Value of Continued Existence vs. Quality of Life
A central theme revolves around the trade-off between simply continuing to exist and the quality of that existence, especially when facing severe medical challenges. Many acknowledge that the desire to live longer isn't absolute and that a life filled with pain, suffering, or disability may not be a worthwhile existence.
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"I get what you're saying, but continued existence has to be balanced against the quality of said existence. If it's agony, pain or extreme disability that prevents enjoyment of life, life seems less compelling." - the_af
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"Better than getting shocked all day or feeling shitty after a transplant because of the drugs you have to be on forever." - jf22
Understanding the Choice to Forgo Treatment
Several commenters emphasize the difficulty of judging the author's decision without experiencing the situation firsthand and highlight the potential trauma associated with medical interventions. People are sympathetic and attempt to understand why the author may decide to forgo a heart transplant based on their experiences.
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"The decision may be more logical once you experience the same situation" - vjvjvjvjghv
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"It's very difficult for someone who hasn't experienced this (like me and, I guess, you) to put themselves in the other person's shoes. I think I can understand the decision he's making, and it doesn't seem to me to have been taken lightly." - the_af
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"All three of the grandparents I actually got to meet ended up doing this same math and getting the same result: sometimes life-extending care isn't worth what you have to go through to get the extension of life." - reverendsteveii
The Burdens of Transplants and Immunosuppression
The long-term commitment and lifestyle changes associated with organ transplants are raised as a significant factor in the decision-making process. The need for lifelong immunosuppressants and the potential impact on quality of life are considered.
- "A transplant always is a life altering change. You'll be on immunosuppressants for the rest of your life which has a massive impact on your quality of life - and that's if you get a transplant before you die." - finaard
Acknowledgement of Potential Mental Health Factors
Some commenters speculate on the role of mental health, particularly PTSD, in influencing the author's perspective and willingness to accept death. The potential for depression and anxiety stemming from traumatic medical experiences is considered.
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"When reading the rest of his posts, I think you are right to ponder how his mental health is negatively impacting his outlook. He seems to be more ready to accept death than I'd expect, given how young he is." - gusmally
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"Perhaps he 'needs' anti depressants and go for a transplant. It's not clear to me he is in a completely lucid state of mind - he is saying himself he thinks he has PTSD, plus he has a bunch of stuff to live for it's not like he hates life - he just hates this shitty medical mess he is in." - weatherlite
The Impact of Defibrillator Shocks
The thread delves into the specific issue of defibrillator shocks, with several people noting how the unpredictable and painful nature of these shocks can severely diminish the quality of life, leading some to prefer death.
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"This is at least the second time I've heard someone say that the defibrillator implant shocks are so bad, they would rather be dead." - nancyminusone
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"I never thought about the uncertainty of it all. If the shocks are very painful and can come at any moment, without notice, they must be terrifying. The author of the article describes being fearful of even trying to sleep..." - the_af
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"It’s literally like those experiments that test the effect of electric shocks in rats for avoidance of something, and there’s a control group of rats that are just shocked randomly. The randomly shocked rats become highly stressed and neurotic." - Modified3019
Agency and Pre-Commitment vs. Choice in Medical Intervention
A detailed discussion on the possibility of giving patients more agency in the delivery of defibrillator shocks raises the point that while the ability to choose may seem empowering, it could become a constant source of anxiety and a test of willpower. The argument is made that pre-commitment to a fully automated system, despite its drawbacks, might be preferable to the burden of making life-or-death decisions in moments of weakness.
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"The most “usable” form of this would be to allow the patient to agree or disagree to the shock (maybe defaulting to agree if no response is given in time); this would place the agency in the hands of the patient and allow them to be mentally prepared." - nneonneo
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"I can only speak for myself, but, assuming it's feasible to implement as you describe, that sounds awful. In full auto mode, unpleasant experiences happen, but at least without specific anticipatory distress...I'd much, much rather pre-commit than have to face that aversive decision time after time and day after day. Knowing that my life is on the line if I'm caught in a moment of weakness. That calculus is much too important to me to leave to the whims of my reactive brain." - alwa
Dying as a Commitment
One perspective shifts the focus to highlight that even choosing to die is a commitment. The thread then explores how our societal views, which assume death is distant and to be avoided at all costs, influence our evaluation of medical decisions.
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"Yeah, my thought on reading this line was that dying also requires a pretty irrevocable commitment...Treatment is a commitment. So is dying. Treatment will go on for the rest of his life. Without treatment, dying will go on for the rest of his life." - reverendsteveii
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"A lot of the things we do and ways we look at things assume that dying is 1) very far off, 2) to be avoided at all costs. If either of these things becomes untrue the calculus we do to determine reasonable courses of action goes flying out the window." - reverendsteveii
Differences in Values
Several people pointed out that ultimately, it is up to the OP to decide what their values are, and that other people may not understand them or agree with them, but ultimately it is not up to them to decide.
- "You just have different values than the OP. I have values different from yours as well that would have me turn down a transplant... and it's not that I wouldn't want to live longer. There are just some measures I'm unwilling to take." - NoMoreNicksLeft