[HN Gopher] How ECMO Is Redefining Death
___________________________________________________________________
How ECMO Is Redefining Death
Author : _xerces_
Score : 83 points
Date : 2024-04-30 18:36 UTC (4 hours ago)
(HTM) web link (www.newyorker.com)
(TXT) w3m dump (www.newyorker.com)
| PaulHoule wrote:
| See https://archive.ph/0GP4F
| captainkrtek wrote:
| Another real world story on the usage of ECMO
| https://archive.ph/TZ90v . A snowshoer got lost around Mt.
| Rainier, fell, and had to be rescued. He was hypothermic and went
| into cardiac arrest, with not a high probability to survive,
| saved by ECMO and had a full recovery.
| idontwantthis wrote:
| This is definitely in the "nice problems to have" ethics pile.
| OJFord wrote:
| What? In the sense that better to have that problem than just
| already dead because ECMO doesn't exist, you mean?
|
| Otherwise I can't think of any way it's at all nice, and that
| applies to any dilemma - you can always say 'oh well nice to
| have the option, better than only the bad lemma'!
| idontwantthis wrote:
| I mean that countless people going forward will be saved by
| this. Some people will become ICU bound walking corpses. It's
| an incredible technology that will have profound benefits for
| humanity.
| jprete wrote:
| ECMO is a miracle, but can also lead to some of the saddest
| situations imaginable:
|
| "Without ECMO, she would die. But owing to the complexity of the
| machine and its attendant risks--catastrophic bleeding, stroke,
| infection, malfunction--she couldn't leave [the ICU]. She was
| waiting, stuck in a kind of limbo between life and death."
| MikeTheGreat wrote:
| To be fair that pretty much describes all patient visits to the
| ICU. You're not there because things are fine and you'll be
| going home soon, you're there because you're on death's door
| and the hospital folks want to keep you on this side of it.
| crote wrote:
| The difference is that most other ICU patients are there with
| an (albeit slim) chance of recovery. Their body just needs
| time to heal, and the ICU provides the support necessary to
| do that. 75% of ICU patients are discharged from the hospital
| alive, and those who die often do so within the first few
| weeks.
|
| On the other hand, it seems some ECMO patients have _zero_
| chance of recovery. Their own organs have failed and aren 't
| coming back, and a transplant doesn't seem to be an option.
| Sooner or later they _will_ die in that room, most likely due
| to complications.
| lozenge wrote:
| Great article, did New Yorker abandon its rambling house style?
| drxzcl wrote:
| Not to downplay the dilemmas we face today, it seems to me that
| the main problem is that the machine is too expensive, too
| complicated and too large to serve as a permanent heart/lung
| replacement.
|
| We have an excellent record of making machines smaller, cheaper
| and simpler to operate. This machine will be the pacemaker of the
| future.
| sxg wrote:
| That's definitely not the main problem. Risk of intracranial
| hemorrhage/strokes and other complications make it problematic.
| saurik wrote:
| But that isn't the problem from the article--the ethical
| issue of how to deal with a ton of people who are being kept
| alive on a "bridge to nowhere" when the machines might could
| be used in the interim to save many more people--as if you
| have an intracranial hemorrhage you are going to start down
| the road to actually dying. (And the article also talks about
| attempts to improve the bleeding problem anyway.)
| toth wrote:
| To me it sounded like part of the problem is that people on
| ECMO cannot leave the ICU because at any moment they might
| have a complication that requires immediate emergency care.
|
| So it's not enough to make them smaller and cheaper, they
| also have to be made much less prone to these
| complications. I am sure that will happen in time, but I am
| also sure we'll be able to grow people new lungs in time
| FireBeyond wrote:
| Critical care paramedic: that's very much the bigger
| issue. Some life flight helicopters are being fitted for
| ECMO and there is NOT much space in a helicopter, once
| you fit in two providers, a patient on a gurney and care
| equipment (most HEMS units are Bell 429s and EC/H-135s -
| MSP uses much larger AW-139s).
|
| https://live.staticflickr.com/3142/2639039443_ba623ddca0_
| b.j... shows the working space on a -135. Note that
| access to most of the patient is heavily restricted -
| only chest and head, really.
|
| Still, to be clear, we are not really at the 'portable'
| stage either. There's about 65lb of equipment needed for
| an ECMO patient just for the ECMO itself, beyond other
| things like Lifepaks for monitoring.
| Animats wrote:
| Yes. The first recipient of an artificial heart was tethered to
| a sizable amount of hardware and confined to an ICU. Now,
| implanted artificial hearts are regularly used.
| timr wrote:
| It has very little to do with the size and expense of the
| machine itself. ECMO requires 24/7 human maintenance because
| humans are messy dynamic meatbags, and tubes clog with clots,
| blood changes pH, people have an annoying tendency to move,
| etc. Every hospital with ECMO literally has "an ECMO team" to
| support the thing. It's mind-bogglingly expensive in terms of
| human capital.
|
| Other people on this thread are trying to imply that these
| things are like artificial hearts. That is true only in that
| the heart is _one_ of the things that an ECMO machine attempts
| to replace. We don 't have anything like an implantable
| artificial lung.
| jonah wrote:
| TFA says that they're currently working on a portable
| (external) lung replacement[0]. I see no reason that it
| couldn't be installed in the chest cavity with a port for the
| O2 bottle connection.
|
| [0] https://archive.ph/0GP4F#selection-1103.0-1110.0:~:text=T
| o%2....
| timr wrote:
| Even if "they're currently working on" meant "it's
| available now or practical in the near future" (it
| doesn't), that doesn't affect what I said about the immense
| costs involved.
|
| The portability of the device is not the core issue here.
| It's a bit like arguing that you _can_ build a quantum
| computer today, so therefore we 'll all have one on our
| desktop soon.
| xboxnolifes wrote:
| A lab "working" on something is the equivalent of not
| having it. It should be not be read as an inevitable
| outcome.
| credit_guy wrote:
| Exactly. This is progress. There is no ethical dilemma here,
| whatsoever. This is a technology that is keeping people alive.
| It's bulky, expensive, dangerous, etc, etc. But those things
| are not set in stone. In time it will become small, affordable,
| safe, etc. Until then, every little step should be celebrated.
| iancmceachern wrote:
| It will, you are right. Anyone who wants to design hardware
| in the space feel free to reach out.
| FuriouslyAdrift wrote:
| ECMO is a last resort type treatment that has common life
| altering side effects.
| sithadmin wrote:
| Yep. A good friend of mine who is a perfusionist (a relatively
| obscure midlevel med tech role focused on ECMO/CPB operations)
| has made it clear they would rather just be allowed to die than
| be subjected to either. The majority of cases they're involved
| with, but most especially the ECMO cases, per their account,
| are associated with what seems like unnecessary suffering
| pending death. Their opinion is that in most cases, it's
| probably not worth the extreme cost and effort, and that
| tracking 'survival' as the criteria for success is misguided
| given poor quality of life afterwards, and usually death
| related to long-term side effects/complications. They admit
| that their opinion may be clouded by the fact that they've
| self-selected into working in hospitals that are the most
| likely to take 'hopeless' cases, though.
| FireBeyond wrote:
| I'm a paramedic, and in between seeing quality of life issues
| post resuscitation, ongoing care challenges and,
| unfortunately, the state of some skilled nursing and rehab
| facilities, myself, and I would say a "very very large
| percentage" of my peers are absolutely on the same page.
|
| Unless full recovery with no to minimal deficits is likely,
| not so much.
| Workaccount2 wrote:
| I have heard the sentiment before that ICU doctors would
| rather die than go through the ICU. Couple this with PTSD
| being a common side effect from ICU care and it starts to
| make a picture that maybe death is just the way to go.
| mahkeiro wrote:
| ECMO is used by emergency service in Paris and they it bring
| to the patient wherever he is having a cardiac arrest. This
| is really changing how many people will survive a out of
| hospital cardiac arrest, as a lot of people saved can resume
| a normal life (about 40% from 6% without it)
|
| If you understand French here is a video of how the procedure
| is done. https://youtu.be/bX5yZFM2Dn4?si=h0hod5XXgWCWrfLa
| sithadmin wrote:
| Je le parle :)
|
| SAMU's program is impressive and shows a lot of promise as
| a bridge treatment, and it's completely unlike anything
| available here in the US today (where myself and the friend
| I mentioned earlier live).
| iancmceachern wrote:
| They even did it in the Louvre!
| darth_avocado wrote:
| This is common conversation doctors have amongst themselves and
| with patient's family. In cases of premature births with
| complications, often doctors suggest not having the child on
| ECMO unless the chances of survival are really high.
| carterschonwald wrote:
| My niece was on Ecmo several years ago after a serious accident.
| She's applying to university now.
|
| That's what any non end of life treatment strives to achieve.
| mezentius wrote:
| I fail to see how this is, as one specialist puts it, a "profound
| ethical dilemma," and not simply a temporary and embarrassing
| misalignment of resources. If you can prevent people from dying--
| and enable them to live meaningful, sentient lives despite being
| tethered to a device--then the solution is clear: scale up
| production while making the devices smaller and cheaper, and in
| the meantime seek out alternative long-term facilities for
| palliative care to avoid occupying hospital beds.
|
| The fact that the article frames the problem as "we have this
| fear of letting people die"--instead of a difficult but solvable
| problem of research, economy, logistics--seems to me emblematic
| of a certain dead-end, anti-growth mindset that pervades much of
| supposedly humanistic writing from the NYer.
|
| So what if this is "a bridge to nowhere?" So is life! And in the
| end, we are all, in our own ways, waiting for time to run out,
| tethered to something immovable.
| feoren wrote:
| It absolutely boggles my mind that this is such a controversial
| viewpoint. We're talking about a machine that can keep people
| not just alive, but awake, talking, and riding an exercise
| bike, _without working lungs or a heart_. It 's an insane,
| miraculous treatment, and extremely strong evidence that death
| is something we can conquer. And people come along and just
| downvote comments like yours, with no explanation at all,
| because it's so deeply engrained in their brains they they and
| everyone they love simply _must die_ , and everyone who
| believes otherwise must be naive and stupid. Because death is
| this magical, spiritual, special problem unlike any other
| problem humanity has ever faced: the _one thing_ we will never
| be able to solve?
|
| It absolutely is a dead-end, anti-growth mindset, and I don't
| understand it. Why is everyone so in love with death?
| jprival wrote:
| It's not a particularly fair accounting of the framing of the
| article, which also profiles people who are working precisely
| on making the technology more practical and portable and ends
| on a hopeful note. For the time being it's a high maintenance
| way to keep people alive, though, so the ethical dilemmas of
| resource allocation are real.
| DSMan195276 wrote:
| > scale up production while making the devices smaller and
| cheaper, and in the meantime seek out alternative long-term
| facilities for palliative care to avoid occupying hospital
| beds.
|
| I feel like you're just hand-waving away the issue. If they
| could move them out of the ICU they would have, the issue is
| they require constant care while on the ECMO machine.
|
| Additionally, while the "smaller, cheaper, no care required"
| devices may appear in the future (the article talks about this
| very thing), they're not here _right now_. There's currently a
| limited number of machines and people who can maintain them in
| the hospital, and hence an immediate problem that they have to
| deal with when there's more people who can benefit from them
| than machines they have.
| samus wrote:
| It reminds me of the situation people used to face when they got
| Polio. Often, they got stuck in an iron lung for a while and
| quite a few also never ever recovered lung function, meaning they
| were stuck for life as well.
| skerit wrote:
| "A patient whose heart has stopped could potentially live on the
| machine for months, awake, able to walk and read the newspaper.
| But he might never leave the I.C.U."
|
| The only ethical problem I see is other people deciding what life
| is worth living.
| margalabargala wrote:
| Fully agree. They have this case study later in the article:
|
| > Around a decade ago, a teenager who couldn't be saved was
| admitted to a New England hospital. Like Shania Arms, he had
| cystic fibrosis. A previous lung transplant was failing, and
| his only hope was another transplant. He was put on ecmo while
| he waited. Two months later, doctors discovered that he had
| developed an incurable cancer. Now there was no way for him to
| leave the I.C.U. His lungs were beyond recovery, and the cancer
| made him ineligible for transplant. He was caught on a bridge
| to nowhere.
|
| > Some members of the medical team thought that ecmo should be
| stopped. Transplant was no longer possible, and ecmo machines
| were scarce. As long as the patient was on the machine, it
| couldn't be used to save someone else. It's also expensive;
| according to a 2023 study, the median hospitalization charge
| for covid patients on ecmo was around eight hundred and seventy
| thousand dollars, and prolonged cases can exceed several
| million. These resources might be needed to help other
| patients, and the boy couldn't live in the I.C.U. indefinitely.
|
| > But others on the team disagreed. "He was texting with his
| friends," Robert Truog, a pediatrician and bioethicist who was
| involved with and wrote about the case in The Lancet, said. He
| was spending time with family, and doing homework online.
| Because he could be awake on ecmo, he could still engage in
| activities that were meaningful. Situations like this represent
| a "profound ethical dilemma," Raghu Seethala, an intensivist
| and ecmo specialist at Brigham and Women's Hospital, told me.
| "The technology is ahead of the ethics," another expert said.
|
| The technology isn't "ahead of the ethics" as the one quote
| indicates. This is a simple case of some people apparently
| advocating for killing a living, conscious, interacting-with-
| the-world teenager because he wouldn't just hurry up and die,
| and they want to use his resources for something else.
|
| I bet those same people would learn that over 80% of people
| aged 70-75 reside in a home they own, and immediately come up
| with a modest proposal for how to solve the housing crisis.
| wizzwizz4 wrote:
| The most ethical position is utilitarianism, up until the
| point where people who _aren 't_ weak or sick or poor or
| otherwise downtrodden have to sacrifice a single grain of
| rice, after which it's deontological ethics and how dare you
| infringe upon property rights. (And I'm not just criticising
| other people, here.)
|
| It's a hard problem. We have different intuitions for large
| groups (do whatever saves the most people) and individual
| cases (how dare you even _consider_ killing someone for spare
| parts!); and somehow, improving society somewhat - say,
| funnelling some of that yacht money towards lifesaving
| treatment - never factors in to these life or death
| decisions. So what can you do, with limited resources?
|
| It's a coordination problem, more than anything.
| https://www.principiadiscordia.com/book/45.php contains about
| as much actionable advice as this here complaint of mine.
| datadrivenangel wrote:
| How much work should we expect a person to do to keep another
| person alive?
|
| At a certain point, our obligations to another person have to
| end. At what point do we fault someone for not putting in
| work to delay someone else's death?
|
| Obviously, withholding immaterial support is ethically
| deplorable. If it costs $1 of medicine to cure a child's life
| threatening illness and give them a high probability of
| living a typical human lifespan, you'd be a monster to not
| help.
|
| But what if it costs $100,000 and has a low chance of healing
| them?
|
| Or $10,000,000, with no probability of them ever leaving the
| hospital room, and their use of the room and machines will
| mean 10 additional deaths that could have been prevented?
|
| I think we should be biased towards life over money because
| it's more humane and we'll probably learn useful things along
| the way that improve care in the future, but even with that
| overweighting, at some point it looks like a bad trade-off.
| margalabargala wrote:
| We as a society make a significant distinction between
| declining to provide something in the first place, and
| choosing choosing to take back something someone already
| possesses. To wit:
|
| > At what point do we fault someone for not putting in work
| to delay someone else's death?
|
| That isn't what is happening. I'm faulting someone for
| putting in work, to expedite someone else's death.
|
| Sure, there's all sorts of math you can do to justify
| things either way. You can say "oh but it'll cost ten
| gajillion dollars and the equipment could have saved an
| entire ethnic group from extinction", as though you have as
| much certainty about hopeful future hypothetical benefits
| as you do about the person dying. On the other side you can
| say "oh for someone age 16 a week is the same proportion of
| their life so far as 3.5 weeks for someone aged 55, so if
| we can keep the 16 year old alive for another week that's
| better than keeping a 55 year old alive for 3 weeks".
|
| It really all comes down to the difference between action
| and inaction, between causing harm and declining to prevent
| harm. Is someone who pushes someone in front of a bus no
| worse than someone who sees a bus coming at someone and
| doing nothing to warn them? That's a hard sell.
| dbt00 wrote:
| I might agree with the decision to keep the one person alive,
| but right now we have limited numbers of machines and medical
| professionals to run them.
|
| How many people would have to die because this one person is
| monopolizing the one (if any small N, even of one) ECMO
| machine before it's unethical to keep them on it waiting to
| die of cancer?
| margalabargala wrote:
| Like most things, it's not that simple.
|
| Frequently these machines are used for things like
| surgeries, which frequently may not need to be done _right
| this day_ while still being important. Keeping this one
| person on it may simply have decreased the number of such
| surgeries that could be performed per day, mildly
| increasing patient wait time.
|
| How much of an increase in surgical throughput is worth
| killing someone for?
| renewiltord wrote:
| Just so it's clear: Your preferred strategy is that once
| anyone is placed on ECMO, they should not be removed except
| through their consent under any circumstances. Is that true?
| sithadmin wrote:
| >able to walk and read the newspaper.
|
| Reading the newspaper is a 'maybe' here, but the notion of
| patients just generally walking around while on ECMO treatment
| as we know it today is absurd. Letting a patient be ambulatory
| during ECMO treatment is still in the realm of very, very, very
| small-n clinical trials, and the risk of near-immediate death
| from things like a cannula dislodging are very high. Even if it
| was safe, you're looking at a massive cart of equipment and 1-2
| dedicated personnel to walk around with the patient while
| tweaking its settings.
|
| In general, nobody being treated by ECMO is 'reading the
| newspaper', if they're cogent and conscious at all. It has
| absolutely brutal effects on the body, and people are kept
| sedated while receieving the treatment for good reason.
| darth_avocado wrote:
| > The only ethical problem I see is other people deciding what
| life is worth living.
|
| It's more complicated than that. If there's only 10 ECMO
| machines available in a hospital, someone has to decide who
| gets those machines. Like the entire field of medicine, triage
| is necessary and sometimes ethics dictate someone should not go
| on that machine based on their chances of survival.
| xboxnolifes wrote:
| Even more complicated is debating if it's ethical to take
| someone _off_ the machine if it leads to savings more people.
| I know triage and giving up on treatment has precedent, but I
| 'm not too familiar with forced removal of on-going
| treatment, knowing it will kill someone.
| feoren wrote:
| "The overarching problem here is that we have this fear of
| letting people die"
|
| This feels like a crazy thing to hear a physician say. Our
| acceptance of death as inevitable is a learned helplessness.
| Modern medicine is not even 100 years old by some accounts, and
| every new decade brings new "miraculous" treatments that
| naysayers called completely unrealistic before. There's no reason
| to believe that humanity will need to accept death as inevitable
| forever. Any theory of medicine that is based on accepting that
| people die is dooming itself to a primitive, barbaric existence.
|
| The ethical dilemma goes away if these machines become more
| portable and 100x cheaper, a transformation we've seen many
| times. From keeping a cat alive for 30 minutes in 1934 to humans
| in 1952 to days in 1971 to months/years in the 2010s-2020s to ...
| what, decades? Centuries? These people are having conversations
| and we're saying "well we should let them die because death is a
| part of life" -- no, it clearly doesn't have to be. Yes, there
| are cost concerns, triage concerns and quality of life concerns,
| but those are engineering problems that we know we could
| dramatically improve if we actually invested significantly in
| this technology. I do not accept that we should not be afraid of
| "letting people die" -- let's be fucking terrified of it and do
| everything we can to stop it, please. Because everything we've
| seen from medicine over the last 100 years indicates that _we
| can_.
|
| And to those who say that death must be a part of life or (insert
| societal problem with shaky justification here) will happen, I
| ask: what if the situation were reversed? What if everyone lived
| forever and we were facing overcrowding or whatever -- would your
| solution be to _kill everyone_ nearing 100 years of age?
| FireBeyond wrote:
| I don't think it's so much that we kill people. It's that we
| let them die. If we are truly, brutally honest with ourselves
| (and overcoming denial, social, religious, whatever
| conditioning here is a huge struggle), much of the time, the
| efforts we put in to keeping loved ones alive is really often
| more about us than it is about them.
|
| The elderly (and I'm generalizing, I realize) are far more
| accepting of death. It's easier to accept that when you feel
| you have lived a full and happy life. Contrarily, that full and
| happy life often involves having the presence of loved ones,
| who are NOT ready to accept that their life will be - or
| rather, will feel - less full and happy without that person.
|
| Even just simple denial is a huge thing. One of my first
| experiences in emergency medicine was an older gentleman,
| family patriarch. The rest of his extended family had been able
| to gather at the hospital while he was in and out of arrest.
|
| A provider and support person went to talk to the extended
| family, who was adamant about following his son, the 'number
| two patriarch', and his steadfast insistence, "He is a good
| strong Christian man, and he is going to be okay." (I say this
| not to mock Christians, to be clear, and also to be clear, he
| didn't mean in the "eternal life" sense, he and the family
| truly believed almost that divine intervention was going to
| take care of things).
|
| After some discussion on this, a decision was made to bring the
| son into the ER where we were working on his father. Seeing the
| hopelessness and futility, seeing his father the shadow of the
| man he knew, and all of that assorted detail was no doubt
| traumatic, but it also made it viscerally real to his son. No
| matter the concerted efforts of nearly 10 medical
| professionals, drugs, defibrillation, ventilation, we were not
| going to be able to keep his father alive, and there was not
| going to be any divine intervention. He watched this silently
| for a few moments, and then asked us to discontinue CPR and if
| his father's organs were suitable for donation.
|
| My heart broke for him. But this is a struggle we have not
| figured out, recently. We had it figured out, historically, by
| necessity, but we are complacent now.
|
| Leaving aside the separate issue of healthcare costs, you can
| still look at the ratios:
|
| In the US, on average we spend more on healthcare keeping
| someone alive for the last year of their life than we do on the
| previous decade. And we spend more on that decade than we do on
| the rest of their life. Some of which seems obvious, given
| youth, but nonetheless.
| feoren wrote:
| It's a powerful story, but it's simply not relevant to my
| argument, and I suspect the reason you think it is relevant
| is because you've deeply internalized the inevitability of
| death. Of course you, and we all, have: it's been inevitable
| for the entirety of human existence. But humans were never
| able to fly across the ocean for the vast majority of our
| existence either, nor were we able to orbit the Earth or
| communicate at near light speed with the other side of the
| Earth. People who say death is inevitable are putting it in a
| special category: it's the _one thing_ humanity will never be
| able to solve with technology? We can colonize other planets,
| split the atom, develop computers and AI, but keeping oxygen
| flowing to the cells is just _forever_ beyond our reach? No.
|
| Your story is about a man's denial that his father, currently
| in critical condition, would die. Yes, the probability that
| humanity would solve death in the hour of life his father had
| remaining was low. I'm talking about humanity's denial that
| death is just a giant bag of problems that we can,
| eventually, solve one by one. The probability that humanity
| will solve death in the next thousand years is nearly 100%;
| the probability that it will be solved in our lifetimes may
| be low, but it's not 0. (Keep in mind, 1000 years is _ten
| times_ the lifespan of an exponentially accelerating medical
| field, not simply 1% of the whole human history in which
| basically no progress was made.)
|
| If we had a simple, maintainable, cheap machine that could
| keep people alive for 100 years without a working heart or
| lungs, there is no ethical dilemma, and the line between
| "killing them" and "letting them die" becomes pretty blurry.
|
| The reason this matters is that once we actually start to
| realize that death is a problem that we can actually solve,
| then we can _get the fuck to work_ on it! We could be
| investing so much more than we are in treatments like ECMO.
| There should be a national moon-landing-level initiative to
| make these machines available to everyone. But the longer we
| mope around with our learned helplessness, calling people
| like me naive and in denial, the more people will die
| needlessly.
| FireBeyond wrote:
| Then going to your point, there are many discussions around
| theoretical upper bounds for human life, even factoring in
| technology.
|
| Studies look at blood cells and footsteps and establishing
| hard limits. One of the more recent ones suggests around
| 150 (today it's around 120).
|
| > with things that usually kill us omitted, our body's
| capacity to restore equilibrium to its myriad structural
| and metabolic systems after disruptions still fades with
| time. And even if we make it through life with few
| stressors, this incremental decline sets the maximum life
| span for humans at somewhere between 120 and 150 years. In
| the end, if the obvious hazards do not take our lives, this
| fundamental loss of resilience will do so.
|
| https://www.scientificamerican.com/article/humans-could-
| live...
| feoren wrote:
| Ctrl+F > "telomere" -- 0 results
|
| Weird to not mention telomeres in that article. It sounds
| like basically what they're talking about. We already
| know about Telomerase:
|
| https://en.wikipedia.org/wiki/Telomerase
|
| We are rapidly developing gene editing, e.g. with CRISPR:
|
| https://en.wikipedia.org/wiki/CRISPR
|
| Not to mention that we already know about "immortal"
| organisms that beat this "limit". There's no reason to
| think that "fundamental limit" is anything more than yet
| one more problem to solve.
| strgcmc wrote:
| Leonardo da Vinci imagined flying machines. When most
| people may have believed it to be a priori impossible
| during his time, instead da Vinci probably believed it to
| be simply another (solvable) engineering problem.
|
| That being said, even if da Vinci had absolute certainty
| that his viewpoint was correct, that heavier-than-air
| flying machines were a factual inevitability... what could
| da Vinci have done to capitalize on this knowledge? Other
| than draw some diagrams and hope future generations pick it
| up, but in his own contemporary timeframe, this knowledge
| of the inevitable future would still be generally useless
| to him. It would not affect his daily life, it likely would
| not change a single decision that he would make otherwise.
|
| Likewise, let's say you're right, that conquering death is
| an inevitably solvable engineering problem. So what would
| you do with that knowledge, right now? Of the cases called
| out in the article, of people who could not live off of
| ECMO, how does having this knowledge of inevitable
| immortality that's coming 100s of years later, how would
| that change the decision-making rubric today for those
| patients or whether those ECMO machines are better used on
| someone else?
|
| I venture to say that, even if you knew with absolute
| certainty that engineered-immortality would be achieved by
| a known future date, say 200 years from now (though it took
| ~400 years between da Vinci and heavier-than-air flight)...
| IMHO it shouldn't make any difference at all to the
| present-day decisions of how those ECMO patients should be
| treated today. Only if you knew the date of pending
| immortality was let's say, <10 years away, would you make
| some kind of drastic push to try and keep everyone alive
| barely long enough to benefit from that breakthrough.
|
| ... In fact, I vaguely remember reading a short story about
| this very conceit, of generations of humans in a fictional
| setting, working towards immortality, and how at a certain
| point, they reached a stage of awareness that, achieving
| immortality was likely going to happen soon in the next
| generation, so what would they do with that "last
| generation" of humans to ever need to face death? How would
| people feel, how would they react, if they knew that they
| were just a little bit too early to benefit from the
| breakthrough that might come 20 years from now? Sadly can't
| recall what that story was called or any more details that
| would make it easier to search for.
| feoren wrote:
| For your analogy to hold, let's assume that everyone on
| Earth in 1500 A.D. had a strongly vested interested in
| heavier-than-air flight (as they do with not dying
| today), and Leonardo da Vinci was completely convinced it
| was possible. You assert it wouldn't have made a
| difference. I assert it could have changed the course of
| human history.
|
| Leonardo would have done what everyone like him did
| around that time: convinced a wealthy patron to fund his
| experiments. If he had gotten many very rich nobles
| convinced as well, he may have gotten tons of money to
| hire lots of people to build and test various designs. We
| might have had heavier-than-air flight 400 years earlier.
| Of course, without powered engines, they wouldn't have
| had nearly the success they have today, but one can
| imagine some pretty elaborate gliders, or possibly hot
| air balloons, showing up hundreds of years earlier than
| they actually did.
|
| So I absolutely reject your notion of "it would never
| have made any difference." The fallacy that history must
| always have gone exactly as it did is a common one, but
| it is a fallacy nonetheless.
|
| > Likewise, let's say you're right, that conquering death
| is an inevitably solvable engineering problem. So what
| would you do with that knowledge, right now?
|
| I already told you: organize a nation-wide (or
| international) Moon-landing level effort to make ECMO
| machines 100x cheaper, more portable, and more widely
| available by the end of the decade. Spend 4% of GDP on
| it. Keep spending 4% of GDP on similar research.
|
| > Only if you knew the date of pending immortality was
| let's say, <10 years away, would you make some kind of
| drastic push to try and keep everyone alive barely long
| enough to benefit from that breakthrough.
|
| It's not one date. It's a long path with many problems to
| solve along the way. It may indeed take hundreds of years
| to achieve complete agelessness. But every year that we
| wait to start (and we _are_ waiting, because of our
| belief that it 's not possible), is another year that
| people are needlessly dying. Every problem solved along
| the way is a few more years for many more people.
|
| > I vaguely remember reading a short story about this
| very conceit,
|
| Yes, bad sci-fi has used the inevitability of death as a
| plot element for a long time, along with the silly
| argument "do we really _want_ to live forever!? BUT
| EVIL!! " It's never really held up to scrutiny.
| spondylosaurus wrote:
| For a contrasting viewpoint, you might consider this New Yorker
| article from a practicing physician ("The Hidden Harms of
| CPR"): https://www.newyorker.com/news/the-weekend-essay/the-
| hidden-...
|
| Death is a necessary consideration, but so is prolonged
| suffering.
| ok_dad wrote:
| I only wish the technology were better ten years ago when my
| father in law passed away. He was on one of these types of
| machines, but only after he had surgery and his heart and lungs
| were already failing for days and his body was weak. If they
| could have put him on the best and newest machine of today right
| away, then his body could have recovered a bit before they had to
| operate to fix his heart valve, which was faulty.
|
| I do have to say, at the end when we visited him before they
| turned the machine off, it was absolutely a horror scene with
| huge clear tubes with blood flowing through them and the machine
| was fully clear as well, I assume to let staff catch any clotting
| early. When they turned off the machine I almost couldn't help
| but look at the machine and the blood filled tubing, knowing that
| my father in law was given a second chance by it even though it
| failed. I used to have nightmares about the scene I saw there,
| but now I think of how great it is that we can replace some of
| the most important organs with machines, even if it's still
| limited to hospitals.
|
| Morally, we should advance this tech as fast as possible so maybe
| next people can use these in their homes, or as a backpack or
| something, then on to artificial organs inside the body. The
| people going on these machines today are pioneers and the things
| we learn today will help other down the line even better.
| daedrdev wrote:
| There is some discussion about the long tail of patients who
| don't get better, but from the article, this machine seems like
| it has lead to some incredible outcomes. Better respiratory
| illness recovery for extreme cases, better ability to recover
| from some cardiac arrests, etc.
|
| Additionally, for most long term patients, the reason they exist
| on the machine is because a lack of organs for transplant. There
| is little hope for more organs now, but in the future modified
| pig organs seem like a possibility for people that could really
| transform the ability to save peoples lives.
|
| Like it is nice that we can have ethics questions about this
| machine, and hopefully it can give some terminal patients the
| chance to find their own peace.
| xkbarkar wrote:
| I feel the article makes ECMO sounds like a viable common
| treatment for lung ailments. I have personal experience with
| ECMO.
|
| Disclaimer: I have no medical training. But I have had two loved
| ones in ECMO in my life.
|
| An adult age 48 and a premature infant that weighed a little over
| 600 grams at birth.
|
| The adult died after a very successful month in ECMO during
| routine change of tubes. Bled to death after a ruptured artery.
|
| The infant survived and is thriving today.
|
| ECMO is highly specialised, very expensive, incredibly intrusive
| and also requires large amounts of blood plasma. Blood plasma is
| not an abundant resource.
|
| Just the cost is almost twice that of a standard, expensive
| cancer treatment.
|
| "The mean estimated total hospital costs, including pre- and
| post-ECMO procedures, was 213,246 USD".
| https://pubmed.ncbi.nlm.nih.gov/19699650/#:~:text=Results%3A...).
|
| Cancer treatment cost example
|
| https://www.asbestos.com/featured-stories/high-cost-of-cance....
|
| So adding to the dangers of using ECMO it is also very very
| costly.
|
| It doesn't make a lot of sense to promote ECMO as casually as
| this article does.
| huitzitziltzin wrote:
| Hello - it's your friendly neighborhood health economist (and I
| have worked on a topic adjacent to ECMO machines).
|
| ECMO is unambiguously cost effective (even at US prices!) for
| the infant. (I'm not _defending_ US prices - needless to say if
| anything is cost effective at US prices it 's passed the
| hardest cost effectiveness test.) It's also cost effective
| (even at US prices) for the older patient. Honestly the cited
| figure of $213,000 is nothing compared to the value of a
| statistical life (for the infant) or a bit under half of one
| (for the adult)
|
| There should be more of these machines and they should be in
| wider use. The possible impact on heart attack mortality alone
| is enough to justify wider investment and exploratory use more
| broadly, even if the precise effects end up being smaller than
| that's cited in the article.
|
| This is a great example of technological change pushing the
| boundaries of what's possible in health care. (And frankly...
| even though I am _not_ defending US health care prices, a high
| price for this new technology is exactly the kind of signal you
| want to send to entrepreneurial types, several of whom appear
| in the article. If ECMO can be taken out of the ICU (by some
| future version of the machine) that seems highly likely to
| generate huge benefits.)
|
| Sure, there are some moral issues to be worked out. Those
| issues would be much better worked out while a bunch of
| patients who would otherwise died are plugged into ECMO
| machines...
| mynameisnoone wrote:
| ECMO is often a "Hail Mary" that rarely includes a favorable
| outcome.
|
| OTOH, perfusion is an under-staffed specialty offering a good
| career without as much academic investment as an MD. The
| downsides are the possibility of being on-call and sometimes
| having to be the one who pulls the plug.
| iancmceachern wrote:
| I've worked in this industry, designed several pumps.
|
| Check out Ventriflo, www.ventriflow.com
|
| There is so much opportunity for innovation in this space, it's
| like 10 or 15 years behind of what's possible
___________________________________________________________________
(page generated 2024-04-30 23:01 UTC)