Cancer Is the Best Way to Die, Says Former BMJ Editor
In a reflection on the many different ways we can die, including sudden death, the slow decline with dementia, and stepwise organ failure, the former editor of the BMJ, Richard Smith, MD, concludes that "death from cancer is the best."
In what he admits is a "romantic view of dying," he says that when cancer is the cause of death, "You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favorite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion."
"This is...achievable with love, morphine, and whisky," Dr Smith writes.
"But stay away from overambitious oncologists," he adds, presumably to avoid overtreatment and also what he describes as a death that is "kept at bay by the miracles of modern medicine," quoting the Spanish film maker Luis Buñuel.
In fact, Dr Smith goes even further and suggests, "let's stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death."
The comments appear in a blog post published online December 31 in the BMJ and have provoked an onslaught of comments in response, mainly from relatives of individuals who have died from cancer, who say the death was slow and horrible, and also from cancer patients who are very grateful that research into cancer is keeping them alive.
"This blog is wrong on so many levels. This doctor has clearly not lived with someone suffering from pancreatic cancer," writes the widow of a patient who died from the disease.
"My husband was diagnosed at age 48 after being healthy all his life. He was in severe pain, especially when lying down, so he could not sleep and had to just pace about corridors or outdoors." She provides quite a bit of detail on his treatment, which allowed him to survive 27 months after diagnosis, and comments that the "treatments did give him time pain free and a chance to live life outside work." But she says she remains traumatized by the actual death, watching while he "starved."
Another commentator argues that "Dr Smith's argument is very poorly presented and poorly written. He seems to be trying to make the case that extensive medical intervention is cruel, but in choosing cancer as 'the best' death, he actually chooses the one type of death (of those he mentions) that requires the most extensive and invasive treatments ― contradicting his whole argument."
"Perhaps worst of all he posits that we should do away with all cancer research without a single shred of evidence," the commentator writes. "What of the tremendous strides made in treating childhood leukemia or breast cancer? He mentions none of that, and he makes sweeping generalizations about oncologists as well, saying stay away from the 'over-zealous' ones, and not mentioning the good that so many of them do."
Another commentator agrees, adding: "With that attitude we might as well cancel all medical research as 'your number is up when it's up.' I don't mind your (completely baseless) belief in fate but don't involve others in your crazy religion."
Most of the comments are in a similar vein, registering shock and disgust over the 'insenistive' opinions that Dr Smith expressed. But there are a couple of commentators who offer some agreement with his views.
"Perhaps cancer is the most humane way of dying in these modern times," writes one commentator, who also contemplates drowning, burning to death, and being kidnapped and tortured to death. In contrast, she imagines that death from cancer would involve getting "the best care in a hospice, you get to have your family with you, you get the best drugs and painkillers to ease the way. You get to say goodbye. That's good enough for me."
Better Than Sudden Death and Dementia?
In his blog post, Dr Smith writes that he thinks a lot about dying and that he has talked to people about how they would like to die. (He worked in television for 6 years and was a TV doctor for both the BBC and TV-AM.)
"There are, as I endlessly repeat, essentially four ways to die: sudden death; the long, slow death of dementia; the up and down death of organ failure, where it's hard to identify the final going down, tempting doctors to go on treating too long; and death from cancer, where you may bang along for a long time but go down usually in weeks," he writes. "Suicide, assisted or otherwise, is a fifth, but I'm leaving that on one side for now."
Most people say they would like a sudden death, Dr Smith writes, but he points out that this is terribly hard for those who are left behind, and especially if there are relationships that are strained at the time of death.
"The long, slow death from dementia may be the most awful as you are slowly erased," he comments.
"Death from organ failure — respiratory, cardiac, or kidney — will have you far too much in hospital and in the hands of doctors," he writes. Dr Smith recalls the horror he felt as he watched, as a medical student, news bulletins about Franco's death in 1975, when one organ after another failed and doctors tried to compensate. That is the "most horrible medical death," he says.
So, out of the scenarios that he describes, he concludes that "death from cancer is the best."
But he asks, "will I be ready?" And in closing, he adds as a competing interest that he will die, and "perhaps soon," because he is 62 years old.
Dr Smith was the editor of the BMJ until 2004. He is now chair of the board of trustees of icddr,b (formerly the International Centre for Diarrhoeal Disease Research, Bangladesh) and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.
BMJ blog post. Published online December 31, 2014. Full text
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