Spoilt Victorian Child wrote:I think brain death is just a concept useful in helping people to make a terrible decision. It is obviously not the same as actual death, which initiates a process of decomposition, and doesn't need the word "brain" appended to it.

Yeah

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:06 am
by antoine
Brains are pretty important

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:08 am
by chimp
JohnK wrote:Our intensivists push for a quick withdrawal when it’s obvious there won’t be any meaningful recovery, but it’s obviously an incredibly hard decision for a family member to make because they don’t want to “kill” their loved one before a miracle (that’s unfortunately never going to happen) happens. Had a lady not too long ago who was 42 with zero history go into v fib arrest and I think it was like 20 minutes until ROSC. EEG showed theta coma and we tried to explain everything to the family but they just couldn’t do it. They elected to have her trach’d and a feeding tube placed in her stomach. So she just lies there with a look of discomfort on her face and has random involuntary movements of her extremities and it’s just the most pitiful thing. And she’ll go to a long term care place where nurse:patient ratios are not 2:1 or even close and she’ll get contractures and pressure ulcers or pneumonia or some other infection and she’ll die anyway. And it’s really sad and you can’t blame them for not wanting to “give up too soon” and asgflgjdjkhld it’s just the worst and I hate it.


yeah this is very difficult. i think it probably happens more in the US? people tend to be less religious and (my impression) more deferential to medical staff in the UK which i think is probably relevant. i don't think a family would be permitted to choose to have artificial nutrition and tracheostomy in this situation in the UK. haven't spent that much time in the ICU though so i could be wrong.

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:08 am
by Spoilt Victorian Child
Having said that I'm fine with it counting as "legal death."

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:12 am
by chimp
the difficulty is in placing this kind of decision on family members who are just not equipped to make it. same with CPR. the australian attitude to CPR is quite different to the british attitude. in the UK the decision on whether or not to perform CPR ultimately remains a medical decision. the family must be involved in and informed of the decision but it's never a situation of being bound to perform a futile intervention because of family insistence

e: whereas in australia it seems to be more a case of "hmm, the family say that this multiply comorbid extremely frail 90 year old is for CPR and ventilation. well, OK!"

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:13 am
by barrier
Dr. Norm Thagard wrote:My (favorite?) Part was when someone called the cops on them in NJ and said they were keeping a corpse


This made me so angry! Fuckin internet vigilantes thinking she’s takin advantage just because she went out to dinner once and bought a purse.

Echoing what someone else said itt, i feel like there was a chance all of this was avoided in the first place if the hospital had treated this poor family with some actual compassion

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:13 am
by Lucky
What's the longest hospitals will keep someone brain dead alive for chimp

On the legendary British tv show Eastenders they just kept some girl going for like 3 weeks because her dad (who inadvertently caused her death by trying to jump off the roof of the local pub, thus causing her to come up and save him before ultimately falling to her own demise!) was in denial and was trying to get lawyers to prove she could be saved.

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:15 am
by chimp
Tom Cruise wrote:What's the longest hospitals will keep someone brain dead alive for chimp


i don't think there's a hard and fast rule about this but i'm not an intensivist

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:22 am
by The Priest
it's sad but also fascinating that our capacity to facilitate a nearly-dead person's recovery is entirely economic (in the literal sense)

also there's trillions of people en route so as I see it if I'm ever at a point wherein contemporary science can not bring me back to prior state I'm dead by any rational definition

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:28 am
by chimp
. wrote:it's sad but also fascinating that our capacity to facilitate a nearly-dead person's recovery is entirely economic (in the literal sense)


i mean i was just hypothesising above. it's probably the case that the majority of these people won't ever recover no matter how much time and money is spent. but yeah very hard to know for sure

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:48 am
by Spoilt Victorian Child
"Recover" seems like a more contentious word than "death" here.

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 12:59 am
by chimp
yeah i'm using "recover" in a very limited sense to mean "may eventually give some more-or-less-ambiguous evidence of some kind of awareness", sorry if that wasn't clear

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 2:20 am
by Spoilt Victorian Child
Right.

Personally I'd like to be alive as long as I'm able to understand my environment — at least if private insurance is paying for it. I don't think I'd want to make the state pay $150k a week, even if that state were New Jersey.

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 3:19 pm
by Prof. Horatio Hufnagel
what if you're itchy all the time? i wouldn't want to risk it, i'm dead whenever i can't scratch myself or indicate to somebody that i'm itchy

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 4:31 pm
by tricksforchips
I don't know if that's not dead and I was in that state then I'd probably want to be dead, which sucks because I wouldn't be able to communicate it.

This debate and conversation, to me, is ultimately meaningless in this situation because her life is worse than death at this moment.

Re: What does it mean to die?

PostPosted: Wed Feb 14, 2018 4:36 pm
by tricksforchips
Dr. Norm Thagard wrote:What if she's having awesome dreams and death is just bad dreams?

There is no evidence suggesting this so it's irrelevant.

The question can easily be inverted.

Re: What does it mean to die?

PostPosted: Sat Mar 17, 2018 3:35 pm
by fresco painter
to philosophize is to learn how to die