What makes for a good death?

I was reminded to think about how I’d like to die. It’s actually pretty simple: a long, slow, painless death, greatly deferred. I’ve actually got it thoroughly planned out.

I’m on my deathbed in my undersea dome, surrounded by my children, my grandchildren, my great grandchildren, my great-great grandchildren, and my great-great-great grandchildren (it’s a very large dome). I’m looking good — I’ve lost some weight, the rejuvenation treatments have been working well, and I’m also feeling terrific — but I know my expiration is imminent. I get ready to speak my last words.

“I love you, Mary.” The phone rings.

“Yes, this is he,” I say. I whisper to Mary, “It’s the Nobel committee.” “Yes, thank you, it’s an honor. You’re lucky to have called just now — another 10 minutes, and I would have been posthumous, and no longer qualify. We have a spot all picked out on the wall for it, right next to all the Olympic gold medals. But now I have to get back to dying. Later!”

“My children, my descendants, I’m very proud of you all,” I continue. The phone rings again.

“Hello, Madam President. Don’t worry, stop crying, you have nothing to worry about — I trained you well, you don’t need me any more. Also, my wife has agreed to step in as an advisor, and you know she’s the smart one of the family. Besides, with world peace and prosperity a reality, it’s not as if you need my guidance anymore. Bye!”

I turn off the ringer on the phone, and settle in for a quiet exit. “Now where was I…”

The door bursts open! There, standing in all of his regalia, is the Last Priest in the World!

“I could not miss this opportunity for a deathbed conversion,” he hisses, swinging his censer and and shaking his staff, resplendent in his bright orange robes and mitre (as the last priest, he was also the Pope, the Dalai Lama, the Head Imam, etc. — religion had tried a desperate series of mergers to stem the rising tide of atheism.) Then his words are lost in a welter of glossolalia and Latin.

I leap from my deathbed, and gripping his throat in my left hand, I lift him off the floor; with my right, I deliver a stinging series of slaps. “There <SLAP!> is <SLAP!> no <SLAP!> god! <SLAP!>” I throw him to the floor.

He shakes, as if waking from a dream. “You’re right,” he says, “I’ve been living a lie. I don’t know how I deluded myself for so long.” He throws off his mitre, his yamulke, his robes, his staff, his orb, multiple fragments of old saints’ corpses, his magic underwear, and rises naked, unashamed of his humanity. “I think I’ll go back to school and learn something useful. Do you have any recommendations?”

“Biology is always good,” I say as I vault back into my deathbed.

“Now where was I…oh, yes, my last words.” And I say them, and they are witty and wise and will be quoted down the centuries, but I can’t tell you what they are, because they’re also totally spontaneous, so you’ll just have to wait.

And then, with a soft quiet sigh, I die instantly and painlessly.

At least, that’s how I’m planning to die. Reality may interfere. But you know what isn’t anywhere in my scenario?


Cancer is an ugly reality — that would introduce a slow, painful factor to my demise.

That makes it really weird that Richard Smith, a doctor, has written a bizarre editorial in which he fantasizes about dying of cancer.

So death from cancer is the best, the closest to the death that Buñuel wanted and had. 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.

He admits to having a romanticized view of cancer, but still…I found it hard to believe what I was reading. Yeah, you’ve got an ulcerated tumor, you’re in pain, you’re experiencing progressive organ failure, but this is the perfect opportunity to read a poem and listen to a concerto. You thought my deathbed story was silly and unrealistic? This one puts it to shame.

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.

There’s something contradictory here: enough morphine and whiskey to dull the pain of terminal cancer, and you won’t be in good shape to appreciate that book of poems. Love might help, but if you really love someone, you’ll give a thought to them…and watching you die slowly, drunk and squirming with pain, and turning away medical help, is no kindness.

But worst of all, any of us who have seen what cancer does are horrified at the idea of a doctor suggesting that we shut down cancer research. Many people diagnosed with cancer are not interested in sitting down with a bottle of whisky and dying in a bleary haze — they have things to live for and want to fight, and it’s only modern medicine that gives them the tools to do that. Because of those treatments, many people experience remissions and additional years of cancer-free life…during which they can read all the poetry they’d like and listen to all the concerts they desire.

I have seen relatively peaceful cancer deaths, of the sort Smith imagines. My aunt died of liver cancer many years ago, and her last months were spent in quiet calm, visiting with family. But the only way she was able to do that was thanks to cancer medicine: she was undergoing chemotherapy to keep the tumors under control, and was getting the very best of palliative care.

No, she wasn’t getting blotto on alcohol. She had good doctors who were monitoring her frequently, and tailoring their treatments to optimize her quality of life. That doesn’t happen without oncologists, and a worldwide investment in treating cancer.

I have no idea what Smith was thinking. It is ironic that he’s chair of the board of Patients Know Best, an organization that lobbies for patient rights. I guess any patient’s desires should be supported, except for those patients who want well-informed doctors with the best and most up-to-date therapies in hand.


  1. Al Dente says

    I’m reminded of a scene from the movie “Oscar.” A son is at his father’s deathbed. The father asks: “Do you want me to die happy?”

    “Yes Papa.”

    Father slaps son: “So you want me to die!”

  2. says

    “… they have things to live for and want to fight,… ”

    Yeah, but truly terminal cancer means it’s not gonna happen, is it?

    I thought there were studies that show in a truly terminal cases there is more life lost than gained from medical-account-emptying, Hail-Mary-Pass chemo/radiation/voodoo? Honesty on the part of the medical profession and an abandonment of the Hallmark Special outlook in some cases might be far better than ravaging a body and taking away another month or two of sunrises and sunsets. Maybe some research is needed into this as opposed to funding cancer studies which seem to have gained a life of their own justifications, just like the Fusion-Will-Save-Us brigades battle cry (always at least one PhD career away).

    The two of you seem to be approaching this point with a lot of unstated assumptions lurking in the dark beyond the campfire.

  3. Beatrice, an amateur cynic looking for a happy thought says

    Death from organ failure—respiratory, cardiac, or kidney—will have you far too much in hospital and in the hands of doctors.

    But death from cancer won’t?! Only if you don’t treat it, and you can do the same with any other illness.

  4. carlie says

    Dammit, PZ, you really scared me for a second there. Given that “Cancer.” was the last thing before the jump, I was petrified because that looked like a direct lead-in to you saying after the jump that either you or someone close to you had it. So glad it wasn’t that. But jeez, you’re a powerful writer, be careful where you aim those words!


  5. twas brillig (stevem) says

    There’s only 2 things guaranteed to happen: death and taxes. /snark snark
    Seriously though, the DEATH thing is a thing everyone has to look forward to. This Richard Smith guy is focused on only one aspect: Warning. He is saying it is better to know one is certainly headed for the doorway, and given time to say goodbye. Rather than the sudden, inexplicable, instant deaths so many people have had. He totally overlooks the other aspects of the CANCER prognosis. We certainly disagree that CANCER is a “romantic” mode of Death. And for some reason he discounts CANCER as painful; has he ever met a cancer patient? He said his attitude is “romantic”; thus denigrating the meaning of the word.

  6. azhael says

    When they make the movie (and they better) i hope they make just one small change and they give you a tentacle where your right hand used to be so that the slaps make a hilariously moist sound.

    Also, someone take the medical licence away from that moron….

  7. mirrorfield says

    No, our dear host, there is no good death. There may be situations where it’s …less bad… option in comparison to all other availables. There may be even …not that bad… ways to die. But in the end, it’s bad.

    Long forewarning of one’s own death… Well, that has it’s pros and cons. On the pro side, you can set your affairs to order. On the con side, knowledge of your own imminent death is prime depressogenic.

    I also admit my fondness to ancient Epicurean approach to death: “Death, therefore, the most awful of evils, is nothing to us, seeing that, when we are, death is not come, and, when death is come, we are not.”

  8. twas brillig (stevem) says

    and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.

    uhhh, aren’t “enjoy” and “oblivion” mutually exclusive? If you are there, it ain’t oblivion, and only if you aren’t there can it be oblivion. Even accepting the first as possible [existing within oblivion]: if it is oblivion, what is there to enjoy? I think this guy got stuck on “turns of phrase” to make any kind of rational argument for the concept of “cancer is the ideal form of death”.

  9. Alex the Pretty Good says

    Given that cancer is the the main cause of death in my father’s family (including my father at 66) and cancer treatment has given those family members the chance to actually enjoy the years (or months) that were left after diagnosis, I really want to slap that docter silly.
    Also, several people I know were cured of malignant tumors that were discovered on time. If he would have gotten his way and cancer research were to be abandoned, they’d have died a absolutely un-romantic death.
    Add another doctor to the list of people I wouldn’t visit … especially not if my life depended on it.

  10. says

    [FtB seems to have eaten my first attempt at this; please forgive me if this shows up twice.]

    What this story also leaves out is the tragedy of pediatric cancer. I grok that cancer is, probably to a much greater degree than many of us realize, a disease of aging… but it does not follow that all cancer patients are old folks just waiting for a “good death” (even if cancer really were that).

    As the father of a survivor of pediatric brain cancer, I’d like to tell this bozo what he can do with a rotting porcupine corpse!

  11. Bernard Bumner says

    I know people who have died from cancer, scared of pain, scared of lingering in the half-light of opium delirium, scared of eating and drinking for fear of regurgitating more shit-smelling foulness. Brave people, hopeful people, smart, funny, loving people, robbed of a deservedly gentle and peaceful end by various evil malignancies.

    This fantasy is utterly foolish. You may as well hope for a glorious, painless car crash, foreseen in advance.

    Who gets the death they hope for if it is not within their own powers?

  12. barbaz says

    Actually, I’m quite happy that my cancer got cured 19 years ago. I also read a lot of poetry since then.

    I might be inclined to agree that dying from cancer is better than dying in a car crash, as it gives you a chance to settle your affairs. But only if there is an option of physician-assisted suicide to skip the pain part. In how many countries is this possible right now?

  13. PaulBC says

    Speaking of “romantic” deaths, I thought tuberculosis had the monopoly on that (i.e. novels referring to “consumption”) before it became treatable. While I’m sure there is much to be said for the fascinating characters you meet while dying in a mountain sanatorium, most people would rather just have their life back. What are we going to do when we cure all the best ways to die?

    I am also optimistic that there will be much better treatments for cancer in the next few decades as oncogenes are identified and targeted specifically. Many forms of cancer respond well already to existing therapies, as hard as it is for patient. The outlook can only get better.

    Clearly, something like hospice care is prefer to expensive, painful, and ineffective treatments, but the key is to figure out whether they are effective or not.

  14. essjay says

    I think that Richard Smith suffers from an extreme lack of imagination, since he is unable (or at least) unwilling to imagine what such a death would be like. It shouldn’t take much imagination to see that a death by cancer would be anything but romantic.

    I find the term “good death”–like a “good war”–to be an oxymoron. The only exceptions I can think of involve death as a release or escape, such as assisted suicide in the face of unbearable suffering. Even then I can not see how death is “good.” The only “good death” for myself that I can imagine would be a sudden, unexpected, instant death, such as dying in ones sleep. I still can’t see that it would be “good”; it would only be a blank.

    There are those who claim they accept and are not afraid of death, but I am not one of them. Walt Whitman says “I laugh at what you call dissolution / and I know the amplitude of time.” I wish I could say the same. He ends a late version of the Song of Myself with: “I bequeath myself to the dirt to grow from the grass I love / If you want me again look for me under your boot-soles…./ failing to fetch me at first keep encouraged / Missing me one place search another, / I stop somewhere waiting for you.” The last line makes me tear up every time, but it is still only a wish on my part, not a belief. (I don’t think that Whitman meant this in a religious sense, but I could be wrong.)

  15. says

    Mirrorfield@7: I dunno. I think death could be good, eventually. Would you really want to live for Graham’s Number of years? I grant that current lifespans are well under optimal – I would like to live long enough to see the Milky Way rise over the horizon of an airless planetoid in the Lesser Magellanic Cloud – but an end, so long as it’s a choice, does seem eventually desirable.

  16. says

    Saying goodby to everybody and leaving all your posessions with lovingly written notes attached?
    No thanks.
    My idea is always to go like my grandpa. He woke one morning with a cough, my grandma got up to get him something to drink, when she returned he sat up, looked at her, and died.
    He was still happy and out and about the day before. Life lived to the end.

  17. bramhengeveld says

    “But the only way she was able to do that was thanks to cancer medicine: she was undergoing chemotherapy to keep the tumors under control, and was getting the very best of palliative care.”

    This is to me an example of confusing over ‘cure’ and ‘palliative care’, it’s more of a sliding scale, than a big separation. (which was the old view; ‘we can’t do anything for you’) Radiotherapy is more well known for it’s palliative use than chemotherapy though. The billions that are mentioned by Smith are not on research, but in vain treatment, a good point along rising evidence that early-on palliative care and less agressive end-of-life care are truly benificial on more than one scale.

    I also don’t read into it a glorification of pediatric cancer. It also doesn’t say ‘dying of cancer is fun’ to me. Dying is never, ever fun. Not even when wanted. For instance: euthanasia – which is luckily possible where I live – is always a cesspool of anguish. That being said; talking about what we want, and knowing what can be expected is an essential part of the ‘best death’, which is a better term than a ‘good death’, now that I come to think of it.

  18. PaulBC says

    The bizarreness doesn’t stop with the cancer comment. For one thing, we have sympathy for Franco:

    Buñuel saw how Franco died and found himself pitying a man he hated. Franco’s death in 1975 still stands for the most horrible medical death, a death that only doctors could devise. Organ after organ failed, and the doctors tried to compensate. As a medical student a year before graduation, I watched in horror.

    Maybe you could instead watch this and consider that there is some justice in the world after all. Also is it possible that Franco could have put a stop to it at any time? I would guess that he was the one clinging to life and power.

    Also, a seeming unawareness of life expectancy in 2015 (assuming Smith wrote this):

    Competing interest: RS will die, perhaps soon: he’s 62.

    62 is not young, but many people can expect to live out another third of their lives at that age. Not everyone gets Alzheimers, and many will continue to gain satisfaction out of living as well as enriching the lives of others. A few will continue to make creative accomplishments into their 90s.

    Finally, Luis Buñuel died in 1983. If his was a good death for its time, would it be a good death today? Over 30 years have passed and I like to think there has been some progress in cancer treatment.

  19. Esteleth is Groot says

    Pardon me, I’m seething.

    Two weeks ago, my father – at 56 – was diagnosed with prostate cancer. There is, fortunately, many reasons for optimism: he’s in generally good health, the tumor appears to be small, and there is no sign of spread.

    And yet, I’m worried and scared. As is everyone else in the family.

    Cancer is a good death? I suppose in comparison to others (there are many horrible ways to die, as history will tell you). But I wouldn’t wish it on anyone.

  20. frog says

    Can’t help thinking might be best to just live your life as well as you can so that when death takes you–whether by slow cancer or fast-acting train wreck–your loved ones know you had a good life.

    My best friend’s father died of cancer, slowly over months. My father died of sudden heart failure while on vacation overseas. We’ve had a decade to compare notes, and we agree: I got the better deal. I made sure to tell Dad I loved him before he and Mom got on the plane, because I knew there was always the possibility of a septuagenarian with a tricky heart not making it home alive. He was on vacation from a job he adored (witness that he was still doing it at his age, when he could easily have retired).

    It was a horrible shock when he died, still utterly crushing even a decade later, right this minute. But I am eternally grateful that I didn’t have to see my brilliant, athletic father lying in a hospital bed, losing weight and getting sicker and less coherent every day. (And I know that he would have hated that.) Much, much better that my last memory of Dad is him standing tall beside my mother on the curb outside a terminal at JFK.

    I hope I’m lucky enough to go that way: fast, while actively living my life, at an age that isn’t a statistical outlier (unless at the upper end, of course!).

  21. Tapetum says

    Oh fuck cancer, and fuck Richard Smith. The history of cancer and my family reads like this:
    Uncle, bone cancer, died
    Grandfather, prostate cancer, died
    Uncle, colon cancer, died
    Cousin, non-Hodgkin’s lymphoma, in remission (a few times)
    Cousin, ovarian cancer, 12 year survivor,
    Cousin, leukemia, 8 year survivor
    Aunt, lung cancer, died
    Mother, breast cancer, 5 year survivor
    Father-in-law, Common bile duct cancer, died
    Cousin, pancreatic cancer, in treatment
    Husband, renal cell carcinoma, in (experimental) treatment

    That’s in chronological order, and you might notice a trend towards more survivorship. Because when my uncle got bone cancer, there was very little they could do but lop his leg off and hope, but by the time my cousin developed ovarian cancer, there were options – and options that worked. As little as ten years ago, there would have been nothing they could have done for my husband except carve out everything they could and hope. The only real hope we have now is still in the experimental stages. My father-in-law died a relatively peaceful cancer death, because of a brand new targeted therapy, which kept his pain levels down to highly manageable right up until a couple of hours before he died.

    Are there potentially better ways to make end-of-life, end-of-treatment decisions than we do now? Of course. But Richard Smith can come to my next family reunion and talk about good deaths from cancer. I wouldn’t expect him to get a warm reception.

  22. Becca Stareyes says

    A friend of mine has metastatic breast cancer; she’s around 40. Her oncologist is the one giving her years of life keeping her tumors stable for as long as feasible*. Relying on love and painkillers would cut years off her life (and probably not help her quality of life either).

    While I think there is plenty of room to help folks with ‘this will probably kill you in months/years’ end-of-life decisions, a lot of that is giving them the tools to read poetry, finish that novel, spend time with the kids, etc.

    * From what I understand from her blogging and her support group, the progression is based on the tumors’ ability to mutate around whatever the oncologists are using to keep the damn thing from growing and disrupting important organs. Which isn’t an exact timeline.

  23. says

    @Gillel – My idea is always to go like my grandpa. He woke one morning with a cough, my grandma got up to get him something to drink, when she returned he sat up, looked at her, and died.

    I thought you were setting up the old joke “I want to pass peacefully in my sleep like my grandpa did, not screaming and struggling like the passengers in his car.”

  24. carlie says

    I’m so sorry, Esteleth. And everyone else who has gone through this.
    (also waves and hugs to Bill Dauphin)

    My grandmother died of complications from a cancerous brain tumor. It was her second; it regrew after being removed. I was only 14 when the second diagnosis hit, and my memory isn’t great for anything, but my mom’s reaction when they found out it was back is etched in my mind. It was not “good”.

  25. dianne says

    Fuck cancer. And fuck nihilists who don’t even want to try to cure it. Do you really think dying from cancers interfering with the function of every organ in your body is a GOOD death? Know what people with advanced cancer feel when they get effective chemotherapy? Better. I support the right of any patient to refuse any treatment in existence but I also support the right and duty of any doctor to tell them that they’re being damned fools about it if they are.

  26. Al Dente says

    PaulBC @20

    Franco’s death in 1975 still stands for the most horrible medical death, a death that only doctors could devise.

    For those of us of a certain age: Francisco Franco is still dead.

  27. unclefrogy says

    I have no problem at all that this here doctor wants to die from cancer as opposed to some other way to die. That is is right and privilege to desire anything at all time will tell if he gets his wish. That is not what he is saying how ever. As I read it he does not say “I want ” or “I don’t want” he says you should do a list of things instead excluding serious treatment of course. You You You!
    That list of things are good to do all the time there is no need to wait until you get the “You have 6 mo. to live” message in fact those things on your list as far as I can see are the biggest reasons for living at all.
    He has no right to make that kind of decision for anyone else at all in that way he is just another know it, all self-important Doctor with all the fucking answers for everyone else. He has his own personal reasons he would make that kind of decision but he is an ass to think he should impose it on anyone else and I would bet he would if he could.
    uncle frogy

  28. otrame says

    My ex, who is a truly great doctor (I mean I once spent a dinner listening to a couple sing his praises to the damned sky (He had been called away, of course) and when I got home and told him about it, he said “I don’t know why. All I did was tell them she was going to die within two weeks.”) once told me that a lingering death is better for the relatives and loved ones, so they can get used to the idea ahead of time, while a sudden death is easier on the patient.

    Two very close friends died in the last ten years. One was diagnosed with leukemia at age 70 and died very suddenly a few days later due to a bad reaction to his first chemo treatment–long before I had accepted that he was going to die (denial takes a while to work past, it seems). The other had a cancer the doctor had told him he would probably survive (he didn’t–but he lasted about 2 months after I acknowledged to myself that he was going to die). The second case made me very sad. The first one devastated me.

    So I am going to wish-list myself a problem that will take a while to kill me, hopefully without too much pain, because I want my family to have time to get used to the idea that I am going.

  29. Rowan vet-tech says

    My maternal grandfather died of colon cancer when I was an infant. Mom said it was horrific; that if he wasn’t comatose with morphine, he was screaming.

    Mom has had quite a few polyps removed, including several at age 40. My brother had a polyp removed at 35. I’m 32. I need to schedule my first colonoscopy (yaaaaaaaay) and I need to get them yearly because family history.

    Provided nothing else pops up, my most likely causes of death are colon cancer or alzheimer’s. So, as that is my future, I would like to say a big FUCK YOU to this doctor.

  30. Tapetum says

    Reiterating dianne. Colon cancer is one where catching it early can make every difference. Get that colonoscopy.

  31. dianne says

    Colon cancer is best treated before it’s actually cancer. The best way to do that is to get colonoscopies. Before you’re the age that colon cancer struck your youngest relative with it. This smells like a potential familial polyposis to me and that needs attention.

  32. Lady Mondegreen (aka Stacy) says

    My father died at age 39, after three years of agony. The cancer that killed him (Hodgkin’s lymphoma) is no longer the death sentence it was in those days.

    Fuck you very much, Richard Smith.

  33. leftwingfox says

    Unfortunately I’m facing the specter of this right now.

    I’ve had acid reflux for about 15 years now, and esophageal cancer is one of the risks. One of the warning signs the doctor mentioned was having trouble swallowing. As of the end of November, that’s started happening. I’ll be getting scoped later this month.

  34. says

    leftwingfox, hugs. I hope you get the all-clear with that. :(

    I started getting acid reflux a couple of months ago and my doctor’s referred me for an endoscopy. Don’t know when it’ll happen, yet, I haven’t heard back from the hospital that’ll be doing it. (One good thing about being unemployed here in Oz: I get this test free at a public hospital.)

    The idea of wanting to die of cancer … well, everyone’s already contributed to that on this thread. I’ve seen one family member with cancer (BiL, throat cancer, he recovered) and the treatment alone is horrible enough that I don’t think he’d opt to go through it again.

    But even without the pain and all-round distress of cancer, a slow death? Mmm, maybe if there are lots of things you want to do (that somehow this slow dying doesn’t stop you doing) and you can afford to do them, or if you have lots of family/friends you want to say goodbye to … but if you don’t? And if you’re on a payment like Newstart, you’ll be told you have to keep looking for work until you’re actually physically ill, as just happened to a young man who’s been diagnosed with a terminal brain cancer. No disability pension for him, he has to waste what time he has left rolling up to Centrelink to apply for nonexistent jobs.


  35. rorschach says

    This guy is an idiot, and his romanticizing of death from cancer is ridiculous. I wish he could be deregistered, just like “pro-life” fuckers in the medical profession should be.

    However. There comes a time in many a cancer patient’s journey, and dianne will know this, where our focus turns from cure to palliation, and if a patient wants to swap a chemo that brings hair loss, mouth ulcers, heart failure and vomiting in exchange for a few weeks of prolongation of life for a nice holiday with a few joints and drinks, then who am I to give them a lecture.

    Will I tell a cancer patient to stop smoking or drinking? Not ever.

    When it comes to terminal cancer, there might be an argument to be made for 4 weeks of relative quality of life as opposed to 7 weeks with not eating having blood transfusions being in hospital and having endless blood tests. But it’s always the patient’s decision.

    But this bloke is full of shit.

  36. says

    rorschach @44,

    Absolutely. If I was diagnosed with a cancer whose survival rate was poor, I doubt I’d put myself through the horrors of treatment at all. But cancer as a desired way of dying? That’s just … oy. Words fail. It’s even more stupid than the romanticisation of TB.

  37. dianne says

    Will I tell a cancer patient to stop smoking or drinking? Not ever.

    Never? I doubt that. I’d certainly tell a resectable stage I lung cancer patient that they dodged the bullet this time but need to stop taking crazy risks. But later stages? Nope, nope, not at all.

  38. Marc Abian says

    Be more careful with what you write above the line, PZ. I was thinking this post was going a very different way.

  39. seranvali says

    I want to slap this man! How dare he talk such rubbish about an illness that causes so much pain and suffering?

    I’ve just been semi-discharged after five years with bowel cancer and I have no doubt that it was modern medicine that’s kept me alive. His comment about stopping cancer research…sorry, I’m too angry to be articulate.

    Has he actually watched a loved one die this way? The end can be horrific and he’s talking about some romantic, peaceful, bullshit scenario?

    My aunt was a palliative care nurse until very recently and took care of people who’d chosen to die at home and when I was diagnosed she told me what to expect from treatment. People don’t die “good” deaths of cancer, you’re either in terrible pain or in that strange dreamland that morphine creates. There are many nurses, my aunt among them, who have acted out of compassion and overdosed their patients when the difference between a therapeutic and a fatal dose are very close. That shouldn’t be necessary because that decision should lie firmly in the hands of the patient.

  40. PaulBC says

    His comment about stopping cancer research

    When I see references to stopping research I keep thinking he didn’t really say this, but I checked and I guess he really did (“let’s stop wasting billions trying to cure cancer”). That is a truly terrible, unethical viewpoint.

    What rock has he been living under? As I mentioned above, Luis “good death” Buñuel died in 1983. Clinical outcomes have improved for many cancers since then. More to the point, our knowledge of genetics has undergone a revolution. While biotech has a track record of being over-optimistic, there are surely more opportunities than ever to understand cancer at the broadest level and develop cures for every form of it.

    “Potentially leaving us to die a much more horrible death?” Yes, well I’ll take my chances on that one. Maybe we’d all just be better off falling into a coma from meningitis and not have to face the cruel world for another day.

    Smith’s editorial could conceivably have a point if he limited his target to “overambitious oncologists”. There is a point when the focus should switch to end of life care. But it sounds like he thinks cancer is just a big win all around. True, it did look like kind of a laugh riot in The Bucket List, but I am pretty sure not everyone is that lucky.

  41. Richard Smith says

    A name is all I have in common with that man. My father died of complications due to a particularly aggressive prostate cancer. If it hadn’t been for the treatments available then, he would have died sooner and, most likely, with far less quality of life during that time.

    If I could choose the way of my own death, a second heart attack similar to the one I had in 2013 would be okay. No real pain, mainly just very, very tired. Go to bed, and don’t wake up again. Only found out about the original heart attack when I roused myself enough to go the hospital for an apparently unrelated complaint. Seems they get very fussy whenever you mention any degree of chest pain. At least I discovered that the way to my heart is not through my stomach, but my right wrist!

  42. Yellow Thursday says

    [L]et’s stop wasting billions trying to cure cancer…

    Those billions have changed what lymphoma means to patients and their families.

    For my father, it was a long, downward slope of chemotherapy and radiation therapy that caused him to lose his appetite and his hair. Eventually, the treatment destroyed his immune system enough that a secondary infection took his life 23 years ago. I got to see my once-strong father turn into a frail skeleton with skin.

    By contrast, for my coworker’s husband, stem cell research had improved to the point that his treatment, though long and expensive, gave him back his quality of life. Now, 3 years later, he is still cancer-free, thanks to 20 years’ advancement in cancer treatment.

  43. dianne says

    Most people with diffuse large b-cell lymphoma can expect to survive it with modern treatment.

  44. says

    There might be good arguments that cancer research funds are allocated poorly… but giving up? Seriously, fuck this guy.

    I had a friend in high school die of liver cancer. There may be really good arguments that cancer research money is poorly allocated, but seriously, that sort of suffering is something we need to address. Giving up the fight is simply inhumane, to the cancer sufferers and those they leave behind. Argue about which cancers should get the most funding, argue about the balance between curative and palliative research, fine, those are important discussions to have. But arguing to give up, if that’s your position kindly fuck off from this discussion forever.

  45. neuroturtle says

    I am fairly sure that slowly suffocating was not in my stepdad’s list of “favorite ways to die.” Palliative chemo and radiation extended his four-month prognosis to two years; all but the last month was not fun, but tolerable. That probably had something to do with his excellent doctors and their world-class cancer research, but hey, what do I know.

  46. carlie says

    Just for the record, I wanted to append this response to that editorial. It’s thorough, cutting, and worth the read. Excerpt:

    I go into the chemo centre every 14 days. The in-patient part takes seven hours, from start to finish. I then return home connected to a chemotherapy pump, which runs for another 42 hours. A nurse comes to my home on day 3 to disconnect the pump.

    Of each 14 day cycle, I lose at least 8 days to nausea, clinical fatigue, chemo brain, neuropathy in my hands and feet, sores in my mouth etc.

    With the remaining 6 days, I have some time to work through my bucket list.

    These physical aspects are cumulative. I built myself a ‘quality-of–life’ spreadsheet that allows me to score simple everyday physical and emotional goals – like if I’m up to having a shower or having visitors. Or how positively I’m thinking. There are over 40 indicators that I score every day. For most of the first week my quality of life score is below 25%.

    As time moves on, I notice that I am slower, the number of symptoms is increasing, and the rate of recovery is diminishing. So I don’t buy the ‘fall off the edge’ scenario that you suggest.

    In fact this raises an important question. At what point is a terminal cancer patient ‘dying’?

    My view is that it really starts the moment the doctors tell you that you are terminal. Sure you have good and bad days, weeks or months – but in my experience, and talking to others in a similar position, it really is an extended period of dying. Not a set of phases of which the last is dying.

    I fight hard every day for some more quality time to do the things that are important to me. I go to the gym 3 times a week. I manage my diet. I’m sensible about how I use my energy reserves. I try and keep my mind active. In short, I’m doing everything I can to enhance the time I have left.

    BUT there is never a single day when I don’t reflect on the fact that I’m dying.