My SO is currently in hospice after 6 brain surgeries for brain cancer (4 over last year with her state gradually deteriorating). For the last year she was severly disabled and had to be help with sitting down, standing up, lying down and adjusting pillows and blankets as she had very limited use of her hands and general body coordination. She had to be kept safe while walking. It wasn't as good life as she had before but it was life. She was spending time with family, watching ton of netflix and movies, enjoying meals, especially when on steroids. She even managed, with a bit of help, to throw a party for my 40th birthday in march this year, that was cool enough to stave off my usual birthday downward mood swing.
Now she's lying in hospice bed with only minor control of her eyes and even less of her mouth. Barely concious. At most minimally responsive. Feeding tube, oxygen, urinary catheterer, central venous catheter. She's kept alive and somewhat sedated.
First reccurence she had after 5 years after initial treatment and diagnosis. Last recurrence happend in two months. It's already a month past last operation.
I'm a bit torn because I'm firm realist and I believe no matter how bad life is, it is the only thing that has a value for you because it's the only thing you have. When your life ends, there's nothing else, no new game, not even admiring your high score. Your life has an ultimate value to you and you have to try to make the best of it even if it consists of sleeping on morphine all the time till your body just falls apart.
On the other hand... she wished to die on an operating table under general anesthesia. Unfortunately she had too good surgeon for that to happen. If she were to spend 5 years like that I think she'd wish for her cancer to grow faster.
I wish you much strength. The kinds of decisions you are facing (have faced) are the hardest you can imagine and can only be understood if you have been in the situation yourself. I believe that nobody has the right to judge them. Last October, I lost my then 61 year old wife to Early-Onset Alzheimers disease. I saw her slowly fade-away and losing all her abilities, returning to a baby-like state. People often asked me, if she still recognized me. I often explained that that was a meaningless question. For me, it was far more important, whether I still recognized her. And I did. Luckily for her and us, her death came rather swift. She died within one and half week after developing a high fever (possibly due to dehydration) spending the last five days under palliative sedation.
> I wish you much strength. The kinds of decisions you are facing (have faced) are the hardest you can imagine and can only be understood if you have been in the situation yourself. I believe that nobody has the right to judge them. Last October, I lost my then 61 year old wife to Early-Onset Alzheimers disease. I saw her slowly fade-away and losing all her abilities, returning to a baby-like state. People often asked me, if she still recognized me. I often explained that that was a meaningless question. For me, it was far more important, whether I still recognized her. And I did. Luckily for her and us, her death came rather swift. She died within one and half week after developing a high fever (possibly due to dehydration) spending the last five days under palliative sedation.
I am so sorry for your loss. I need you to know that your words moved me deeply. Particularly
> People often asked me, if she still recognized me. I often explained that that was a meaningless question. For me, it was far more important, whether I still recognized her. And I did.
One of the hardest parts on me was seeing my father suffer a similar decline, but it was the moments of lucidity or idle chat or little things that showed me he was still there to some extent. Thank you so much for saying what I have long felt in my heart.
> The kinds of decisions you are facing (have faced) are the hardest you can imagine
The thing is there are no decisions to make. She'll be kept alive as long as possible as law and religious morality requires. All the previous decisions that were made were the most reasonable we could take and there were barely any alternatives along the way.
The hard thing for us is just experiencing it all the way and beyond.
I understand what you mean. I more mend it, for the people from the outside, who sometimes, so easily, make their judgements and come with their advice.
Although I live in a rather liberal country, the choices are still rather limited. The general approach for people with dementia who are accepted in a care home is palliative care: focus on their well-being, not on extending or shortening life. But there is some room for movement, although the final decision is always in the hands of the responsible physician. For example, as family (or personal representatives) you may indicate that you wish that the administration of antibiotics should start as soon as an infection is suspected or delay it as long as possible, instead of it being administered only to relieve discomfort. We decided for palliative care. But still I felt that there were moments, when choice were made to extend her life. Not with respect to medical treatment, but with respect to feeding her. She was given special high-energy drinks and especially in the last half year, a lot of effort was made to feed her. For example, when she was too tired during a meal time, they would try to give it at another moment. Yet, I felt that I did not have the moral right to interfere or to even bring up the issue. I have respect for the manner in which the decisions were made by her physician and the people who took care for her. Although it was hard to go through the experience, in the end I was at peace with my decision to not to interfere and basically let the professionals make the decisions. But maybe my situation was much easier than yours, because my wife long ago had lost the faculty to know that there were any decisions to be made.
All the love to you my friend. I have stage 4 colon cancer + it made its way into my liver. I've been alive for a year now and I have no idea how much longer I have.
I know what you are both going through. I know what myson & wife is going through, seeing me on my bad days during treatment. Knowing that one day I will leave them sooner than we had originally planned.
No matter how bad things are or appear to be I'm a firm believer that there's more after this life and unfortunately we have trek through the good and bad of this one to get to the end. Besides, where did we come from before we were born?
I only live for today, because this is all I have.
Be strong if you can. It's tough and hard. What we are experiencing is apart of life
I was dx the same 5 years ago. After two years of treatments and surgery with what I thought was the best team in the country (UCSF) they decided that my liver mets were positioned such that surgery would be impossible. But my wife found a team at Sloan-Kettering in Manhattan that specialized in just this case. They resected 70% of my liver and followed up with one round of radiation - I’m now two years NED. Feel free to contact me username at me.com if you want more details.
Thank you. Keep strong. Nobody knows how long they will live. Even healthy people. You have a loving family and the little pleasures. You still have a lot of good ahead of you.
I don't think that life in and of itself is valuable even under terrible conditions. Especially if there is no positive outlook, that things will be better, no reason to hang on.
I think only one thing really matters: QUALITY of life.
Life is not intrinsically sacred. QUALITY of life is to me.
> life of any quality is infinitely better than no life
From someone who's been on the other side of the story (albeit nowhere close in severity) I can tell you that this is a philosophical debate that you might have with yourself for years and not really reach a solid and stable conclusion. Because it will change depending on your state. Like promising never to drink again during the worst drunkenness or hangover.
On one hand that low quality of life may be the worst thing you ever experienced and there's the distinct risk of going even lower. On the other hand we have no idea what lies on the other side - nothing or something that may be better or worse. And of course there's always the sliver of hope that all goes well and giving up on life too soon is a waste.
> not really reach a solid and stable conclusion. Because it will change depending on your state.
I can clearly see with myself how my mood affects my train of thought. And how my mood comes from the state of my body. I think I can stay grounded pretty well even when my mind is in terrible physical condition and goes to the darkest places as a result of that. I can somewhat filter out the influence of mood on my thinking.
> On the other hand we have no idea what lies on the other side - nothing or something that may be better or worse.
We can be pretty sure that there's no other side. All of neuroscience, medicine, biology and what we know about neural networks point to it being that way. The only thing that points to there being some other side is uneducated* people's fantasies and wishful thinking.
> I think I can stay grounded pretty well even when my mind is in terrible physical condition
Perhaps it's just like torture, given enough time and suffering things change. Every person has a breaking point. I can't imagine anyone taking torture as "keep doing it because it's still better than dying".
> We can be pretty sure that there's no other side.
Pretty sure. I'm not a spiritual person so this isn't about religion. I was just being thorough so until I get to see nothing on the other side I will at least give the option a passing mention.
And I don't think your mind hangs on to life just because once it's over there's only nothingness. The human mind probably can't even conceive what "nothing" means. You might hang on for more "practical" reasons, like "I spent years building this life, I can't waste it especially if there's a slim chance it gets better".
I imagine a year in solitary confinement (how is solitary even legal still?) would likely change your mind. I'd say no life is better than a life of torture, and taking "life of any quality is infinitely better than no life" to the extreme, would mean that hell with eternal constant torture would be better than not existing, which I can't agree with nor understand. I'm glad that you have such a positive outlook on life, but I doubt that you could maintain it in the face of a long torturous experience, few can.
People spend whole lives in prison and they still don't want to die. Very small number of people with healthy brains (undamaged by depression for example) kill themselves intentionally even though it's not that hard. Life is very fragile. Somehow even in this world filled with suffering practical calculation lands for almost all people on the side of "let's not end this just yet".
You can ponder eternal torture and not existing but I'm talking about more down to earth thing. Your single life. You will never have anything besides it. It's not eternal torture, it's not even all torture. It is everything you own and the only thing you own. How could you give up any future piece of it that you didn't have to?
Is there a living will? What is their wishes, either written or verbally spoken?
In cases where we have to make hard decisions like this, I find some solace that they have made their decisions ahead of time so that we only complete their requests.
I don't envy you at all in this. The same thing happened to my dad, except the life-saving measures failed, and the doctors said there was nothing else they could do. They gave my mom an 'out', since it was not her choice.
No will, no specific wishes, except for 'be healthy' and 'if not possible, die on the operating table'. No way to obtain them now. Even so they'd make no difference. Ending life is prohibited by both law and religion of the land. Any attempt to do less than possible to keep her alive would be illegal and religiously immoral. We just have to wait till life-saving measures will fail.
As a theoretical scenario you are right but brain is very flexible. If all you know is pain wouldn't you just get used to it and still didn't want to die because as I said, there's nothing else for you?
I can respect both positions. I understand completely why people want to hang on to life no matter what, and I also completely understand wanting to be done with a life that offers nothing but pain.
This is why it's desperately important to be honest with your loved ones about what your wishes are, and to respect and help them with theirs.
Personally, I want to live now, and I suspect from watching other people at the end of life, I'll know when I'm ready to go.
Depression gives you a negative outlook, regardless of how good your quality of life is. An irrational thought loop that whispers to you (or screams at you) that things will not get better. It's easy to conflate negative thoughts into reality.
If you do find a way out, the idea that life itself is sacred (regardless of quality of life) can help keep things in perspective for next time.
I deeply believe that depression is just physical brain damage and dark thoughts are just the symptom making harder for you to get treatment just like a pain in the knee might make it harder for you exercise it a bit or get to the doctor to get treatment. I don't think that dark thoughts by themselves cause depression or even directly contribute to it. Same way the feeling of pain doesn't make your knee worse.
I think it might be helpful to have distance to your feelings. To understand that unlike your thoughts, your feelings have direct purely biological source. You might find it easier to suffer through them, like you can suffer through limping.
I hope I'll never get depressed so I won't have to find out whether that makes any difference.
Depression is a negative thought loop that in the moment feels impossible to escape. Irrational thoughts seem rational. In a clinical sense depression (as a disorder) may be the cause. It persists even when your quality of life is good. That said, depression can also be an effect (triggered by a traumatic experience).
Distancing yourself from your feelings may help temporarily, drugs do that.
Occupying your mind with activities that provide a positive reward loop and positive feeling (hobbies, exercise, social activities) likely makes the most difference.
The (well off) CEO of a company I work for went through something similar. Life can get really hard no matter who you are. We are guests to the world on borrowed time and life is precious and fleeting.
> I'm a bit torn because I'm firm realist and I believe no matter how bad life is, it is the only thing that has a value for you because it's the only thing you have.
I find this to not be self consistent. you would trade two boring work days for one awesome day right? Two bad weeks for a happy one? There has to be some long tail of uncomfortable days that you would rather enjoy on a shorter time frame, even if the long tail is unknown length. Might a warm send off not be preferable to difficult times ahead?
> you would trade two boring work days for one awesome day right
In principle you are correct, but in practice you rarely can make such choices because you can't possibly know the future.
You can think you are choosing better life by foregoing the treatment, but it turns out that severe symptoms set in sooner than expected and your life's bad anyways. Or you can think you are choosing longer but worse life but the side effects of the treatment don't seem to affect you much, therapy works way better than expected and you get to experience some joy you couldn't wish for, like holding your newborn grandchild.
What people usually do is balance probabilities and go for longer non-horrible life and hope for the best, and when everything becomes horrible there's usually not much left to make decisions about, which are inherently flawed even then.
it seems illogical to spend a lifetime making decisions on incomplete information and then foregoing the last one.
I mean I get that people make their own choices. I just am confused that more people aren’t interested in having a death of their choosing. Or even consider it. Like, I have a song that I would like to hear as I’m dying. I want to think and reflect on things and feel safe in spite of the incoming end. I am convinced that with a better cultural mindset we could make death a happy, celebrated, communal event that people look forward to in a bittersweet way. The way most people die to me sound sad for all involved, including the dying.
The thing is, last moment of your life isn't in any significant way special. It matters just as much which music you will listen in your last moment as it matters what music you'll be listening in exactly 43 minutes.
If you like to make decissions you can make and implement them now.
The thing is decissions are tiresome. You might want to forgo some avoidable decissions and focus more on pleasures of living.
Can she use an eye tracker sometimes? At least then she'd have a line of communication and be able to still watch netflix. I been setting up a tobii ( https://www.tobiidynavox.com ) recently for a friend who thankfully has now got enough control back below the neck to use a dabber with a touchscreen. It didn't take me too much practice with the thing to be able to search for cat pictures on google, using dasher.
I think at this state she doesn't have enough focus to follow a movie. She was temporarily in a bad shape after previous surgeries (though not that bad as she is now) and she didn't want to watch movies then.
As a 58 year old, I think semi-constantly about my need for an advanced health directive. I also now suspect (reading this) that whilst no 15 or 16 year old is actually capable of processing the issues (amygdala) even young people need an AHD.
I'm all in favour of the tubes. My partner is not. If you don't know, then your fate in the system is left to others. The AHD won't give you your wishes but it at least tries to address them.
Hard for me to imagine wanting this life. Imprisoned in a state worse than solitary confinement for more than a decade. Life is very good, most of the time, but there are states where less is more.
That really depends upon how bright you think the future is.
If you think the future will bring amazing medical breakthroughs and immortality, then tubes is only temporary and all you gotta do is hang on long enough.
>If you think the future will bring amazing medical breakthroughs and immortality, then tubes is only temporary and all you gotta do is hang on long enough.
I'd say don't bet on it.
The changes to life expectancy and quality of life from early low hanging fruits (most of which weren't even that advanced, like clean water, washing hands for surgeries, basic antibiotics, etc.) dwarf later developments such as heart surgery, bionic limbs, and advanced drugs (aside a few important breakthroughs for people affected with specific conditions).
A more realistic outlook is whether you think you might eventually get out of the coma -- which does happen.
Even if immortality were to become reality, what incentive could there be to cure the ill?
Perhaps I'm just unimaginative, however I can't really fathom a world in which it would make economical sense to cure the ill rather than simply prevent people getting sick. Economically those with illnesses and/or genetic conditions (myself included) unfortunately seem like a bit of a lost cause.
Surely restoring a skilled 58-year-old with decades of experience to full health is much faster and cheaper than making an entirely new human and training them to the same level.
As for preventing people getting sick—well, from what I've heard, a significant reason older people are more likely to get cancer is that their immune system and their body's ability to repair itself are weaker (and one part of cancer is DNA damage), so it seems like the most likely approaches to preventing cancer are also going to help with curing other illnesses.
I think more than an external incentive, it would provide an incentive for workers to be able to afford their own immortality, prior to debilitating diseases.
At what point should hugely disproportionate healthcare be provided to select individuals at the expense of everyone else'e healthcare?
I have Sarcoidosis, a genetic condition that means my immune system literally attacks my own body. It's extremely rare. Should I demand that a hugely disproportionate amount of money be spent to cure me so that I can enjoy this theoretical immortality? Seems a bit selfish. That money could presumably be spent to benefit many more lives beyond my own.
This isn't pro-capatilism reasoning, it's just being realistic and reasonable.
EDIT: To clarify I'm not advocating that we don't invest money in treating Sarcoidosis (or other rare conditions); right now it's much more realistic and more likely to cause immediate benefit than immortality moonshots! However, down the track perhaps the best investment would instead be prevention in newborns. In which case I'll miss out. A shame for me, but if that happens to be the approach that's going to have the best net positive outcome for society, then go for it.
If scarcity was an actual issue, we could collectively decide what a fair distribution of that scarce resource would be. Few things beyond a lottery would be considered fair by most, but we can try.
However, we live under conditions of extreme supply for many things, including most factors that would inhibit healthcare. We rarely need to choose.
This has to be a "worst nightmare" for most people. I came across a guy a very long time ago who had been in a long term care unit after an auto accident for something like 15 years at that point. The story I was told, and I don't know it's veracity, is that he was resuscitated against his stated wishes and the hospital was paying for his care forever. His eyes would open but he didn't respond in any way to any stimulus that I saw. He had a feeding tube if I recall, and breathed on his own without ventilator support. He was a swollen belly with stringy arms and legs as atrophy did it's thing. The nurses moved him around to prevent ulcerations and tended to his "survival". It was terribly disconcerting and I hope to god he wasn't aware because that sounds like hell.
As @ggm mentioned the documents...everyone should get an advanced directive. Anyone can do it and you don't have to have a reason, unlike a DNR which has more restrictions and requires a doctor's approval. A living will/advanced directive is a 5min bit of paperwork you can get done free at hospitals and doctors offices in most places. Submt it for your medical record and keep a copy in your emergency papers. Unsure how much it would have helped the guy above as I don't know the full story, but it's easy to do and important to have. I've seen loads of cases where people were strung along barely or not even "alive" by any metric other than "technically". for months and years and families fought over care etc. Don't put it off as tomorrow might be the day you need it.
There are also cases where an advanced directive isn't possible like with children. An ambulance driver friend of mine had a patient a few weeks ago, a newborn that had been abandoned, was deaf, blind, thought to be mentally retarded (not sure why) and suffering from heart failure. Apparently there was quite a bit of ethical debate at the hospital that night.
A DNR might be good for people in specific circumstances but an advanced directive should not be required to be allowed to die.
I suspect after enough months of no stimulus you just go unconscious. Your brain learns to be conscious why wouldn’t your brain learn not to be. It’s normal mode is to stop caring about noise.
SOS is pretty recognizable even by people that don't know morse code. It has a very distinctive pattern to it. You can use it to get someone's attention.
As someone who was in the boy scouts then the air cadets as a kid, this seems true. Is it the same for people who have not had an upbringing that involved outdoor activities?
> unlike a DNR which has more restrictions and requires a doctor's approval
this varies upon states. Definitely check with the state that you're in.
I'm a Paramedic and sadly, we experience these situations rather often. End of life issues are tricky and it's a conversation that people want to avoid, but it's a conversation that I believe they absolutely must have.
...kept alive by a system that didn't care enough to learn his name
While it is ridiculous to me that they didn't do a simple fingerprint check, it's kinda strange to use this language and then go on to tell how the "system" has provided round the clock care for over a decade costing millions of dollars. The system seems to care. I'm sure on the BP side they are just overwhelmed and don't have the manpower to run something like this down.
Agreed. I'm proud of the "system" for choosing to keep him alive. My wife works in a county hospital here in CA, and I'm proud of the great work they do to save the lives, every day, of the 'illegal' immigrants, of the indigent, of the homeless, of prisoners.
I'm not sure about system's motivation though. There are 2 "systems" - the one which pays and the other one, which receives the payment for the care, and this one probably wants him alive for as long as possible. They mentioned it cost 4 million, it's around 20k a month. For a person that takes up one bed in a corner of a room densely filled with people like him. Ignacio would be lucky to earn 2k per month from back-breaking labor if the incident didn't happen, and yet now he generates much larger amount for the system just laying on the bed.
so he was mostly unresponsive but could still feel pain. they were doing stuff with his tubes with no pain meds for almost two decades. that has to be one of the most horrifying things ive ever imagined.
That was really surprising to me. I’m not a doctor but it seems easy enough to assume that patients in a vegetative stage can feel pain and medicate them accordingly. The risk of over medicating in that situation seems to be outweighed by the risk of someone having to suffer in silence.
The assumption that someone who can’t communicate pain is unable to feel pain seems misguided at best.
This type of thing is standard in healthcare. Doctors only began saying babies felt pain in the late 1980s, and only then because a mom made a big fuss in the media about it when she discovered on accident that her baby received open heart surgery without anesthesia.
All of a sudden the decades of research that had been interpreted as showing babies didn't feel pain was overturned and new research showed they did.
Medical research really is mostly a series of fads.
I can imagine that there are legitimate reasons not to use anesthesia on babies who show no signs of remembering the pain when they've become able to communicate. Anesthesia is not without risk, probably doubly so for a developing brain.
You are in an accident and have to be operated on, but using anesthesia would drop probability of survival from 90% to 10%. They can give you instead a drug that will prevent you from remembering pain that has no influence on probability of success operation.
What would you chose?
I'm not saying that this is the exact case with infants. Just trying to illustrate there might be valid reasons to inflict temporary pain to save health.
Technically we don't know whether general anesthesia actually prevents you from feeling pain, or whether it just prevents you from forming memories. As far as I know at least.
General anesthesia is usually a combination of multiple drugs. We know exactly what each drug does, medical science isn’t so good at explaining why the drugs have these actions. anesthetists combine these drugs to suit the requirements of the procedure and the patient
Anesthesia usually includes drugs with distinct, separate actions, like an analgesic (to block pain receptors), muscle relaxants (so patients can be moved/organs accessed), CNS depressants (to prevent unexpected spasms disturbing the surgeon), coma-inductors (so patients don’t chat with the staff and freak them out after practicing on cadavers for years), and amnesia-inductors (because surgery is kind of gross).
We know enough about them to use them safely, but most anaesthetic drugs are somewhere on the spectrum from "not fully understood" to "a complete mystery". Science knows how anaesthesia works in the same sense that I know how a car works - I can push the pedals and turn the wheels with sufficient proficiency to get to the grocery store in one piece, but I'll be damned if I can explain what's happening under the hood.
I guess that's technically correct, in that it's difficult-to-impossible to "know" about someone else's subjective experiences.
On the other hand, painful stimuli tend to (e.g.) increase a person's heart rate and blood pressure, and that the proper anesthetic plane blocks those responses, so it's clearly doing something in the moment. What we don't know every well is the mechanism of action for general anesthetics.
I would imagine that we must know that by now. We should be able to just see on a brain scan whether the pain centers are lighting up in response to pain.
It seems like a case of motivated reasoning. Doctors needed to operate on babies; anesthetizing them would be hard. So they decided that babies can't feel pain and never investigated methods of anesthesia on babies.
More like anesthetizing them would be risky and they're not gonna remember it so it's not worth the increased risk to their life since infants are already fairly fragile and saving their life is the primary goal.
It's not just "it's hard and we're lazy so lets make up an excuse" like you seem to be implying.
Edit: Since apparently it wasn't clear, we're talking about the timeline when this issue was hashed out, so the 1980s. Anesthesia carried substantially more risk then because back then we didn't understand it nearly as well.
We anesthetize infants fairly often now[1]. It's still a bit risky, but it's fairly common. It's gotten less risky because we do it a lot and have gotten quite good at it. If we'd never revised the science on infant pain, we never would have even bothered to try. Turns out, it's possible to do it fairly safely.
It's one thing to say, we're not going to use anesthesia because it's too much risk, it's another to say that they don't feel pain at all so let's not worry about it.
We're better at anesthesia now, but would we have ever gotten good at anesthetizing babies if we kept believing that they didn't feel pain in the first place? Why bother working out how to do it if we think they don't feel pain?
Insane! Stories like this one make me question if it should be a requirement for every person to have on file his/her AMD for situations related to this outcome. People shouldn’t fear death or existence may be an extreme prison of torture. Why people continue to allow this is beyond me. Heck only till recently in all of humankind has this kind of torture become a thing. Geese..
Why is a matter of agency and fear of death and ability to give non-impaired consent. People fear "getting written off" by other's judgement.
It is one thing when it is readily apparent neccessity -medics can only give you morphine while your guts are hanging out and getting you potentially barely saveable would cost say ten other lives of people who only need the bleeding stopped. It is another thing entirely when they have all of the time in the world and it involves tough decisions nobody wants to make until the conclusion is utterly foregone like total brain death.
And I'm so happy I live in a country that permits Euthanasia. And the rules for it are clear:
(some of them)
1. Intolerable suffering
2. No outlook on any improvement
There are cases where people recover after years being in coma. However, there are many, many, many more people in the same state who never recover, who are just plants.
3. Patient's affirmative consent (antedated if need be)
I too am happy to live in a country with a humane policy towards voluntary end-of-life, but this is not a clear cut case where euthanasia would apply: this is a patient with at least some consciousness left, but that no court would find competent to make decisions, and with no known relatives (up until the reporter found one).
The question then becomes not only whether the required conditions for euthanasia apply, but also whether the state-appointed legal guardian has the mandate to make such a fundamental decision on behalf of the patient. Personally speaking, granting that kind of power to a government representative is not something I'm comfortable with.
Your happy ending is subjective as mine in the end. I know if this happened to me, I would be dead because I have my AMD on file and everything can move on. Btw, what you wrote shouldn’t be against assistance in death but personally for your own situation.
At home, the family spoke Mixtec, an indigenous language; at school, Ignacio learned to speak Spanish. He was the only one in his family who went to school past the primary grades.
And he's spent about half his life in the US with extremely limited ability to interact at all and probably mostly hearing English.
What language do you think he's supposed to be capable of responding to? One of the two he grew up with, but hasn't actually used in half a lifetime?
There are documented cases of people with head injuries losing the use of one language they knew but not another.
I have a serious medical condition and I grew up in a bilingual home. I've had incidents where I was exhausted and stressed out and could not speak English for an hour or more, only German, though I'm not especially fluent in it.
I don't care what language you use with Ignacio. He's probably not mentally fluent in any of them anymore, having nothing to do per se with how impaired his brain is and everything to do with the fact that he's probably mostly not heard either Mixtec or Spanish for half his life and has instead been immersed an English-speaking environment with which he mostly couldn't interact.
I’ve signed legal documents to prevent this happening to me in the future. I have not signed a DNR, but I’m certain I would never want to be kept alive arguably against my own will and the will of the natural world.
After watching my grandfather succumb to Alzheimer’s I’m relatively certain we’ve taken some forms of hospice and medical science too far. Albeit, extending the life of our bodies past the reasonable lifetime of our brains.
> I would never want to be kept alive arguably against my own will and the will of the natural world.
I get what you are saying, but let's not forget that "the will of the natural world" includes dying as an infant from diarrhea, an untreated fever, etc. There are plenty of diseases which are now easily treatable and yet killed millions until a century ago.
Now she's lying in hospice bed with only minor control of her eyes and even less of her mouth. Barely concious. At most minimally responsive. Feeding tube, oxygen, urinary catheterer, central venous catheter. She's kept alive and somewhat sedated.
First reccurence she had after 5 years after initial treatment and diagnosis. Last recurrence happend in two months. It's already a month past last operation.
I'm a bit torn because I'm firm realist and I believe no matter how bad life is, it is the only thing that has a value for you because it's the only thing you have. When your life ends, there's nothing else, no new game, not even admiring your high score. Your life has an ultimate value to you and you have to try to make the best of it even if it consists of sleeping on morphine all the time till your body just falls apart.
On the other hand... she wished to die on an operating table under general anesthesia. Unfortunately she had too good surgeon for that to happen. If she were to spend 5 years like that I think she'd wish for her cancer to grow faster.