Should we initiate assisted dying?

Question

Health.SE is dying. Continuing the medical analogies, we are suffering from multiple organ failure:

• bad questions
• bad answers
• not enough activity by experienced users
• not enough experienced users

We are slowly entering dangerous territory where bad answers (like a recent example from me) gather 2 upvotes or even get accepted just because low activity.

We as a Community have tried multiple different treatments. Just to list a few:

• Re-Evaluating Site Moderation
• Control Measures
• Personal Diagnosis

We even had to defibrillate it at some point:

• Defibrillating Health.SE

I personally think the site is not salvageable, that death is final and very close.

Now, it is time for us as a very small community to come to a conclusion? Should we actively unplug life-sustaining machines and basically perform assisted suicide, or should we watch the site rot and die in agony?

Obviously I'm a bit biased because - I admit - this post is partly encouraged by my frustration of how many treatments have failed or weren't put into effect. I will refrain from voting, but I think it is important that we make such a decision.

---

^{Maybe I need to clarify: I don’t want the site to die, but I think it is important to have this discussion. Hopefully, we can extract a plan on how to improve this site and act it out, something we weren’t able to do with previous plans.}

Answer 1

Yes and No

I think the site could still be viable. As the site currently stands, it is a pool of dreck, constituting a lot of the worst beliefs and misconceptions about health. I think that is one of the things that drives away a lot of potential contributors, as they don't want to sit in their office all day fielding "Dude, what is this pimple looking thing" kind of questions, to come here and field the same things. So if we continue with the same model, no, I don't think health can survive under its own weight.

If we change the scope of the site (Which has been discussed before), and align it more along the lines of the Medical Sciences propsal, then it has a chance. It would take a lot of heavy lifting at the start, and would require both participation from the user base as well as the moderators (To include possibly replacing absentee/tired mods). It has been done before, Fitness carved off Nutrition as being off topic, also amid some calls for the site to be shut down.

https://fitness.meta.stackexchange.com/questions/186/is-this-site-in-a-state-of-chaos

https://fitness.meta.stackexchange.com/questions/306/fitness-and-nutrition-is-now-physical-fitness

(Among others, search "scope" if you are interested)

Also, on an established site Movies & TV, there was a recent initiative to declare ID questions off topic. This required a coordinated heavy lift between CM team members as well as site members. It can be done.

As Robert says in the fitness thread, it's not a silver bullet. However, given that the medical science proposal is 6 months in, still needing 19 followers and 36 10+ questions just to get to commitment phase. I don't think it is going to make it, but the interest shows that it could be viable. I would be in favor of shifting the focus, changing scope, etc. We would probably need to replace one mod, possibly more, depending on how they feel about the site change and the effort needed. There would be some heavy handed policing until we can attract more traffic of the kind that we want.

Would it be 100% fix? No, but I think it would be the best chance for survival, and create a useful, professional oriented site, rather than a dead beta and a soon to be dead A51 proposal.

Answer 2

I'm all for dying with dignity, and I want to be able to do that in my personal life as well. But not everyone feels that way, There are always those that cling to the small possibility that the dying patient will pull through, even if they've been in a coma for 5 months. In that case, you wonder what things will look like if they awaken... Ok, enough medical analogy.

Back when the call went out 39 moons ago, I expressed my doubts.

A tiny bit of history maybe behind the scenes is that those most interested in such a site were most interested in getting their personal medical questions answered. I've never seen so many differently worded questions on lateral epichondylitis in my life!

In any case, I was asked to be a mod, and I accepted with reservations. One of my requests was that I not be the only medical professional on the mod team. Two docs were selected (the other had already gotten the request email, so that was easy.) When faced with actual moderation, though, it was a rough and tumble fight between those who wanted a professional site and those who didn't (e.g. fought against sources, wanted to allow personal medical questions), and that mod quickly jumped ship. She even quit once. I don't quite understand why she reapplied for the position. But, suffice it to say, she believes to a destructive degree that the role of mods is to do as little as possible. On this site, that is not wise.

I have expressed this elsewhere. SE is not a good fit for medical questions. People upvote answers that sound good, especially if there's the obligatory reference tossed in there somewhere. It's not good enough. People with T1DM die, not live a long life without knowing that they have the disease (an accepted answer.) People who have odd encounters with bats need prophyllaxis, no question about it. People do not get tired after a meal because blood flow is diverted from the brain to the gut, or that insulin causes serotonin and melatonin secretion to increase. (That last answer, initially submitted without sources, was from the site's main CM, who ignored all of the recommendations he approved of.)

As a conscientious physician who was afraid of this from the very start, it was impossible for me to stand by and see this (often upvoted) misinformation fly freely. That means confrontations ensued: post notices, down votes, and a lot of comments pointing out that the sources weren't reliable, or worse, that the source didn't say what they claimed it said. Arguments in comments, complaints in meta and even on Meta.

That was at the beginning. What hasn't changed: bad questions, bad answers, answers without references even from medical professionals here and here on the same question (note the reasoning in the deleted answer: "as an MD, I rarely have the time to look for references though I know where exactly to find them. The American College of Cardiology (I'm a member), www.uptodate.com (I have a subscription) and several other serious medical sites have plenty of material to cover almost any question here but my problem is time. Therefore, I choose not to answer questions anymore.") (That was not the first doc to react to a request for sources that way. My reasoning is if you know exactly where to find an answer in the literature, why not provide a quick link? It's an extra minute of your life.)

Good questions won't happen because the community hopes they will. Docs won't stay who a) are too uppity to provide a link, or b) get tired of the poor-quality questions and stop coming to take a look.

I was gone for a year and I remained the highest rep user. That should say something.

I know many are fighting for the site. But the plain truth is that SE users, both those familiar and those unfamiliar with the SE model, don't like the 'rules' imposed on this site. I don't think making the rules plainer, or restricting the scope further will help the site. What will help the site is outside of the SE model, and therefor the CMs won't allow it.

If I were a semi-comatose patient on a vent for two years, I would want the plug pulled. This site is very much like a semi-comatose patient on a vent. You can't pull off a miracle.

Edited to add: As I'm not a regular here any more, the reason I posted an answer is the sense of responsibility I felt and the enormous amount of time I gave in trying to keep it alive. The re-incarnation of this site will require the same, but there are no interested medical professionals who have the time to commit to it that it will need. I don't know how many part-time medical pros it would need, but they will need to be of the same mind with regards to the site. If history repeats itself, nothing will have changed. I also want to commend the currently active mods who have stuck it out and devoted their energies to this difficult site. They have my respect.

Answer 3

Just to add a perspective:

Over at Psych & Neurosci we have very similar issues. Your stats on Area51 are in fact pretty comparable; not enough questions (not enough users), a failing %answered ratio (not enough hi-rep users / many poor questions) and not enough answers per question (something that the SE network desperately wants to cling to their voting system).

There we have 2.4 questions/day, you're at 5. There we have 85% answered, you're at 62% There we have 1.4 answer ratio, here you have 1.3. There we have 370 avid users (a gross overestimate imo) and you have 226. There we have been in beta for about 7 years, you're only at three years.

All in all pretty similar and given that we are two times as old as you are, it's pretty much identical, and we are still standing over there! Instead we have been actively improving our site, by changing our site's name recently (slightly increasing #questions, perhaps...) and we have been adding a well-thought close-reason (slightly increasing %answered). This has put us in regular (but not frequent) contact with the SE team in terms of our site's name and so forth, making sure we are noticed at the top.

Bottom line, you're only dead when you give up.

• bad questions --> close them
• bad answers --> comment and downvote
• not enough activity by experienced users --> try to encourage folks to do more by getting together folks in chat to reach common goals
• not enough experienced users --> try to lift the site's standards overall

I'm not saying this will save your site, it's just to put things in perspective.

Answer 4

I"d like to see if a last ditch measure can be made to save this site.

To this end I've asked a couple of questions. If the others can do the same, then we can get some exemplars up to show what type of questions we're looking for. But that means all those interested need to rapidly downvote those questions that don't meet our new criteria so that they can disappear quickly.

PS: A surgical resident answered my question on PCP prophylaxis. So, there may be hope after all with this way of going forward.

Answer 5

While we are trying to resuscitate this site can those who vote to close a question just tell them to see a doctor and not give a spiel about seeing their GPs, better management etc. Their questions are off topic, and the added information is just confusing to them as it looks as though we are conflicted.

Edit: Come on people, there must be more than 4 people who are active daily who can vote to close these off topic questions!!

Answer 6

If the problem is users not following the rules, not because of the SE model, or the lack of qualified users, as @anongoodnurse says:

I know many are fighting for the site. But the plain truth is that SE users, both those familiar and those unfamiliar with the SE model, don't like the 'rules' imposed on this site. I don't think making the rules plainer, or restricting the scope further will help the site. What will help the site is outside of the SE model, and therefor the CMs won't allow it.

...then I don't think it's necessary to unplug it. Eventually some other new users who accept the model and the rules here will come and stay. Until then, bad answers with positive votes will survives, and we have to accept it as how we have to accept our unfair history. We can only do what we can.

_{If you really want to see bad answers be downvoted harder, my proposal is to let the required rep to have that privilege much lower, so that qualified users can act immediately. Further discussion: Why should downvoting be a privilege?}