Have you ever thought about how you would like to die? More specifically, are there illnesses you really would not like to be your last?
The reason for this week's rather unusual introduction is a blog by Dr Richard Smith, a former editor of the British Medical Journal, in which he suggests we should "stop wasting billions to cure cancer" because, in his opinion, terminal cancer is the best way to die.
One of the reasons for this, according to Smith, is that a cancer diagnosis gives people time to say goodbye to those close to them. In what may be an indication of his own worst fear, Smith went on to say that by investing large amounts of money in curing cancer, people are more likely to die of worse conditions, such as dementia.
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He listed four broad ways to die: sudden death; the long, slow death of dementia; the up-and-down death of organ failure; and death from cancer where you “go down, usually in weeks”.
Dementia
About dementia he says: “The long, slow death from dementia may be the most awful as you are slowly erased, but then again when death comes it may be just a light kiss.
“Death from organ failure – respiratory, cardiac or kidney – will have you far too much in hospital and in the hands of doctors.
“So death from cancer is the best . . . 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.”
While acknowledging this may be a somewhat romantic view of dying, Smith says it is achievable “with love, morphine and whiskey”.
I do not agree with his statement that death from cancer usually happens in weeks. This may be the case when someone enters the palliative phase of the illness but with an earlier diagnosis and an active treatment phase, months or even years may be a more accurate estimate.
And while the pain, breathlessness and vomiting that often accompany the latter stages of cancer are amenable to treatment, full symptom control may not be possible even with copious amounts of love and the best of malt whiskeys.
Personally, I would rather drop dead or die in my sleep. Not easy on my family and friends, I admit, but from a purely selfish point of view it has its advantages.
It seems especially apt when someone is a good age, with many of life’s ambitions at least attempted if not completed. But for a younger person, although painless for the individual, sudden death will likely be hugely destructive in what it leaves behind.
Clinical experience
I suspect if you asked a group of experienced health professionals this column’s opening question, you would come up with a broad range of illnesses based on each person’s clinical experience.
Within days of Smith’s blog came an interesting study on why certain people get cancer.
Researchers from Johns Hopkins University school of medicine in Baltimore found that two-thirds of cancer cases can be blamed on random mutations and are not due to risky lifestyle choices such as smoking.
In other words, plain old biological bad luck is the main driver of oncogenesis. Of 31 cancer types analysed by the authors, some 22 of them – including leukaemia, ovarian and brain cancer – could largely be explained by these random mutations.
However, colorectal cancer, basal cell cancer of the skin and lung cancer were more heavily influenced by hereditary and environmental factors.
Just as with our mode of death it seems we cannot, in the case of many tumours, readily influence our fate.
mhouston@irishtimes.com muirishouston.com