There is no best way to die
There’s a blog post floating around Facebook that’s driven me to distraction today. The post was written by Dr. Richard Smith for the BMJ (formerly known as The British Medical Journal) titled, “Dying of Cancer is the Best Death.” I encourage you to read it in its entirety. I’ll wait…
This is a horrible title, and likely the key reason it’s stirring up so much anger, but I’m going to give Dr. Smith the benefit of the doubt and assume that an editor came up with the title of that post (I wrote a column for a local NY paper for three years, and they always changed my title to something that I pretty much hated). It was probably the same editor that thought BMJ was a better name for a medical journal than The British Medical Journal…But, I digress.
Dr. Smith’s post is stirring up some outrage among people within the cancer community (which is pretty much everyone because who hasn’t been touched by cancer in some way?) because he’s basically painting cancer as the ideal way to die compared with the three other (less best) ways to die: organ failure, dementia and sudden death (you can’t make this shit up). So, there are four ways to die according to Dr. Smith: cancer, organ failure, sudden death and dementia (the last being the least pleasant, according to the good doctor, and – in my opinion – the one he’s most likely suffering from based on the content of this article.)
As the mother of a child with cancer, I think I have a legitimate reason to be incensed with rage about the content of this blog post from such a renowned member of the medical establishment. Particularly the part where he explains why he thinks cancer is the best way to die – namely, you have time to say good-bye to your loved ones, wrap up your affairs and go gently into that good-night. He wraps up the post with these words:
“You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.
This is, I recognise, a romantic view of dying, but it is achievable with love, morphine, and whisky. But stay away from overambitious oncologists, and let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death.”
So, as I said above, I have every right to be outraged, but I’m not actually angry. I’m astounded that a man of Dr. Smith’s stature – he was the Chief Executive and editor of the British Medical Journal for many years and a DOCTOR could cite cancer as the best way to die. Is he the only person on the planet without a firsthand experience of cancer? Does he have such a colossal lack of imagination that he thinks everyone who is diagnosed with cancer and (it would seem) forgos extensive treatment, has time to wrap up their lives in a neat little package and drift serenely into oblivion (with the help of whiskey, morphine and love )?
I can’t believe that this is the case. More likely, he’s seen many people suffer from prolonged treatment with little benefit – a chronic problem and one that I am acutely aware of when agreeing to any type of treatment for Ana (it’s why she didn’t end up getting two thoracotomies back in June). So this may be his intent with this article – embrace death as part of life, avoid costly and painful treatment that doesn’t provide any additional benefit to the patient (and may harm them), and say your good-byes on your own terms. But if this was his intention, he majorly missed the mark. In the first place, classifying death into only four categories is a very doctory way to look at things. It is clinical, detatched and lacks imagination.
I’m not a doctor. I’m a writer. Thus, I can say with absolute conviction that there are thousands of ways to die – and none of them are pleasant. In the end, it may always be “sudden death” or “organ failure” or “cancer.” You can choke on a chicken bone, contract an antibiotic resistant infection, get stabbed in a dark alley, stumble into a swarm of angry wasps or get an incurable disease, and in some cases you’re gone in the blink of an eye. In some cases you may linger – with pain or without – with consciousness or without…but if it’s you, or if it’s someone you dearly love, then there is no BEST way to die.
Dr. Smith may have meant well (I read some of his other posts and I do think he has the patient’s best interest at heart), but his delivery was poor and his points were muddled among many other controversial things – how much should we spend on cancer research? What kind of conversation should we be having with our oncologists about treatment versus quality of life? How do we want to die? How do we want to live? It’s all jumbled together in a way that seems callous and naive, particularly to those of us who have taken up residence with cancer and have seen, firsthand, that there are no clear choices, no easy answers, and many things that morphine and whiskey can’t fix (particularly for a 13-year-old girl with a new liver).
I think Dr. Smith is afraid, as many physicians must be, of dying in a way that he can’t control – dying in the hospital, in the ICU, in unbearable pain, or dying suddenly, without a chance to wrap things up and say good-bye. Maybe he was trying to paint cancer in a positive light, thinking it got a bum wrap, as far as “causes of death” go. Maybe he’s seen a lot of dead bodies, spoken to a lot of distraught families…I don’t know what inspired that post, but whatever his intention, he got it wrong. His words were offensive, even painful, because they came from someone who should’ve known better. I’m glad he’s not my doctor – or Ana’s.