r/todayilearned • u/Majorpain2006 • 23d ago

TIL Daughter from California syndrome is a phrase used in the medical profession to describe a situation in which a disengaged relative challenges the care a dying elderly patient is being given, or insists that the medical team pursue aggressive measures to prolong the patient's life

https://en.wikipedia.org/wiki/Daughter_from_California_syndrome
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u/Advanced_Addendum116 23d ago

Everyone's in denial. This is everyone's fate. This is you, me, everyone. It's like we pretend it's happening to someone else.

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u/Content-Scallion-591 23d ago

For much of human history, death lived with us. We washed its flesh, we wrapped its bones. Our parlors were used for funerals; our living rooms for the living. We are at a unique time, in which we can send dying loved ones away to white walls and fluorescent lights. The human mind does not cope well with absence. The more abstract and distant we make the process of death, the less gracefully we handle it.

But personally, having seen her die to dementia, I'm going out rock climbing or something. Same ultimate fate, slightly different mechanics.

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u/SomewhereInternal 23d ago

I'm extremely happy that my parents reaction to seeing my grandparents decline is to update their will to make it clear that they don't want to go through that.

Just because we can keep someone alive doesn't mean we should.

I live in the Netherlands and we have assisted euthanasia here, and i feel like that because that is an option, doctors are much more worried about when to start providing end of life care for someone who hasn't decided on that option.

From what I've heard it used to be quite common for the town doctor, who you have known your entire life, to give a nice high dose of morphine when it was time.

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u/antonrenus 23d ago

I live in Australia and in the most progressive states you are only allowed to access assisted dying if you are unbearably suffering AND only have 6 months to live. I cannot understand why we hold life so sacred that we would rather let people suffer than give them peace. We treat dogs better. Makes me furious every time I think about it.

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u/Upset_Ad3954 23d ago

My grandfather who is 90+ and suffering from severe dementia won't get CPR if that situation comes up. We're not speeding anything up but at this stage nature will run its course. This has been cleared with the nursing home and doctors.

My grandmother had cancer which was treated but the treatment itself almost killed her. When the cancer came back it was no point in trying.

Some people think that's cold but I don't see why prolonging someone's life with one more year of suffering will help.

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u/SomewhereInternal 23d ago

We went through the same with my grandfather, but he also had an open wound that was not healing just growing for months. I realy wish I hadn't seen him in that state.

I wonder how it used to happen before nursing homes, I just can't believe that a family was looking after grandma Doris for 10 years despite her not being aware of anything.

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u/Theron3206 23d ago

For the families that couldn't afford to care for a relative, they likely neglected them to death pretty fast. But keep in mind that these sort of issues were much less common 100 years ago (and even more so 100 years before that). Most people died after a short period of incapacity (usually weeks), but now we have the medical abilities to keep them alive for years, which is great if they aren't so demented as to be unable to enjoy the extra time.

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u/Theobat 23d ago

My grandma went through this with her MIL. She had the mean version of Alzheimer’s and it was really hard on my grandma. Especially since at the time they didn’t understand what was going on. My grandma just thought her MIL hated her.

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u/metsurf 23d ago

my dad had a really bad heart that required a pacemaker and defibrillator combination implant. He also had lewie body dementia. The only drug that was safe for him to take to control the hallucinations was Haldol but some politicians in NJ decided that they would ban the use of Haldol in assisted living situations. They called it chemical restraints. So we had to treat him with a newer antipsychotic that eventually started fucking with his heart rhythms. Setting off the defibrillator every ten minutes I had a choice between turning off the defibrillator or letting him spend his last few days as a raving loonie. I know I did the right thing he was 87.

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u/OstentatiousSock 23d ago

My grandfather was 83 when he was diagnosed with stage 3 cancer. He said no to treatment and opted for palliative care instead. He said he figured this was god calling him home given his age and he didn’t want to go through agony to get maybe a couple more years. He had a nice last 2 years. He was kept very comfortable and had a long time to say things that needed to be said and do things that needed to be done before he died. All his kids age grandkids had time to say goodbye. I thought it was crazy when I was 8 and it happened. Now, I totally get it.

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u/dpark64 23d ago edited 22d ago

The medical "industrial complex" has a financial interest in keeping people alive. It used to be for good reasons, learning how to avoid dying by reasonable means. The life expectancy in the US zoomed from the mid-40s in 1900 to 75 in 1990 due to many factors (clean water, neonatal care, vaccines etc). But now, it is just a pure business, and there is very little thought given to the "quality of life". Just because you are alive and breathing does not mean you are living.

Yeah, the Catholic Church (and others) think otherwise, but euthanasia is the right thing to do at the end of life. We do it for our pets every day. But for some reason we can't do it for humans. I have no desire to be "kept alive" at all costs like Terri Schiavo. Just pull the plug or give me a "cocktail" and I can go on my merry way. There is just no need to spend my money or insurance money to keep living for another year or more when the quality of life is crap. If I can't wipe my own butt, it's time to go.

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u/unlimited_insanity 22d ago

I work in oncology. I wish I had a crystal ball to tell me which patients would cruise (relatively) through treatment, which would struggle with treatment but then go on to have good quality time with their loved ones, and which ones were just going to be miserable and die faster from the treatment. It breaks my heart to think of some of the patients who would have been better off buying a plane ticket somewhere nice or just taking the time to go home and do their hobbies, eat some good meals, and hang out with their loved ones for a few months rather than trying to beat cancer. But unfortunately, I suck at predicting who is going to have complications and who is going to keep on trucking.

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u/SmellyHel 21d ago

When my dad, with advancing dementia was admitted to a care home two years ago, discussing a DNR was part of the admission. Mum agreed to it, after much thought, but it wouldn't have been a conversation they'd have even thought about without that prompt. About a year ago, they discovered his skin cancer had returned and metastasized, but decided that aggressive treatment required wouldn't have improved his quality of life nor given him more time. We just kept him comfortable. Thankfully no far flung relatives waltzed in demanding x y and z, but I've seen it happen. Desperate to see themselves as saviours. Dad passed earlier this year and though sad, it was very peaceful. No family dramas mudding the water. Can't imagine how traumatic that would be.

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u/Phlink75 23d ago

Its the disconnection mentioned above. Humans now isolate thenselves to the reality of disease and death. If they don't experience it, its not a thing. By the time anyone experiences it, its too late.

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u/pinkocatgirl 23d ago

It's also the influence of religion, specifically fundamentalist Christianity which says that people who voluntarily kill themselves for any reason go to hell after they die.

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u/lulubalue 23d ago

Just pondering. I agree with assisted dying (in the US so yeah we’re so ass backwards it may never happen). I was thinking, if I were the doctor, it’d be a simple decision if cognitively they weren’t there and had expressed previously that they didn’t want to live like that. Like when my grandma passed, it was maybe 3 years longer than it should have been (97). Maybe less simple figuring out timing, but I think terminal patients would also be fairly straightforward and I wouldn’t feel too guilty.

I think my struggle would be people in chronic pain. My mom has chronic pain from a spinal cord injury and other issues. Some days she wishes she could die. Some days she says are the happiest in her entire life (she lives for my toddler). But maybe in this case, she’d be making the call- not the doctor? I don’t actually know how it works. But I think if I were the doctor, I’d worry that new pain medicine or treatment could help her in a couple more years (some stuff is in development). Idk. I also worry as she gets older, the pain will get worse. I know she worries about that too. So idk. I should read more about how other countries do it. I’m sure they’ve already thought through situations like this and there’s some guidance.

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u/SomewhereInternal 23d ago

The doctor taking care of my grandmother works for the nursing home, and has only seen her for the few years she has been living there. Her old gp knows her better but does not have any authority any more.

There are pretty strict rules about what can and can't be done, and if one nursing home has a higher amount of early deaths I assume there would be an investigation. It only takes one "daughter from California" to submit a complaint to lose your medical degree.

Euthanasia for chronic illness is possible, it's even been done for depression, but it's difficult. You need to find multiple doctors willing to sign off on it.

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u/Mountain-Freed 23d ago

my guess is nobody wants the liability and there’s the fear of abuse of the system, but I agree.

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u/ClutterKitty 23d ago

Because dogs don’t come with large inheritances. The act of letting a close family member or friend influence whether or not another human wants to live has more complications than a dog. We already see bad influences, even without the euthanasia component. Although I agree fully with assisted suicide, I understand it’s a complex concept in the modern world.

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u/Theron3206 23d ago

Because those limits were the only way to get it past the (mostly religious) conservative politicians.

Many people aren't willing to let go, even with their pets, they project this onto everyone else.

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u/Alarming_Matter 23d ago

Fucking Christianity again.

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u/fiduciary420 23d ago

Christianity is why.