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Richard Smith: Dying of cancer is the best death

31 Dec, 14 | by BMJ

richard_smith_2014Luis Buñuel, filmmaker, surrealist, iconoclast, moralist, and revolutionary, thought a lot about death. “Sometimes,” he wrote in 1982, a year before he died at 83, “I think the quicker the better—like the death of my friend Max Aub, who died all of a sudden during a card game. But most of the time I prefer a slower death, one that’s expected, that will let me revisit my life for a last goodbye.”

How do you want to die? You must think about it.

Buñuel was clear about how he didn’t want to die. “I’m not afraid of death. I’m afraid of dying alone in a hotel room, with my bags open and a shooting script on the night table. I must know whose fingers will close my eyes.”

“An even more horrible death,” he wrote, “is one that’s kept at bay by the miracles of modern medicine, a death that never ends. In the name of Hippocrates, doctors have invented the most exquisite form of torture ever known to man: survival.”

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. I think of the death as an incompetent carpenter trying to get a table level, sawing something of one leg, then the next, and eventually ending with the table on the floor.

Buñuel died of pancreatic cancer in Mexico City in 1983. He spent his last week discussing theology with a Jesuit brother.

His long time friend and collaborator, Jean-Claude Carrière, wrote: “Luis waited for death for a long time, like a good Spaniard, and when he died he was ready. His relationship with death was like that one has with a woman. He felt the love, hate, tenderness, ironical detachment of a long relationship, and he didn’t want to miss the last encounter, the moment of union. ‘I hope I will die alive,’ he told me. At the end it was as he had wished. His last words were ‘I’m dying’.”

Will you be ready? Will I be ready?

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. Suicide, assisted or otherwise, is a fifth, but I’m leaving that on one side for now.

I often ask audiences how they want to die, and most people chose sudden death. “That may be OK for you,” I say, “but it may be very tough on those around you, particularly if you leave an important relationship wounded and unhealed. If you want to die suddenly, live every day as your last, making sure that all important relationships are in good shape, your affairs are in order, and instructions for your funeral neatly typed and in a top draw—or perhaps better on Facebook.”

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, 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.

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.

Richard Smith was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly 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.

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

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  • Peter Brown

    If you think logically about what Richard has written here there is a lot of logic in what he says. Perhaps the money spent on cancer research would be better spent on things we can control like making sure everyone on this planet gets enough food and clean water each day to survive. From personal experience I can say that not having the chance to say goodbye to one of my family members is the single hardest thing that I have had to cope with in my 50 odd years. While I understand its very hard when young people especially children get terminal cancer, the reality is they could have been a car accident victim or a drowning victim, we just never know.I am a great believer in fate and I feel the world today is fighting to hard against things we really have no control over and our energy would be better spent just going with the flow. Bottom line is this, when your numbers up, its up, no matter how sad that might be.

  • Janet Freeman-Daily

    As a metastatic lung cancer patient, who has networked with many other lung cancer patients, I’ve thought a lot about my impending death. Death from lung cancer is rarely the idyllic experience you describe. The majority of patients are diagnosed when the disease has spread to the brain or other organs. Lung cancer sometime claims patients before they realize they’re dying, before they’ve had those important discussions with family or raised their children, before they’ve even conceived children or finished college. Many lose the ability to do what they love, control their pain, communicate with loved ones, or think clearly. Most will
    eventually find themselves dependent on others for their basic needs, placing an enormous emotional, financial and time burden on loved ones. This is not the scenario I would prefer.

    Few of us know for certain how our end will come, and no amount of preparation can guarantee that our loved ones will cope well when faced with our death. I have cared for an elder who died of dementia after a decade, seen people struck down in their prime by heart disease or stroke, known people who daily cope with unrelieved pain, and lost friends to accidents. If I had my druthers, I
    would rather live each day with full awareness, do and say what’s important while I can, and go quickly with my full faculties while enjoying life and my loved ones.

  • Kay

    How DARE he say this, my daughter died at 37 of triple negative breast cancer, 7 weeks after diagnosis and this is a preferable way to die!!!!! What about her 2 children aged 2 & 4, this is good for them in what way please tell me. I am appalled at this mans statements especially in his position. Why is this garbage being reported I hope me and my family never cross his path.

  • Lucy Telfar Barnard

    Dr Smith, I can see your argument for why some people might choose to die of cancer in preference to other ways of death. Implicit in that, though, is the idea that our death would happen at the same time regardless of how we die. If you’re dying at 83, cancer may not be a bad option. But for the many, many people who die of cancer at a much younger age than they would have died if cancer were curable, saying “let’s stop wasting billions trying to cure cancer” is a cruelty. If your choice is not “you’re going to die some time over the age of 75, would you rather leave in a hurry or have time to say goodbye to friends first” but rather “you can die of cancer at 25 and say goodbye to friends first, or depart in a hurry from heart attack at 75”, your answer is likely going to be very different.
    We can argue about other life shortening diseases and which ones cause the most YLL and so which ones most deserve billions being spent on them, but the simple argument that curing cancer would affect only how we die, not when we die, is false.

  • Dr. Smith:

    In referring to cancer as “the best death” and referencing “love, morphine, and whiskey” you far too glibly gloss over the terrible pain – both physical and psycholigical – associated with cancer.

    My 36 year old brother died after a four year battle with Ewing’s Sarcoma and endured unimaginable pain and suffering, which I won’t detail here out of respect for his privacy.

    While he did enjoy a trip across the US while in remission, and while we got to say our goodbyes during several weeks while he was bed-ridden prior to his death, it was hardly “the best death.” It was horrendous, and your turns of phrase border on the callous and heartless.

    Lest you think the multiple treatments my brother endured prove your point, they were his choice, not the machinations of over-zealous oncologists.

    He was an athletic and fit 32 year old teacher and coach looking forward to a summer on the golf course when he was diagnosed.

    He wanted to live, and he did everything in his power to beat cancer and live as long as possible.

    From my perspective, I can’t begin to tell you how difficult it was to wait for your sibling to die; you simultaneously want him to live, but you also want him to die so he won’t suffer anymore. (I’m also currently watching a family member deep in the throes of dementia.)

    Leaving aside the question of whether comparing different forms of death is even germane to your fundamental argument about determining when overzealous treatment meets diminishing returns, I can assure you that people with cancer and their familes don’t deserve to see cancer described as “the best death”.

    One would rightfully expect greater sensitivity from the British Medical Journal and its former long-time editor who happens to be a Medical Doctor.

    Yours sincerely,
    Mike Broderick

  • J. Lock

    Dr Smith has clearly lost his mind. If he so chooses he may wish to be taken by this disgusting disease. However, having watched someone being slowly eaten away by prolific cancer cells, I would suggest that he has his head examined. Let him see a loved one die of starvation and dehydration as they can no longer swallow. Let him suffer with knowing his loved one faced the lack of dignity as Macmillan nurses talked about them as if they were an inanimate object. Let him face the idea that a loved one has been ripped from life at a young age. I would say the best way to die is from old age. I would suggest this professor has no understanding. As a scientist he should know that it is best to reflect every day. Reflection is not something to save for the end as there is no way to progress as a human being if you do this. Apologies for the ridiculous claim will be considered as and when it is given.

  • Simonette Boele

    YES I so agree! Of cause it is painful to loose an other person, no matter in what way. But in the context of all possible ways of dying, cancer really seems one of the better options. Ask anyone who has had a heart attack about the fear that accompanies the attack to know that not all quick deaths are good deaths. What about dementia or muscular dystrophy where one looses faculties one by one. Talk to anyone who has lost a parent to dementia about the feeling of “loosing ” the parent even before they die – a slow fading of the person themselves. Even the proverbial “dying of old age” is now proceeded by months or years of living increasingly being propped up by medication to achieve what? Live another day…and another day… to be able to get to the commode at the end of the bed?
    I much prefer to die with my faculties intact, being myself to the end. I put all my faith in good palliative care.
    I was diagnosed with cancer and am grateful that I have cancer rather then dementia. It has increased my joy of life as I am now part of the exclusive club of people who truly know that life will end and the only possible insurance is to enjoy the moment.
    I do acknowledge though that it is far easier for me to live with my cancer then it is for my husband and daughters to live with my cancer.

  • Amelie Framboise

    I think this is a fantastic view and opinion made by Dr Richard Smith. He is right. Cancer as a disease gives time to the patients to put their lives in order, do the last minute paper work and to come to terms with the fate that one faces ie death.
    Yes it may be painful but as he says there is love. whisky and morphine to provide comfort. How true. When you see what chemotherapy and radiotherapy does to an individual one wonders if all that is really worth the effort just to have a further 2 weeks of a miserable existence. Instead of becoming emotional and criticising what he has said, we need to actually look at the reality and think differently. Quite often we try and bring in emotive arguments and get really upset when such comments are made.
    Millions and billions of dollars are spent each year for research into cancer. Yet the cute is still very elusive. What we do is buy time, but time that is fraught with misery, dysfunction and terrible side effects of chemotherapy or radiotherapy.
    As a species, humans have become more successful at prolonging life, overpopulating this planet at the cost of making other species extinct, devouring natural resources and raping mother nature and generating an imbalance.
    If we dont bring back that balance we will annihilate our entire species. Just look around and what the imbalances have caused – wars, natural disasters, disease epidemics ( even H1N1 ie swine flu is not allowed to work its evil way because we have technology to keep people alive)
    We are just trying to defy nature that is working extremely hard to try and reestablish the balance.
    I think Dr. Richard Smith is right . We should stop researching into cancer and accept Cancer as a biological mishap. We should stop trying to cure Cancer at any cost. With advanced Cancer and those that have no meaningful treatment we need to follow the course of comfort care.
    This is NOT a romantic view of dying BUT a very PRACTICAL and logical approach.

  • Paul Anderson

    Sir, your comments have left me to question your expertise with cancer. I have seen someone die from cancer, and palliative care only goes so far. I think your belief is rooted more in some romantic Victorian notion of death than in medical reality.

  • Paul Anderson

    Palliative care is imperfect, and a death from cancer still entails great suffering. Romanticising it is crass and ignores the reality of the disease.

  • MM

    Cancer is not the worst way to die, but it has become the diagnosis we fear most, possibly because other causes of death are not usually delivered to us with the same terminal prognosis. We are frightened of dying, and cancer is the disease that makes people in the developed world think about death the most. The language of cancer charities is about fighting, stamping out and defeating cancer, but it is totally reasonable that we stop and think about what we would be left with if cancer could be stamped out. What would be the next battle: old age?

    I am not talking from callousness, my husband died of cancer two years ago leaving me alone with two teenage children, but this trade in fear makes me angry. With acceptance and good palliative care, death from cancer can be peaceful and comfortable, planned and free from trauma, both for the patient and for their loved ones.

  • Ben M

    Many people who die of cancer die in excruciating pain and fear. Their death, when it comes, is the culmination of a dying process which may have lasted months or years and stripped them of their physical, emotional and spiritual dignity and well-being. Cancer patients are also forced to witness the suffering and helplessness of those who love them. Richard Smith posits a sepia-tinted alternative vision (whisky helps, apparently) and then shruggingly admits his is a ‘romantic’ view of the process. It is hard to say which of his comments – the fantastic or the flippant – is more despicable.

    That one might regard the experience as having some compensations if handled with bravery, and that one might wish to support cancer sufferers in finding a way to understand and cope with their illness, is not a reason to ‘stop wasting money trying to cure’ cancer. It is absurd one should have to write such a sentence. That it includes a direct quotation from someone with a public platform on this issue is shocking.

    There can be little doubt that an acceptance and awareness of mortality is a crucial part of an examined life. One cost of a sudden death is that it forbids the individual an opportunity for that kind of psychological or spiritual work. (We cannot know if it forbids epiphany.) But this is not a basis on which to make judgements about better or worse ways to die. Any such judgement, if it is to be made at all, is to be made with care, subtlety and humility.

    If the search for a cure is a ‘waste’ of money, it is not because dying of cancer ain’t so bad. Arguments against the occasionally disingenuous use of the language of cure – and in favour of a more pragmatic, or more philosophical recognition of death’s inevitability – can be made better than this. That is to say, they can be made without a shoulder-shrugging attitude towards basic medical ethics, and without rank insults to the dead, the dying, and their families.

  • Sandy

    We will all die: FACT. Most of us do not choose how that will be. Dr Smith has beautifully described a condition that gives time to deal with whatever wants or demons that we have. If cancer is seen as painful then the medial care has failed. Morphine is such a wonderful drug and yet in the palliative care situation there are still idiots who worry that the patient will become addicted.
    When it comes to chemotherapy, the life gained is probably spent in hospital rather than with family….so why bother?? Do patients really make an informed choice as to side effects and possible response rates…..and is cure, or for the most part, lack of cure mentioned.
    So I agree with Dr Smith why bother wasting Billions when the outcome will be the same.
    Conflict of interest: retired surgeon and pharmaceutical physician

  • Ben M

    Many people who die of cancer die in excruciating pain and fear. Their death, when it comes, is the culmination of a dying process which may have lasted months or years and stripped them of their physical, emotional and spiritual dignity and well-being. Cancer patients are also forced to witness the suffering and helplessness of those who love them. Richard Smith posits a sepia-tinted alternative vision (whisky helps, apparently) and then shruggingly admits his is a ‘romantic’ view of the process. It is hard to say which of his comments – the fantastic or the flippant – is more despicable.

    That one might regard the experience as having some compensations if handled with bravery, and that one might wish to support cancer sufferers in finding a way to understand and cope with their illness, is not a reason to ‘stop wasting money trying to cure’ cancer. It is absurd one should have to write such a sentence. That it includes a direct quotation from someone with a public platform on this issue is shocking.

    There can be little doubt that an acceptance and awareness of mortality is a crucial part of an examined life. One cost of a sudden death is that it forbids the individual an opportunity for that kind of psychological or spiritual work. (We cannot know if it forbids epiphany.) But this is not a basis on which to make judgements about better or worse ways to die. Any such judgement, if it is to be made at all, is to be made with care, subtlety and humility.

    If the search for a cure is a ‘waste’ of money, it is not because dying of cancer ain’t so bad. Arguments against the occasionally disingenuous use of the language of cure – and in favour of a more pragmatic, or more philosophical recognition of death’s inevitability – can be made better than this. That is to say, they can be made without a shoulder-shrugging attitude towards basic medical ethics, and without rank insults to the dead, the dying, and their families.

  • Reg

    Im interested by the may negative and sometimes vitriolic comments left for Dr Smith following his candid views on death. I can understand anyone watching a dear one dying from cancer may well experience a negative reaction to the idea that cancer is a blessing. Consider the alternatives.

    Ive rarely seen the living death of dementia go well. I have seen the fixed expressions of agony remaining on the faces of those who have suffered an unexpected demise.

    We are all going to die. More and more of us from cancer.

    I have seen good deaths from cancer with time for loving farewells and profound reflections on life that have enriched everyone.

    I hope I die from cancer.

  • Saddened by this

    I cannot understand why or how you would say something like this. I am sure that you have had no dealings with anyone who may have or may be, dying of cancer. To see your loved one fade from the person they were to the person they become because of the cancer is not something that anyone would want for their worst enemy. I understand your sentiments in being able to say the things that you want or need to, before they die, but believe me, I would have much preferred to be having the run of the mill conversations with my mum rather than the conversations we had about her dying, my life after her death and all that comes with it. You say that Buñuel had the death they wanted, how close were you to this person? Were they of your flesh and blood? I don’t think so. Whilst I don’t wish this on you, I do hope that you are able to change your opinion at some stage, albeit that you have to go through the “process” that so many people on here and in life have gone through, in the loss of a loved one.

  • Kimberley Unsworth

    You seem to be one of the very few unaffected by cancer. I am was diagnosed with secondary cancer last year aged 30. Do you think that I should be grateful that this is the way I will die? No! I have 2 young children that need their mother & thanks to the research & money put into it my cancer has almost been eradicated and my oncologist is planning a very long life for me. I think your comments are disgusting, insensitive and down right arrogant.

    How insensitive?! | Kicking Cancers Butt Blog
    http://kickingcancersbuttblog.wordpress.com/2015/01/02/how-insensitive/

  • Hannah

    I hope people reading this realise it reflects the opinions of the author only, and not “British Medics” in general.

  • Phill Richards

    Dr Richard Smith should look at what people are going though! Not base it on an old fashioned belief that because he has a qualification he can decide what direction my life will take. Take my pain my disabilities for a month and tell me what you want in life then?

  • Phill Richards

    My mother was diagnosed with acute leukaemia and was told that she has 3 weeks. She was so weak at this point that she could not put any of her affairs in order. They moved her to a palliative care home. The sister there asked if it was the same woman she had seen 2 days earlier because of the deterioration of her health. I saw a ruddy faced mother go to a yellow skeleton pass away in fear and pain. Maybe a little more research would of eased this.
    My Father also died from leukaemia but non of the doctors think this unusual?

  • Magda Litha

    Either this ‘doctor’ is a cyborg/clone (they’re everwhere, no kidding), he’s being set up or this is the medical mafia now openly laughing at the decades-long billions raked in by the terminally-ill public and its loved ones. After all, chemotherapy is known to kill more cancer victims than the actual disease itself.
    Remember, if Smith’s been editor of the BSJ and currently sits on various boards, he will already have sold his soul to the medical devils. So he could well have done something to pee his superiors off.
    Those who know more of the inner workings behind the scenes: it would be great if you could comment about him. As this entire article smacks of something else motivating it.

  • Beth Gainer
  • RunRichRun

    Controversial, absolutely. Putting death in the conversation is important; more people have strong opinions than express them. See “The Conversation Project” http://theconversationproject.org/

  • Hi Mr. Faigl:
    Thanks for your reply. I must respectfully disagree with you if you feel my response amounts to political correctness, over-sensitivity, or squeamishness about talking about death.

    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.

    He admits to romanticizing death (by cancer), claiming it can be “achieved through love, morphine, and whiskey,” but this simply isn’t true.

    Perhaps worst of all he posits that we should do away with all cancer research without a single shred of evidence.

    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.

    He does all of this in an attempt to buttress a very feeble and poorly presented argument – all while needlessly causing distress to many of us personally touched by cancer.

    In describing cancer as the “best death,” he belittles what many people with cancer and their families endure. (And to what end? It also contradicts his supposed argument. It’s just nonsense.)

    While I agree that doctors are required to have a professional detachment concerning death, we also expect them to have a good bedside manner and “to do know harm”.

    I would say, that in terms of this article, he has failed miserably.

  • Maha

    I reject what you wrote. Cancer death is one of the most auwful deaths out there. Life is slowly sucked out of each cell while you and all around you painfully feel it!
    I lost my brother 3 years back to lung cancer. He was 24 only and I was 31 when I sat beside him every day seeing how he screams of pain and cries out of hopelessness. I am still seeing nightmares. Now I am 34 and almost every night I cry like a child !
    Your words hurt my feelings !

  • susanne stevens

    I don’t like whisky and won’t be able to get hold of morphine, there may not be anybody left to love me by the end I doubt very much whether I will be ruminating on the ‘wise’ words of of intellectuals Moreover the time for ‘reflection’ is whilst we are alive enough to do something about it. The campaigns around ‘death and dying’ and against ‘over diagnosis’ are scary when the end of life is so dominated by the medical profession

  • Steve

    Thankyou Dr Smith, a breath of fresh air. I agree so much with your views. No one lives forever and having a constructive view on exit is wonderful.
    Morphine and Whisky ! Prefer coke, but if it works.
    Thanks for your view’s and a happy new year.

  • FREEDOMBELL

    This doctor’s turns of phrase are callous and heartless. What a monstrosity!

  • Annemarie Jutel

    There are a number of salient points in this blog post. The first is that a diagnosis of cancer is a powerful one. We know much about the terror it reaps, the powerful impact it has on the patient, and his or her family. But it also offers something which both patient and doctor often fail to consider (and which Richard Smith brings to our attention): a chance to reflect upon mortality in a measured way, time to either say good-bye or prepare to meet one’s maker. (Living with terminal disease is never easy, regardless of what that disease might be; readers may be interested in Havi Carel’s incredible book “Illness” which describes a way through). As a sociologist of diagnosis, however, I would suggest that Richard Smith errs in assigning such clean and tidy boundaries to the diseases he names and the ways in which one can die. “Cancer” is many diseases, with myriad outcomes. I can also think of a few more ways to go. We will all, ultimately die of multi-organ failure. It just doesn’t have to be in the ICU. I think this blog post thus begs the questions: how do we support death and dying in our respective countries?, why do we apprehend it so?, and does medicine, in its attempt to vanquish death, go too far?

  • Janet Freeman-Daily

    Amelie Framboise.

    You want facts instead of emotion? FACT: The majority of people who die of metastatic cancer are NOT given the option to receive pain medication such as morphine. Death by cancer HURTS: tumors can gradually cut off your air supply, compress your heart so it can’t beat properly, block your gut so you can’t eat, erode your bones, press on nerves, or destroy bits of your brain so you can’t control your body or think properly. That’s not emotion. That’s fact. “Among patients with terminal cancer, 80% are estimated to experience moderate to severe pain due to inequitable access to medicine.”
    http://www.esmo.org/content/download/14123/252826/file/Global-Access-to-Pain-Relief-Evidence-for-Action.pdf

    In contrast, thanks to medical research, my metastatic cancer has been under control (No Evidence of Disease) for two years and counting, giving me more time to help my autistic son learn to live independently without becoming a burden on society.

    Or do you think people with disabilities also should, like cancer patients, be allowed to die unaided to help reduce overpopulation?

  • Jose R. Borbolla, MD

    As someone who practiced malignant hematology for more that 15 years: basically acute leukemias, myeloma and Hematopoietic SC transplant, I have mixed feelings about Dr. Smith´s comments. While I appreciate that some patients may die “comfortably”, some others clearly do not. I believe the true spirit of his comments will be better understood if taken with “as compared with……” that is…the mean elderly patient with a slow-progressing tumor, is the one probably fitting Dr Smith´s definition, and in those cases I agree with him…..it is clearly better than for example COPD….. anyway…..an interesting and utterly useless digression.

  • Uzma Yunus
  • Uzma Yunus

    As a physician and cancer survivor, I am disappointed that BMJ would allow such inappropriate content. This article has caused extreme emotional pain to the loved ones of those that died of cancer. Dr. Smith, as a physician it is entirely irresponsible to make such conclusions.

  • Chris Winters

    Richard, You are misguided in your analysis. I am a pancreatic cancer sufferer with very little hope of any cure. I’ve lived with this for a year of constant chemotherapy, radiotherapy and failed surgery. The agony that my family has suffered throughout this has been near unbearable – I think as unbearable as my sudden death may have caused, and certainly more prolonged as I suspect that when the day comes they will feel just as bereaved regardless of the way I eventually pass away; I certainly did when my parents died even though I knew full well it was coming. It has not been a bed of roses revisiting favourite poetry and places as you suggest. Your view is perhaps romantic; I would suggest it is totally unrealistic. I sincerely hope that you (and no one else for that matter) has to die prematurely from cancer. I’m 56 and I think that’s a little early to be constantly considering my mortality. I fear leaving my family and I suspect I would fear that whichever way I go the pain will be much the same for them.

  • Rodrigo Lima

    Dr. Smith,

    Thank you for writing such an amazing text. I would only disagree in one thing: better than fading away with cancer, maybe suicide is the best death. People can call it “euthanasia” if they feel more confortable, but I think our societies aren’t ready even to discuss with this terminology. When everything was prepared, and before the arriving of all the suffering described by so many people here, I would love to choose my time to leave this place.

  • Sue Tilley

    Is this doctor living in a make believe fairy tale! My father died from brain cancer. He battled for five years. For the last two he was bedridden. He then suffered with pneumonia followed by a stroke ( which by the way the doctor didn’t even notice!) so I am well aware that a lot of doctors talk drivel, including you. My father didn’t have any nice conversation saying goodbye because the stroke affected his speech, his death and experience of cancer was horrendous. I hope you never have to encounter cancer with a close relative, however it may make you realise how awful it is.

  • seangee600

    This is one man’s perspective and I for one consider it a valid one. It is easy to get emotional about cancer – particularly in the case of the young, but I really don’t get the impression that that was what Dr Smith was referring to.

    Many of the responses site elderly patients who died within weeks or months of diagnosis.

    Consider someone whose partner in their 60s has late stage dementia. At that point the mind has already gone – but the patient may live (if we choose to call it life) for another 20 or more years. How that person must envy those family members who only had to endure a few months of suffering.

  • Humanoid

    I think “Best Death” thesis is not a good argument against cancer research. And I would rather call these scientists modern time heroes than overambitious oncologists.

  • Sandy

    I am amazed at the negativity by virtually all those posting here. No matter what we will all die. Admittedly for some it will be earlier than others. Logic dictates that if someone has a terminal disease, then they should be treated humanely and given whatever drugs (morphine and whisky sound good to me too) to keep discomfort and pain away. Based on the experiences noted in other blogs there is a need for universal access to good palliative care. I would suggest that this is a better investment than “fighting” the inevitable demise with grossly expensive and ultimately ineffective cancer drugs.

  • Kerry Johnson

    Congratulations Richard Smith for having the insight to assess things as they are and the courage to publish as you see it.
    Please disregard the petty, carping comments of those commentators who do not have the good grace to give due consideration to your insights.
    As a multiple cancer “sufferer” undergoing chemotherapy I offer my take on cancer for what it may be worth.

    A Frailty of Spirit – an explanation of cancer.

    Cancer is not a
    disease of the physical organism.

    It is a genetic
    predisposition at the cellular level to evolve.

    It is an inbuilt
    imperative to evolve.

    The dis-ease lies
    within our own psychic and spiritual development.

    This development
    does not rise to meet the evolutionary intelligence inherent in our cells.

    Therefore, the
    answer to dealing with this rampant dis-ease in the physical organism must be
    sought in our individual and collective psycho/spiritual organism.

  • dodobird

    I think he was on morphine and whisky when he wrote this.

  • AMinCAD

    I don’t even know where to start. Words fail to express what I think and feel when reading this.

    I am 43. I have a six year old daughter. I also have metastatic
    breast cancer. It is incurable. 60-70% of women in my situation die within 5 years, average life expectancy is 2-3 years.

    I’m sure my daughter and husband highly appreciate the fact that
    I will have time to say my goodbyes. Never mind the fact that leaving a child her age behind is the hardest thing a mother can be forced to do.

    I am also wholly convinced that if you had the ability to put
    yourself into my shoes, you would be all dandy with the situation, ponder mortality in general and accept the fact that we all have to die one day – just a bit earlier, in my case, but according to your logic, hey, that’s ok I suppose…

    To expect me to accept a discontinuation of research that is
    trying to prolong my life maybe a couple of months or a year, to help me see my daughter grow up a little longer – this is outside of enough. I will likely die a painful, degrading, horrible death. Let me tell you: I have no intent whatsoever to speed up the process of getting there.

    And yes, I DO hope that one day – hopefully during my lifetime –
    they will find a cure.

    You can have my cancer, really, and welcome to it. I’d rather
    spend some more years with my kid. You know: see her finish school (which she only just started), and the like…

    What you write is hurtful, callous and incredibly insensitive to
    all those suffering from this sickness, to all those that currently care for loved ones that suffer and die from it, and to all those who have lost (slowly, though!) loved ones to it.

    I have to wonder whether the reason for your publishing this
    piece of infamy is a quest for short-lived “fame”. If that is it,
    then I pity you – and freely admit I should never have written this comment.

  • Chiffon

    I have had cancer. I always said its best to know ahead. Sudden death leaves everyone hanging. I want to know so i can tie up loose strings. Yes some cancers are very painful. We must know when to not treat but allow a decent exit. It can be done most of the time i feel. As pain meds can help. Its so often families that cant let go and the pt hangs on enduring terrible pain and suffering because they know family cant let go, i for one will take pain meds write my letters. And go on.

  • EMoonTX

    Each person defines what they think of as the “best” and “worst” death for themselves…it is sheer arrogance for someone else to tell them what’s best.

    More importantly, it’s not something individuals get to choose off a cafeteria display of deaths…death comes when and as it comes, and that is what the individual (and the individual’s family) has to deal with. So lecturing people about what death they should prefer–with the implication that they could choose–is cruel as well as arrogant.

    Richard Smith is entitled to consider his own death by cancer ideal, should that be his end, but he is wrong to push that opinion on others.

  • Lysa Buonanno

    As someone living with cancer, and have lost many friends to cancer, this is a horrible death I would not wish on anyone. Some may go quickly and peacefully but most do not. Losing your hair, your body wasting away down to a fraction of your normal weight, not being able to eat, breathe well, or do anything that used to bring you joy. Your family: parents, children and spouses watching you suffer and deteriorate…….ya, that’s a great way to go. I’m going to assume this man has never experienced losing a loved one to cancer. His naive and ignorant statements are shameful.

  • Katy

    I am saddened by the assumption that there are no good natural deaths. My father passed away peacefully in the very early morning while saying his rosary. My great grandmother passed away in a similar manner, after sitting down to get a rest after doing the morning dishes. Both were a surprise though not a shock, due to their ages. How could these not be examples of the best way to die? Is this simply because no doctor need have attended these people, and our author cannot conceive of such a thing?

  • MichiGan

    Why the heck do you need cancer to die with “love, morphine and whisky?” Head injury?Take love, morphine and whisky. Ebola? Take love, morphine and whisky. Diabetes? Take love, morphine and whisky. Dementia? Take love, morphine and whisky!

    What an idiotic blog post!

  • MichiGan

    By your argument, it’s time to shut down all the hospitals and doctor’s offices. Why care, if when your number is up, it’s up?

  • MichiGan

    Why do you need cancer to die of “love, morphine and whisky?”

  • Thank you for your measured and seasoned response, Mike. I wholeheartedly agree with every word you have written, as I helped nurse my grandmother with spinal cancer in 1996. Her doctors and us could never get her pain under control and she suffered greatly – far more than any human should have to. Has Dr. Smith never seen a cancer patient in the throes of unimaginable pain?

    He seems to have simplified something that is really quite complicated, and while he tells the story of Buñuel’s supposed good death (and yes, good deaths are possible), surely his career is peppered with people who have endured horrific suffering due to cancer?

    I am now a practicing death midwife and spiritual carer, and I just cannot fathom how Dr. Smith has come to this brash conclusion. Mike, I wish you nothing but peace. You sound like an exemplary human being.

  • Couldn’t have said it better myself, Paul.

  • Clive Bowman

    Nearly clever but a fail.

    Richard you recognise life trajectories but in focussing on Cancer you distract from the reality that the final cause of death is almost certainly less important than the journey travelled and hence the distressed response to this blog.

    The point you are making is about wanting to retain control and having some degree of certainty and understanding. The flip of that is avoiding frightening aspects of dying such as loss of control, pain, distress isolation and crucially uncertainty (which individually or collectively are key to the fractious debate on assisted suicide) .

    The clarity of transition for many cancer patients to palliative care whilst clearly distressing does introduce a new if unwelcome certainty. This is what is missing from the experience of the growing population of people who are experiencing “progressive dwindling” from degenerative diseases such as Alzheimer’s.

    The bit you have failed to articulate is the inadequacy of present medical and social care models to support “dwindlers” We developed the concept of Formative Care in a JRSM piece last year that focussed on developing a medical purpose (?leadership) for care and support that could bring a certainty to uncertainty that may achieve the same as palliative care has succeeded so well in achieving in cancer.

  • Jana Mae

    I find it interesting that a comment I posted last night, which questions the use of expensive cancer meds and their effect on quality of life, has been deleted. Does this mean if we don’t post what is the consensus, it is not allowed?

  • Cadigan

    Tell you what, Richard Smith––you can trade places with me and die of *my* cancer, and I’ll happily embarrass myself by falling downstairs and breaking my neck at my 101st birthday party, which was what I had in mind for myself.

    Don’t talk about what you don’t know.

  • Siem De Cleyn

    Dear dr. Richard Smith,

    Death is a topic that affect us all. That’s what makes it such a sensitive topic, that’s what makes it such an interesting topic.

    I would say I can agree with your arguments. I don’t agree with your conclusion.

    I immediately thought about euthanasia. That has probably something to do with my background: I’m a medicine student in Belgium. The things you see as important when dying (to be able to say goodbye, not having to suffer, not erasing slowly), are the reasons why some people choose for euthanasia.

    If ever I’m in a position to choose between a death from cancer or a death by euthanasia, I will be glad to live in a country that lets me choose.

  • Jo

    So much misinterpretation of this piece across mainstream media, it’s stunning. Note how he doesn’t write: let’s stop spending money on researching possible cures for cancers, but that’s how this is being rolled out across so many media outlets.

    Every year, billions are being spent on treating people with cancer. Some will be cured, others will at least have their lives prolonged to watch their children grow up a little while longer.

    For many, and this is the taboo Mr Smith touches on, their cancer treatment will involve gruelling treatment that are no better or worse than the original symptoms from cancer, and they will not be cured at the end of it, they will merely have their overall suffering prolonged.

    You may believe that one should try everything and anything in an effort to cure someone’s cancer, that the suffering on the way there will be worth it and that even if there’s only a ten percent chance of survival, you should grab that opportunity at all cost.

    Or you may believe that, on at least some occasions, it might be better treat just the symptoms and make the patient comfortable until his or her death from the cancer.

    From both personal and professional experience I know there are patients who favour the latter, with oncologists who insist on the former. Those patients then have to almost go into battle with their oncologists, because while they are perfectly in their rights to refuse the cancer treatment, they then don’t get the palliative care that would benefit them.

    Most patients, however, will blindly follow their oncologists’ advice and if those oncologists are indeed ambitious this will then mean gruelling treatment after treatment in trying to cure their cancer, when they might be better off with palliative care.

    That is indeed wasting billions trying to cure cancer while in fact leading patients to a more horrible death. And I do agree we should stop doing that. That’s not calling for pulling any plugs on research into cures for cancer, it’s calling for more human care rather than unlikely medical cures.

  • goopeez

    You have to be a special kind of crazy to attempt to quantify human suffering.
    I invite you Mr. Smith to spend time in our lung cancer support groups. Groups that provide comfort & support from the traumatic moment we are told “You have lung cancer”, through grueling treatments, the never ending side effects, the rollercoaster of hopes & fears, the caregivers heartbreak of powerlessness, and to what sometimes ends in painful tragic death. Our Grief group.
    Expected or Unexpected…cancer can… be the worst way to not only die…it can transform what precious time we have left into a living hell and be an agonizing way to live. Especially when the most rampant of all cancers -lung cancer-is treated with disdain & disregard, causing those suffering to spend their “bonus time” fighting for compassion & support that is so often denied those affected by lung cancer …only to die a shame filled, unregaled death. Imagine the comparable “trauma” of those left behind that are forced to defend their deceased’s dignity at the gravesite & for years after when assaulted with “Did they Smoke”? Imagine fighting , suffering while you & your loved ones are forced to bear a mark of disgrace & at every turn must explain & defend WHY you have your disease. Sound like a day at the beach Mr. Smith? Think this affords lung cancer patients all those warm fuzzy moments to “resolve” all their affairs.? Many spend their dying breath fighting for equal recognition & support.
    Yes, Mr. Smith come witness how people living with & dying from lung cancer fight to enjoy every precious breath, every moment with their loved ones, as some watch their lives slip away. Come see how “tranquil & easy” it is to have your body ravaged with this disease… while society blames you for it. Come see how even in death the filthy black Smokers Stigma follows victims of this merciless cancer into their grave. That oughta “cure” You, Mr.Smith, of your delusional romantic notions of how easy it is to roll over & die from cancer. Betsy Thompson

  • Leala Ruland

    Wow, I’m kind of blown away at the nature of everyone’s responses to this blog. It’s not a personal affront or attack or belittling of anyone’s loved ones or the suffering they’ve endured. To take this doctor’s blog personally & to
    become defensive & angry about what he has written is, to me a grossly missed opportunity to reflect on life & what we cherish most. It’s not personal & at the same time it is universally personal. Yes, we are all going to die & no, most people are not okay with that. We cling, attach & hold onto everything in our lives & we see death as a kind of ultimate betrayal of life. But death is not about life betraying us, death is the reminder of how fleeting & impermanent & therefore full of possibility life is; death affirms life! Yes, we suffer, we watch those we love suffer & our suffering multiplies exponentially but to ask that life be a plateau of endless sunshine, to rid ourselves of the light affirming darkness is to say ‘no’ to life & it’s complexity. At marriage ceremonies people do not say “For better…in riches..in health…till death do us part”, if that’s all people cared about what would be the point of a commitment? In the Same manner, we have made a commitment to life & with that commitment comes the acceptance, or fight, of our imminent death. The doctor is not here insulting your pain, he is simply suggesting that in the face of our most harrowing fears there isbeauty & the opportunity for resolution with those we love before our time is over.

  • goopeez

    “You have to be a special kind of crazy to attempt to quantify human suffering.
    I invite you Mr. Smith to spend time in our lung cancer support groups. Groups that provide comfort & support from the traumatic moment we are told “You have lung cancer”, through grueling treatments, the never ending side effects, the rollercoaster of hopes & fears, the caregivers heartbreak of powerlessness, and to what sometimes ends in painful tragic death.Our grief group.
    Expected or Unexpected…cancer can be the worst way to not only die…it can transform what precious time we have left into a living hell and be an agonizing way to live. Especially when the most rampant of all cancers -lung cancer-is treated with disdain & disregard, causing those suffering to spend their alleged “bonus time” fighting for compassion & support that is so often denied those affected by lung cancer …only to die a shame filled, unregaled death. Imagine the comparable “trauma” of those left behind that are forced to defend their deceased’s dignity at the gravesite & for years after when assaulted with “Did they Smoke”? Imagine fighting , suffering while you & your loved ones are forced to bear a mark of disgrace & at every turn must explain & defend WHY you have your disease. Sound like a day at the beach Mr. Smith? Think this affords lung cancer patients all those warm fuzzy moments to “resolve” all their affairs. Many spend their dying breath fighting for equal recognition & support.
    Yes, Mr. Smith , come witness how people living with & dying from lung cancer fight to enjoy every precious breath, every moment with their loved ones, as some watch their lives slip away. Come see how “tranquil & easy” it is to have your body ravaged with this disease… while society blames you for it. Come see how even in death the filthy black Smokers Stigma follows innocent victims of this merciless cancer into their grave. That oughta “cure” You, Mr.Smith, of your delusional romantic notions of how easy it is to roll over & die from cancer. Betsy Thompson

  • kris

    This guy is an idiot I just watch my grandfather pass away this past November from throat cancer and it was the worst thing I have ever witnessed it is not the best way to die it is by far the worst the image of my grandfather on his death bed will forever haunt me the way he suffered and fought to hang on and wasted away to nothing it is something that I never want to go through again. This doctor or even if you can call him that clearly has nothing to back up his claim and has obviously never watched someone he loves die from this or just to heartless to care

  • Tammy Jenkins Buchanan

    As a mother of a 2 year old child who was diagnosed with a hard to treat type of cancer, I am highly offended by Dr. Smith’s viewpoint. Pediatric cancer is the leading cause of death by disease for children in developed nations. Research for a cure is imperative and should be a national priority. Immune therapy and personalized targeted chemotherapy need to be developed, especially for children. Children do not need the luxury of time to heal relationships, say their goodbyes, and explore the idea of repentance to attain eternal life while being half lucid from dilaudid. Another important point is that cancer pain is not relieved with narcotics completely. I have personal experience, as do many people leaving comments here, that cancer is NOT a good way to die.
    More people should live as if they will be passing tomorrow. Imagine how rich lives would be if we repaired relationships every day, as opposed to waiting till we have a diagnosis with a poor prognosis. I am left with the opinion that Dr. Smith is a person who does not wish to put fort effort into have a richly blessed personal life. Instead he wishes to have a few weeks at the end of his life to try to repair a lifetime of being a bad father, husband, friend, etc. The poor guy should not try to impose his issues on the rest of us and he should never, ever, try to convince anyone that more research to cure cancer is a bad idea.

  • Tammy Jenkins Buchanan

    Leda, I am terribly sorry about your diagnosis. I believe that a cure would be in your best interest. My 2 year old fought a terrible cancer. When he was diagnosed there had been no children ever to survive. He got a new type of treatment and he survived. Every person diagnosed needs to have a treatment that gives hope of survival. More research funding would provide those much needed cures. You have your whole life ahead of you and my heart is broken that you have no cure. You and everyone else deserve a cure. the only thing standing between you and the cure is funding. My son will shave his head in the spring for donations that fund research. I hope a cure is to be found. Try to find a treatment center that will explore the cytogenetics of your cancer and match it with a targeted chemotherapy. Also tr to find a clinical trial that will use immune-therapy. If your cancer will respond to the anti PD-1 drugs then you might already have a cure in hand. NEGU (Never Ever Give Up)

  • Andrea McDowall

    I couldn’t believe what I was reading when I saw this last night – so I came back to check today and sadly this blog still exists! My family has a history of deaths from various type of cancers – in fact I became the oldest member of my family, both on the maternal and paternal side, when my father died shortly after I turned 45. I personally nursed my mother and my grandfather and shared the care of my father when he became terminally ill. My mother died just after her 49th birthday leaving myself aged 22 and two younger brothers one of whom was only 15. I was also with my uncle when he collapsed and died of a heart attack in December 2006. Yes, my uncle’s death came as a massive shock as it was completely unexpected and has been the only sudden death in a family where everyone else has wasted away following a long, and frequently painful, battle with the disease which you claim is the “best way to die”! I began to feel unwell just after turning 49, and my health continued to decline over the next few months and after numerous visits to doctors I was finally sent for xrays, a CT and a PET CT scan which confirmed the presence of a 13 cm tumour in my right lung, almost 2 years after starting to feel very unwell. Did I say to myself “It’s okay, I’m 51 now and my 20 year old can manage on his own. I’ve seen many people die from cancer and it’s the best way to die?” Indeed I did not! I had two lobes of my right lung removed and, due to the discovery of the disease in two lymph nodes, it was recommended, that I have chemotherapy. I am currently in remission and although I become breathless easily and still have a few problems from the chemo, which I finished four months ago, I am still here! If the disease recurs I will decide whether I want further treatment based on the prognosis and the treatment available to me. In my experience most cancer patients know when they have reached the end of the road and no amount of treatment will help them.
    If you are, in fact, a medical practitioner of any kind I think this blog post is a disgrace and offensive to people currently fighting cancer, survivors and those who sadly fought and lost the battle.
    If you or anyone who supports your opinions receive a cancer diagnosis at any time you are welcome to refuse treatment and prepare to die “the best death”. It is not my place to tell you what course of action you should take. However, it is not your place to advise others on what they should do when you have not been in that position yourself. It’s also possible should you find yourself diagnosed with this cruel disease you may find that you are not fit to travel, you might have to spend considerable time in hospital and the pain free, easy death you wax lyrically about in this article may not be so easy to achieve! Finally, if the remark at the end of the article about ” 62 and may die soon” is also down to you I’d just like to say it’s probably just about the most crass and insensitive thing I’ve ever read! But hey, congratulations on reaching 62 many cancer sufferers never reach anywhere near that!

  • Samantha Mixon

    Are you serious? I was diagnosed with stage 4 lung cancer just after I turned 33. I had to tell my 7 year old. Do you have any idea what that is like? No. She can’t (2 years later) even sleep alone because she’s afraid I’ll die in my sleep. Yes she is religious and believes in God, but the “not knowing” of when you’re going to lose your mom takes it’s toll on her. My parents have to live this way too. It’s a constant purgatory for patients and families alike. You are not yet dead but don’t feel like part of the living. Before you judge the best way to die, maybe you should get a few more opinions. Or maybe keep the opinion to yourself unless you walk in our shoes. Stop wasting billions on looking for a cure? Let’s not look for a cure for anything if that’s how you feel. It’s ridiculous. And to those who agree with this sort of morbid ideology, I feel sorry for you. You obviously have never experienced the pain of being a terminal mother that would do anything to stay alive as long as possible with her child. We need to keep trying to find a cure. It’s not a “waste” to give families more time. And living knowing that you are going to die sooner than later is not the best way to go. Get your stuff together now, and then die in your sleep. Always tell your loved ones you love them. A slow death is not the best way to die. We need a cure and it’s possible.

  • EllaVader

    I hope the author never has to watch a loved one die from/or experience this disease. It’s excruciating and there’s nothing ‘romantic’ about it. I am one of five people in my family to have had cancer. This September, I watched a dear family member slowly be suffocated by the tumors in his neck. He could no longer speak clearly. Countless amounts of pain killers were not working. He couldn’t sleep. He just had to lay there in pain. He was far from elderly and many decades of his life were stolen by this disease. While it’s ‘nice’ to have the ‘luxury’ of saying goodbyes, knowing your relative is going to pass and be able to tell them everything, etc. – I’d much rather die instantly. I never want to see anyone I love in that state again. I wouldn’t wish the pain of my family seeing me in such a state either.

    Tell people you love them while you’re still alive. Live every day as though it’s your last, and there won’t even be a need to wonder if someone knew how you felt.

  • Sandy

    Hi Jane…check the settings on what you view on the website….sometimes it shows most voted for or first posts and it can be difficult to find your own.
    I agree that the QoL aspects of cancer treatment are suspect: folks clutching at straws will always be postivie as opposed to realistic….and that is what the pharma industry is pushing!!

  • susanne stevens

    A handful of people getting their message across using shock jock tactics which are causing so much distress is revealing how little some really understand suffering and dying. from other people’s perspective…yet they are in positions of influence i There is a kind of macho pride in publishing and be damned – but here the consequences of this are falling heavily on people who are dying and grieving

  • Gilliosa Spurrier

    There is a huge “waste” of money in the cancer “industry” but sadly this has been wasted long before a patient could use treatment to allow themselves a better death – the vast duplication of trials, the industrialization of the research funding process where institutions have to compete for research funding which they then use to pay their bills, the commercialization of the creation of medicines, the lack of input from patients themselves and the total lack of altruistic organization is what is driving this wastage. Dont blame patients and their families for wanting a pain free death at the time of their choosing.

  • io credo che è una vergogna quanto ha scritto. Vada a dirlo ai bambini, agli adolescenti che bevano un goccio di wisky e programmino la loro morte… vada a dirlo ai malati terminali imbottiti di morfina…. comunque, visto che a lei piace, le auguro di morire di cancro.

  • Thanks for the compliment Carly-Jay.

    Like you, I think Dr. Smith has greatly over-simplified a very complicated issue.

    The issues of what constitutes a “good death” (or maybe, more aptly, a “better death”) and also determining when invasive treatments cause more harm than good are very worthy of debate in a forum like the British Medical Journal.

    Unfortunately, instead of bringing intellectual and medical rigour to this debate, Dr. Smith has opted to make insensitive and slap-dash comments about cancer being “the best death,” about “romanticising” death, and – most appalingly – about defunding cancer research.

    It is clear from a multitude of comments on this site that he has caused a lot of people needless pain and distress in the process – all for no good purpose.

    I would have thought that Dr. Smith – a longstanding Medical Doctor and Medical Editor who cares deeply about patient rights and battling chronic disease – would have issued a sincere apology by now.

  • Stagnaro

    Dear Richard Smith, writing well in English does not mean to say all the truth. You should know – do you surely remember the flurry of my comments published when you was the Director of the BMJ! – that “may” be involved by cancer exclusively those individuals who are positive for Oncological Terrain and Inherited Reale Risk in the biological system where, over the time, the cancer occurs. Doctor can recognize such a predisposition with a common stethoscope. Unfortunately you have not uttered a word on Pre-Primary Prevention, according to Manuel’s Story, http://www.sisbq.org/qbs-magazine.html, and Primary Prevention of cancer, realized with the not expensive Quantum Therapy.Why not?

  • Stagnaro

    NOT to be published: my previous comment is on line https://www.facebook.com/pages/Semeiotica-Biofisica-Quantistica/219462041468111, wherein I state my admiration for you, since ever remained unchanged.

  • Nell Webbish

    It’s not just a romanticized view of terminal cancer, it’s an alarmingly ignorant one.

  • Ramji Singh

    Hi, I read the article and comments of few. Each one is right in some or other way because death is an eternal truth and no one on earth likes to see their family members/friends die be it any way. What we hope is only healthy life.

  • satta

    No, we should definitely cure cancer and then replace it with disintegration chambers.

  • Connie Nordli

    Mammograms cause Breast Cancer. People don’t die from Cancer they die from the modern day treatment of Cancer. Find a cure, hell no they do their best to suppress it. Its Big Business, all in name of the almighty $$$$$$$$$$$$$$$$$$$$$$

  • Connie Nordli

    Have you tried Looking at the Gerson Therapy. Read Andreas Moritz book on “Cancer is not a disease” Also do his liver flushes, anyone with cancer has a liver in need of help. Watch the following video of his. https://www.youtube.com/watch?v=Q52JKIzBJ8s

  • Connie Nordli
  • Vontre

    This is literally the worst post on the entire internet. 4chan trolls couldn’t do worse.

  • عبد الرازق سمير

    Stop looking at movies like “The Fault in our stars” and join us in the real life. life is harsh with a lot of pain. Cancer pain, how a person can describe the pain from aching bones all over the body. the pain from a condition like osteosarcoma. how about the unbelievable pain of cerebral mass lesion. how about all of this. for me, I fellowed only 2 cancer patients, both were females. their life was not so much happy. consider being in late untreatable stages. the last one was given “Nalbuphine – Morphine – Codiene – tramadol – Diazepam” to aid her to rest from the pains from metastasis in the bone. No all of that were of no help but to make her crying ” Muffled”. not an easy musical way to die.

  • SISBQ

    Our life is in God’s hands, but we have received the gift of free will, as to be able to effectively prevent cancer, for example, with the diagnosis of the inherited real risk of breast cancer, easy, economical, with only the use of the stethoscope, and such as to promote an effective primary and pre-primary prevention.
    Stagnaro S, Caramel S. (2013) BRCA-1 and BRCA-2 mutation bedside detection and breast cancer clinical primary prevention. Front Genet. 2013;4:39. doi: 10.3389/fgene.2013.00039. [Pub-Med indexed for Medline]
    Stagnaro S., Caramel S. (2013). The Role of Modified Mediterranean Diet and Quantum Therapy in Oncological Primary Prevention. Bentham PG.,Current Nutrition & Food Science ISSN (Print): 1573-4013; ISSN (Online): 2212-3881. VOLUME: 9, ISSUE: 1; DOI: 10.2174/1573401311309010011;
    I agree with Richard Smith, in the sense that it is worth investing more in primary prevention as one of the Quantum Biophysical Semeiotics rather than unnecessarily wasting resources in many current cancer research whose unsuccessful results are under the eyes of all.

  • Theivingbird

    Goodness this has caused some controversy. I think this blog has actually some very valid arguments. If people actually read what Dr Smith has said rather than interpreting it using their own circumsances to take offence. Firstly it is hideously sad when someone young is diagnosed with cancer and reading the comments my heart goes out to each and every one of you who is living with this insidious disease. I have a lot of experience with cancer and I have to agree. The amount of pain and suffering I see from people desperate ( with good reason, who wants to die?) so they put themselves or their loved ones through endless rounds of chemo or radiotherapy which may prolong life, but most of that prolonged life is spent on the toilet or lying in bed in misery. many people are misinformed about cancer treatment and so choose to try everything even though the result will be the same. What I feel the message is from a lot of these replies is that cancer pain is handled appallingly and that is something the medical profession have to do better with. There is absolutely no reason why people with end stage cancer should be in any pain whatsoever. Analgesia is extremely cheap and there is no chance of someone who is dying becoming addicted, nor are you ‘euthanising’ someone by giving them adequate pain relief another commons misconception. I have seen people die in almost every way imaginable and I have to agree, a death from cancer with proper and effective pain control, where the person has been able to put their affairs in order, spend time with loved ones and maybe fulfil some wishes along the way is probably the best option. Is it fair that some people die young from cancer, of course it’s not, no one in their right mind would suggest that, but we can’t pick and choose that sadly. Dr Smith did not say that money should not be spent on research, of course cancer research should continue. What he said was to stop spending money on futile efforts to save a life that needs to end rather than prolong it needlessly. It is the most heartbreaking sight in the world to see someone being put through endless rounds of therapy when all the staff know what the outcome is. As a society now we refuse to accept that death happens to young and old, rich and poor,and everyone looks to someone to blame or save them. It’s understandable of course, life is beautiful. There are oncologists out there who will claim they can cure anything, and by god they give it a good go. That is unethical and more discussion about the reality of the person’s particular form of cancer need to be performed. I think what is more important is that we, the medical profession need to deal with death better, offer much more effective analgesics and give the patients the best care they deserve. life is still very precarious and of course in an ideal world we would all die in our sleep at a ripe old age at peace, but that’s not reality and yes, in my opinion it is better to have a death drifting into oblivion surrounded by loved ones having been able to say goodbye properly and pick my own funeral music rather than being involved in an MVA, some families never cover from those kinds of shock.

  • To the current editor of the BMJ :
    Surely the heartfelt comments on this forum and the distress caused by Dr. Smith’s insensitive comments warrant a formal response and apology from the BMJ? If not from him, than at least from you?

  • Graham Paul Smith

    I helped my sisters and brother at my mother’s death, at 96. It was sad of course, and was a long time coming. But compared with my father in law’s death 50 years ago in a car crash, I’d say the hole in our families’ lives were greater following the car crash. And the final thoughts of Richard’s about overambitious oncologists isn’t to say that cures are not to be researched, but that recognising the best path is tough for the ‘mechanics’. In the hospice we felt the staff were less interested in hydrating than we thought correct. But a few weeks later, at her home, we could see that we too had been overambitious. We had extended our beloved mother’s life of pain. I welcome Richard Smith’s thoughts.

  • tw

    After reading the various responses to your article I decided to reread it to see if I missed something.

    I find it interesting that you veiled your anti-cancer financing crusade by using the facile argument that cancer is the perfect
    death. The idea that you would personally choose something over which you would have subsequently no control is frankly a bit rich.

    This is considering you decided not to include the ultimate death choice which was suicide where you would have control over literally all aspects of your death. Why you do not see this as perfect escapes me; but then again it’s harder to romanticize a cowardly act. Like for example, pretending that the article you wrote is courageous.

    So you create this romantic vision of what death should be
    like to cover your real agenda which is to deny everyone who actually has to make a choice the opportunity to do so.

    You see, when a person finds out they have cancer, they have
    to make some decisions about what they are going to do. This decision is made using an imperfect set of parameters since medicine is not always precise.

    One does not get to choose cancer only what to do about it
    when they get the diagnosis; and even then the choice can be very difficult.

    For example, using your logic on “wasted billions” I would
    be preparing to die from Hodgkin’s Lymphoma because the developments which have generated increasingly improved outcomes in pediatric cancers would not have occurred.
    Instead I was treated and sit here recovered. No bad.

    Or perhaps the woman I met during my last CT scan who had
    been given 6 months to live 6 years ago and her treatment to assist her demise actually cured her.

    Overambitious oncologists? Who is really overambitious here?

    It does not take courage to advance a weak argument that
    uses faulty logic wrapped in a cloak of romanticism. That you make the choice for others, or rather advocate denying others the opportunity to choose their fate when faced with a fateful event is the workings of a coward.

    To put in writing an argument that would be better suited
    for a private personal discussion appears thoughtless and is to diminish those who have sacrificed their lives both in disease and the cause of science.

    A perfect death might be attributed to the people who sacrificed their lives fighting the tyrannical exploits of Hitler; so that you can make such remarks freely and without risk.

    When you sober up from the intoxication of your own self-righteousness, perhaps you will consider that many billions have been wasted on all manner of things.

    Including it would seem, on the merits of your credentials.

  • I can see that Doctor Smith’s comments are well intended but they are deeply flawed. It surprises me that his opinion appears to be so naïve for one so eminent and experienced. As a cancer research scientist of forty years standing I have witnessed and, I like to believe, contributed to the massive improvements there have been made during this time to cancer treatments. Because of this we now have effective cures for significant numbers of patients with various malignancies who would otherwise have died lingering deaths from their cancers in earlier years. Now we stand on the cusp of further enormous advances to cancer treatment (all note due entirely to research) through the use of antibodies and immunotherapy (my own area of specialisation) and new drugs that target the genetic lesions responsible for the cause of particular types of cancer. For Doctor Smith to glibly suggest that we should abandon spending money on cancer research in furtherance of improved treatments and cure rates is irresponsible beyond belief. The UK’s (and indeed global) cancer research community has been and remains completely dedicated to developing treatments that will ultimately prove curative with minimal short and long term side effects for patients. As a cancer research scientist I, and many others like me, have devoted their lives to achieving the goal of cure for all cancers and have been succeeding in this slowly but surely over the years. It grieves me that Doctor Smith should be so glibly dismissive of our efforts. Perhaps he might have held a similar opinion had he been around at the time of Pasteur, Jenner or Fleming and had that opinion been heeded we might not now have immunisation and antibiotics, two discoveries made only through research which have alleviated untold human suffering since their discovery. Doctor Smith, you should carefully examine your opinion and develop a more balanced view that is more in line with reality.

  • Faek Jamali

    As a practicing surgical oncologist, I respectfully disagree with Dr Smith. A cancer death, while it may allow the patient to have some time to get his affairs in order and say goodbye, is a long and painful process. It is very traumatic on the families who often cannot erase the final image of the patient as the shadow of the person he used to be. Death is often associated with chemo side effects, severe pain and wasting. Modern medicine still falls short on palliating such symptoms and I personally believe that dying of cancer is by far the worst way for any human being to die. I offer my sympathies to all the families of cancer patients who suffer the agony of watching their loved ones suffer and wither away and to the patients who are the heroes fighting this curse.

  • EmilyRose

    This doctor’s article has left me so angry and upset that I’d like to join the conversation. My father died of pancreatic cancer a year and a half ago, after a gruelling year of chemo and a long battle with pancreatic problems which left him very ill and underweight before the cancer was even diagnosed. Despite huge amounts of morphine etc, he died in a lot of pain and my family remains haunted by the memory of the suffering he underwent. Dr Smith focuses on the supposed benefits of a cancer death – the opportunity to say goodbye, plan your funeral, tie up loose ends, etc. What he totally ignores is the devastating psychological impact of this on the patient and the family: the knowledge that the patient has to bear that they are going to die; the worry they must undergo knowing that their family will have to grieve them; the fear they feel knowing that the pain they are in will only worsen. I am of course grateful that I had the opportunity to say goodbye to my dad and tell him that I loved him (until the last two weeks of his life when he forbade any mention of it as it was too upsetting for him, knowing he was going to have to leave us), but I would forgo this in an instant to erase the suffering he had to go through. I can only imagine that Dr Smith hasn’t lost someone he truly loves to cancer. If he had, surely he would never dream of writing such an inflammatory and upsetting article.

  • mona

    Both of my parents had the slower death he preferred, one from colon cancer, the other from multiple myeloma. Each was in severe emotional and physical pain before death – despite hospice care which was supposed to make them “comfortable”. My father’s father and sister each dropped dead of strokes and never knew what hit them. I wish every day it could have been that easy for my parents. If you are reasonably introspective throughout your life, you shouldn’t need time for “a last goodbye”. The price for that time can be very high.

  • The eminent Doctor Smith seems to have left something out of his glib equation. I could perhaps agree with him if we were discussing succumbing to cancer after the age of, say, 80. Having seen my young son (2 1/2), my best friend (37) and my mother (73 – and otherwise very healthy) die from cancer, I can assure him that speaking in generalities did his specious argument no favors.

  • Dawn

    I read an article about this blog so as someone with Cancer had to read the original blog. As a healthcare worker myself I can see the extreme point Dr Smith is trying to make, having witnessed many people suffering as they died. However as someone with a brain tumour and now Breast cancer I would not be alive and living a full and meaningful life if it was not for the intervention of medical and nursing experts. They have used evidence & research based treatments and have dedicated their time to ‘saving’ me and giving me back a life! A different life but fulfilling all the same. I give others hope that the challenge of cancer can and often is overcome in my blog http://www.mindthegapa-z.blogspot.com
    Since ‘I joined the Cancer world’ I have witnessed friends die of brain tumours and believe me none of them would have chosen such a death
    So Dr Smiths plea to Cancer charities not to fund desperately needed research, without which I would not be here, is wrong at so many levels.

  • Richard Smith

    I’m grateful for the many comments to my blog, and I apologise to those I have offended. I have now posted a response to comments made here and in other places. You can access it at: http://blogs.bmj.com/bmj/2015/01/05/death-a-response-from-richard-smith/

  • Ashley Fisher

    Dear Dr. Richard Smith,

    I truly hope I read and misinterpreted your blog post. Upon hearing your putrid words and thoughts upon the fact that you believe cancer is by far the best way to die and is tolerable through nothing but ‘love, morphine and whiskey,’ I was, and still am, absolutely horrified to think that any sane person, let alone doctor of any sort, would even begin to think this way. Your romanticizing of cancer is absolutely ridiculous and disgusting, to say the least.

    Your approach to cancer is so close-minded, basing it off of one Spanish filmmaker who lost his life to cancer over thirty years ago. Just because one man was able to handle the news and fight so peacefully does not mean that all patients will react the same way. In fact, think of the children suffering childhood cancer. Just think of trying to explain to them, based off of your beliefs, that they’re going to die, will never become Mozarts, Stephen Hawkings, Van Goghs, or whatever they want to and would have become, but through a few pain killers, some alcohol and love that all will be alright. Tell that to a six year-old child that they just have to listen to their favorite symphony and music, and read their favorite poems, reflect on their lives and be calm.

    Do you honestly think that cancer is really the best way to die? Suffering uncontrollable headaches, reoccurring nightmares of you stomping and bursting your own skull to rid yourself of pain, extreme sensitivity to all light and sounds, terrible pressure, uncontrollable nausea, pitiful weakness, and blurry almost double vision is so wonderful and extremely romantic. While I was suffering my double vision and inability to tolerate anything but my own breathing, let me listen to Mozart’s Requiem and read a few poems by Robert Frost, despite the disgusting pain I was in. Oh, please, let me pilfer my home’s liquor cabinet in search of whiskey, or even vodka, and put it on the rocks while obtaining some morphine because drinking alcohol and taking pain pills while slowly deteriorating is so romantic and something to really look up to and want to live through.
    Where is your morality? Think of those suffering from an unknown killer. I, myself, was suffering these disgusting headaches for as long as I could remember. Pushing them aside as mere migraines, I was suffering. Upon the discovery of even just a tumor, let alone a rare cancer called chondrosarcoma, nothing romantic, calming, reassuring or pleasurable came from my experiences. Moreover, since the discovery of cancer, I’ve been much less than romantic and/or calm, and more fearful of my life. Knowing that it can reoccur at any time, anywhere is absolutely terrifying. Please, tell me, what’s romantic about the discovery of having a rare cancer that’s prevalent in older men at seventeen years old? Please, try to persuade my legal guardians to give me alcohol and pain pills to combat this monster. According to your beliefs, should I just have given up my dream to make something of myself and give back to my world, community, and family, and tell my neurosurgeon to forget about my life saving surgeries and leave me with an IV of whiskey and morphine? Should I have driven through the nauseating headaches and allowed myself to just die, saying goodbye to my hopes and dreams and life itself?
    But what does it matter to you? I am but a name, just a tally mark on the charts of “Those Diagnosed With Cancer.” It probably joys you to hear of another person being damned with cancer. It’s so amazing to die from, why wouldn’t you be exuberant upon hearing of another person being damned? What are we, nothing but statistics to you? With your frame of mind and ideology, you’ve inspired me to think only the same when referring to those diagnosed with HIV AIDS, or other incurable diseases. Why should we look for a cure for them, if love, morphine, and whiskey are all we need? In fact, why don’t we just take the superior and extremist side and close down all hospitals and health care facilities for all, cut out all prescriptions, and tell everyone all they need is ‘love, morphine and whiskey’? According to your logic, it’s only just and nothing more.

    In all honesty and reality, I hope you’re simply ignorant and oblivious instead of being truly daft and thickheaded. The ongoing fight of living with cancer is terrifying with the questions of “why,” “how,” “what,” and ultimately, “when.” Living with a known diagnosis is scary, neither happy nor romantic. It’s not just terrifying being the patient diagnosed with cancer, but also having those around you be diagnosed. There’s nothing delightful about cancer, and nothing regarding the diagnosis except maybe a false diagnosis of cancer can possibly be categorized as happy. The only person who’d think that cancer was happy is a complete imbecile. And how can you, a doctor, even begin to fathom a single, incomplete thought regarding cancer as romantic? Doctors are not just medically literate, but emotionally literate and are supposed to comfort their patients and understand their patients; doctors of any sort are not supposed to think phony, completely belligerent thoughts and want to stop the research of an ongoing medical mystery. Doctors are supposed to be honest with their patients, both emotionally and medically. The fact that you openly believe that such crude, rudimentary, and basic things are all that’s needed to cure a debilitating disease and live every day in ongoing, destructive pain is completely absurd, especially since you’re a a seemly educated man and doctor. More importantly, you as an educated man, should know how ground breaking medical science has been in the fight against cancer in recent times. As previously stated, your idea and and treatment of cancer is completely primitive, based upon the diagnosis of a man more than thirty years ago. Medical science has grown exponentially in the past thirty years, let alone the past ten years. Your ideology is primitive and extremely offensive with your disregarding of the medical research and advances being made, as well as your disregard of life. Your sore and ignorant attitude and aspect towards making cancer the best way to die and the best disease to suffer from only makes me more grateful for the caring doctors I had and continue to have. This also makes me extremely grateful that you’re not a medical doctor, and more specifically, not my medical doctor.

    I hope you don’t take my words lightly and take into consideration those doomed to pass away, those deteriorating, and those already gone. Think of the diagnosed women, children, men, fathers, mothers, teachers, and everyone in between. We diagnosed are worth more than to have funding for our lives cut short, and we are worth, as well as in need of, more than just crude ‘love, morphine and whiskey.’ I hope you rethink your beliefs and come to be less ignorant, as well as really understand the hardships of either you or your close relatives/friends being diagnosed and damned.

    Cranial Chondrosarcoma Survivor

  • Mike

    My mother died four years before Bunuel also of pancreatic cancer at the age of 52, leaving behind a husband and four young children. Should I be pleased that she died racked in pain, a skeleton covered in skin, frightened and desperate to live to take care of her family? I don’t think so. After 35 years it still haunts me that my mother died in such a way, and it annoys me more than I can say that although palliative care has improved a lot in that time, detection, treatment and recovery rates for this cancer are about the same as they were in 1979. For Dr Smith to suggest that dying of any form of cancer, let alone pancreatic cancer, surely one of the most painful, is the best way to die shows that he really has no understanding of cancer, its symptoms, the physical, and emotional effects on the patient, the family or the people caring for them. He has obviously never had the misfortune to have lost one of his own relatives die of pancreatic cancer, and he has been lucky so far to dodge the particular bullet of developing cancer himself. My mother packed a lot into her 52 years, but she only had half a life. She never got to finish her career, or to see her children raised to adults, she never saw her grandchildren, she never got to retire and have some leisure time for herself, and this is one of the great sadnesses I carry with me. Shame on you Dr Smith. You have no business pontificating as you do, because you certainly have no understanding of the distress you have caused. Retract your words and issue an apology to all those you have offended.

  • Ravinder Goel

    a doctor friend from India rightly points out
    Dying of cancer may be best death for those having access to quality heath care but this journey is entirely different, undignified, for millions of deprived as they don;t have love ,morphine etc required for death with dignity.

  • Jacs

    I work as a clinical nurse specialist in the feild of palliative and end of life care I find this blog disturbing on many levels ..
    I have seen many many patients die from cancer and I can assure you that it wouldn’t be there choice. For you to even think of suggesting that it is somehow a romantic way to die is beyond me… And to even suggest that is achievable with love ,morphine and whiskey is absurd.
    You say stay away from over ambitious oncologists I say thank goodness for the over ambitious oncologists and palliative care consultants who offer symptom management no matter what the cost this in turn can help with a more dignified death & give some kind of hope to the patient that someone out in the medical feild actually cares ….. A good death can be achieved with the involvement of palliative care services the experts in medications and alternative therapies & family support .

    In my personal life I have witnessed three family members die at a young age from a sudden heart attack I have also witnessed my sister suffer from a nurological disease , she suffered over many years and I still have awful images now and that was over 17 years ago . My Dad died very suddenly in my home ,My father in law died suddenly at work and my partner died suddenly while out on his motor bike all heart attacks, yes it was a huge shock but it is far better for me to live with there death than my sisters death.
    I have also witnessed my mum die at home from “old age” a dignified death you forgot to mention that many people do die from ” old age” and that is a good death ..

  • JonathanBagley

    Let these responses be a lesson to you, Richard. Patiently comparing the four causes of death, excluding suicide, won’t cut you any slack with this lot.

  • Cat

    I have a lot of opinions about cancer, and I don’t mean to be uncaring or harsh in any way. I just don’t understand why people put them selves and their family through so much by opting to do chemo and radiation speacially when the cancer always comes back and those with hope lose all hope. I have watched family and friends deal with cancer and all opted for the chemo and radiation which did nothing but make them sicker and having your family watch you go through such a struggle just to lose, it is hard. Another question is why do parents put their children through all that pain and sickness knowing that they are going to lose them anyway. I don’t understand alot of things, I know how hard it is to lose someone, If you developed a disease that was going to kill you. Does your will to fight grow stronger?

  • Clay Butler

    Yes, compared to being instantly killed in a car crash, yes, your daughters death was preferable. Are you saying those 7 extra weeks of preparation wasn’t cherished by all. That those seven weeks meant nothing? The article simply said that if you were to die in six months from now, all things being equal, would you want warning or to be taken instantly with no chance to wrap up your life. I’d take the six months. I’d certainly take that option with my 11 year old daughter. To bury her while I continue to live is my greatest fear, but this is a hypothetical situation. Instant death or warning? Most would take the warning.

  • Marina Symcox

    This blog is beyond awful. I was diagnosed with advanced terminal sarcoma when I was 38 yrs old. I had three young children. I was expected by several experts to live only a few months. I endured toxic and extreme treatments and surgeries in a desperate attempt to extend my life for my small children. My body somehow managed to eke out three more years in an extremely dire situation before a highly effective (“miracle”) cancer drug came about as I was in my very last days of hospice and then turned things around for me. (Gleevec for gastrointestinal stromal tumor). I know from first hand experience that dying a slow death from cancer is a nightmare. There is nothing to romanticize. There is no mellow philosophical self reflection during that time. Instead there is fear, extended grief, hardship, suffering, enormous financial burdens. Eventually even a healthy family can spiral into dysfunction from the extreme stress. I have walked the journey myself as the dying cancer patient, but because of a medical breakthrough I have a unique voice to say first hand what the experience is like. I would rather die a quick death. I hope the author is not so unlucky as to discover this directly for himself.

  • Pavel Faigl

    Dear Mike,

    Respectfully too and thank
    you for your comments. I feel you have missed the point of my argumentation.
    Let me to explain again that my main point is related to much wider aspect, to
    the Life and Death, to our existence on earth and what it all means, to me, to
    us, to our dears…and here I wholeheartedly agree with Richard Smith.

    Your reading of him is that he, “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.” is not right.

    You are not correct and it is at a great variance with what he is saying.
    Please refer not to the newspaper renditions of his article, but to the article
    in BMJ itself.

    Richard Smith does not chose anybody’s mode of death, in the same way none of
    us can chose it unless opting for homi- or sui-cides style exit.

    He is merely saying that cancer (usually) gives people enough time to
    reflect about life and its meaning. By virtue of a prolonged departure from
    this world – and usually also with unclouded mind’s faculties – we have a
    chance to say bye bye and take a leave in peace from the dear ones. Usually
    also leukemia is a disease where there is ample time to prepare for departure. Other forms of cancer where the pain can be
    controlled and the mind is not completely knocked out and only pain disappears,
    also can provide this valuable opportunity. Not so a sudden death, as in car
    crash or by stroke. There is a sudden cut and a grief of those left behind is
    much worse…

    The relative “advantage” is this prolonged dying in cancer is
    that there is enough time to be sad and to be happy together…to enjoy the last
    moments and to resolve all issues which may weigh upon one’s heart. Thus leaving
    this beautiful and terrifying world unburdened and happy

    It is an illusion to believe that we live here for ever. Our life has a
    finite duration and we should embrace this limitation given to us by powers
    (gods? God?) which are beyond our understanding. Better live to the full and
    acknowledge the supremacy and the final act of Death.

    Our medicine gives us only illusion of power in the form of advanced
    medical treatments. Yet, at the maximum they only postpone our inevitable rendezvous
    with Infinity. Do you think we become happier if we chose to procrastinate with
    this appointment? Do you think we can master our Death by resisting it or
    denying it? Better, we submit ourselves to Her majesty and at the same time
    show Her that we do not give up without fair fight. Fight without delusion and
    without fear. Be aware that our cards are worth nothing and that Death has all
    trumps. This is bravery: a good fight even if all odds are against you.

    I had the privilege to accompany as a spontaneous carer our distant cousin who came to us for holiday and died in my house (cancer of bowel primary, and of liver, bone and brain secondary. with spine compression) in front of us and I know
    what I talk about.

    If I may suggest do yourself a favour and read what e.g. the Hindus or
    Buddhists have to say about Death. Listen to the podcast of E. Kubler-Ross on Dying on ABC website; please
    see this link:

    http://www.abc.net.au/radionational/programs/allinthemind/archival-curiosities-elisabeth-kubler-ross-on/3117266

    or listen to the mesothelioma diary; there are 5 parts, with dying
    documented:

    http://www.abc.net.au/rn/scienceshow/stories/2007/2108986.htm

    Happy New Year 2015!

  • JayMankind

    My mother was diagnosed with leukemia in Aug 2014 and she passed away in Oct. She was 78. She never suffered much and she was in good cheer until the last moment. She went through geriatric chemo and platelet infusions – both not painful at all. Not all cancer-related deaths are painful. In hindsight while I would much rather that she did not die, if at all her time had come, this was a very dignified way to go.

  • trentclinic

    Aspiring for a ‘good death’ is a philosophical and
    intellectual yearning and probably not a physical need.

    Virtually every organism in the world strives to survive at
    all costs as long as possible. All bodily functions such as eating, drinking, sleeping, procreation and many others are performed to preserve and propagate the ‘ selfish gene’. Human beings are no
    different. Every cell, tissue and organ in our body is instinctively driven to ensure survival of the organism as a whole.

    The only major ‘fly in the ointment’ with this view point is the physiological function of cellular suicide (apoptosis) whereby unfit cells commit suicide when they are irreparably defective. Should we take a cue from our microscopic-self and embrace assisted suicide when we are irreparably damaged as a whole?

  • Wendy Barron

    I can only assume that this post is Dr. Smith’s way of expressing a preference for his own manner of dying, given the options he sees laid out before him. I wonder if the editor of the BMJ continues to practice as a physician during his tenure as the editor. I wonder in fact what manner of physician Dr. Smith is or was (since it’s clear he’s no oncologist). I wonder, too, if he has ever watched someone he loves be devoured from within by cancer and pain, slowly losing everything from weight, hair, and muscle to energy, cognition, and fight. I have done it twice, and it’s not an end I’d wish on any living soul.

    Express your personal preference, by all means, Dr. Smith. But please recognize it as such, and dial down the arrogance. Using your position with the BMJ to espouse the view that cancer is the best death, and that we are wasting millions on researching it, isn’t just a “romantic” view of the disease, it’s dangerous nonsense that has the potential to undermine your professional, personal, and social capital. It may already have done, with any luck.

  • Mary Riley

    While I support the right of every individual to chose both the way they live and die, to suggest doing away with cancer treatment and research is an enormous misuse of this platform for communication. Many people who have far more to do in life are diagnosed with cancer at young ages. As a cancer survivor, I am grateful that a cure was possible for me and others who face this life altering diagnosis.

    We use medications with significant side effects to treat many diseases that are not considered terminal. I think the argument made here; because we call cancer life threatening we should not treat aggressively, is purely semantics. The truth is that there are many other diseases that although we do not classify as life threatening, without aggressive treatment would be terminal. Because a disease is labeled cancer does not make it any less worthy of treatment.

  • janefeinmann

    Hi Sarah, I’m a freelance journalist writing an article about Richard Smith’s blog and the responses to it for a national newspaper – against the background of the current care for people with cancer. I found your comment most interesting and wonder if you would be willing to talk to me a little bit about your own experience of a cancer diagnosis – and your mother’s. If so, could you email me, I’m jane@janefeinmann.com
    Hope to hear from you, many thanks,
    regards
    Jane Feinmann

  • EllaVader

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

    FYI, Doctor, organ failure is also caused by cancer, treatment, and its side effects, which add to the in and out of hospitals and doctors’ offices.

  • MonocleMike

    I am 72 and a widower. My wife of 42 years died 2 years ago very, very suddenly aged only 64. It was awful. I and my children were bereft. I would love to know when I am going to die so that I can say goodbye to the grand-children quietly and calmly and explain. Put my affairs in order so my children can sort out the formalities easily.
    Death is not the end; it is a passing into the next stage. It would be lovely to be able to leave this stage with everything sorted out and the grief minimised.

  • Larry Rees

    Hi Richard

    I hope you will read my response to this article. And then we can continue the debate!

    http://scienceblog.cancerresearchuk.org/2015/01/19/cancer-the-best-way-to-die-you-couldnt-be-more-wrong-if-you-tried/

    Larry

  • Helen Stephenson

    Richard Smith

    I’m afraid I find your post the most offensive, insulting and illogical thing I’ve read on this subject. I haven’t felt so angry for a long time.
    Your simplistic categorisation of organ failure vs cancer completely overlooks the experiences of people like my husband, who died from respiratory failure caused by the very first chemo treatment. As you are a doctor, you do not need me to detail for you what seven weeks in intensive care with artificial ventilation meant for him and for our family.
    My father, in contrast, was given a terminal diagnosis five years after his initial remission and took another three to die. That’s three years of living on a knife edge.
    As regards the ludicrous assertion of ‘putting your affairs in order’ … for the majority of us normal folk, our wills are written and simply pass on our modest ‘estate’ – marital home, a bit of savings, to the next of kin. Nothing else can be done until the death of the person, so please don’t insult those of us who are left behind with your suggestion that ‘tidy affairs’ ultimately makes losing our loved ones any less traumatic.

    “let’s stop wasting billions trying to cure cancer”

    because ….???

    You chair a body called ‘Patients know best’?? Good grief.
    Is this actually some kind of sick satire?

  • CarolineT

    How can someone who’s not died in several different ways then come back to life to analyse his feelings and experiences, possibly presume to know there’s a best way to die, and what on earth that might be?!

    Dr Smith has obviously worked in this area and seen many
    people go through cancer and, I presume because he is drawing comparisons, other deaths. So he is entitled to an opinion and it is probably based on his life’s experiences. But he’s confusing the individual and the society perspective, he’s claiming to understand what it’s like to die which he clearly can’t, and he’s most definitely taking on a rose-tinted romantic view of the whole experience.

    I’m a geography graduate and I work in sustainable
    development: I understand that populations cannot continue to grow indefinitely and that, as a whole, populations and community numbers have to manage themselves. But that’s a societal discussion with huge ethical implications, and not a reason to say, at an individual level, dying from anything is better or worse than from anything else.

    He talks of his ‘romantic’ view of imminent death giving you
    the chance to: ‘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’. What if your bowel cancer is so bad you cannot travel anywhere far from a toilet, or your seizures from a brain tumour mean your driving license is taken away and you’re not strong enough to travel alone, or your drugs that silence otherwise horrific pain have rendered you so sedate you’re not awake long enough in the day to ‘read loved poems’, or your family’s finances are destabilised as a spouse gives up work to care for their partner? And what if this beautiful period of reflective tranquillity lasts for years, and you and your family live with the constant unknown of how long it will last and you witness that softly corrode the life you had built and knew?

    I do not presume to understand how it feels to have someone
    close to you killed unexpectedly and instantly, and I don’t offer any opinion as to how that feels if you’re the actual person dying, because I’ve never had either. But I’m half way through a good book called ‘I’m grieving as fast as I can’ and the chapter that outlines how dying in different ways impacts surviving spouses in different ways. The ins and outs are endless, and the intricacies of emotions that you can’t possibly imagine unless you’ve had that experience yourself are profound. Where does blame lie if someone has been murdered? Where does guilt come in to it if there’s a suicide? What if medical negligence has led to your child’s death? And you’re saying these are all ‘better’ than a
    death from cancer?

    ‘Cancer is the best way to die’: red rag to a bull. How can you Dr Smith, or anyone presume to know anything about this if you’ve not actually been there yourself? I hope you never know, as I wouldn’t wish it on anyone, however flippant their opinions seem to be.

  • Thank you, Dr. Smith for sharing your opinions on this very emotionally-laden subject. This is a very difficult topic to discuss and I can see the pain and heartache in so many people’s responses. Having the luxury of discussing the topic of death (i.e., the state of being alive) hopefully turns us towards our God. I am 46 years old and have had a number of people in my life die: a cousin, three of my grandparents, and my wife’s father. And one of our children was diagnosed with a life-threatening condition when he was 3 months old, which was extremely difficult for us. I don’t personally think about death very much myself, but I am a follower of Jesus Christ and I know I’ve got a home in heaven when I die. All of us have a set number of days on this earth and I say that with complete absence of malice.

    If we are honest, most treatments cancer patients endure in today’s age are horrific and debilitating in and of themselves. There are so many responses to this post from people who are all too familiar with those treatments. Now, those treatments may work, and they may very well extend a patient’s life which I do not oppose. But there is some merit in the doctor’s warning to “stay away from overambitious [although very well-meaning] oncologists” who almost have to kill the patient to “cure” the patient. Yes, I agree he could have presented his position with more sensitivity to those who are still dealing with a traumatic loss of their loved ones. And I’m sure that goes for me as well, but before we summarily silence those with whom we disagree, I gently urge us all to allow a civil discussion. I do not perceive the good doctor as being hostile towards those who have recently experienced loss; admittedly, his view is very challenging. Thank you, Dr. Smith, and thank you, everybody, for sharing your personal and profoundly heartfelt experiences.

  • Amanda Jones

    WTF????!!! This guy is just not alright in the head, my sister died of brain cancer aged 33 and I don’t want her death, I’d rather be ran over by a car. Fast, effective, and with the same results and way less time of suffering.

    Moreover, I’d rather she had been ran over by a car than spending three years not being able to properly communicate with others, on a wheelchair, needing help even for using the toilet due to the increasing brain damage and still completely conscious until her very last day -that, obviously made her feel impotent and subsequently depressed, and had such a devastating impact on her and on every family member. So not that she had a romantic death among Beethoven concertos, Lord Byron’s poems and enjoying long strolls in the woods. Two years after her death, I still need therapy, and my parents will be devastated and not the same forever, not only for having lost a child but for having seen her suffering that way… but oh yeah she had so much time to say goodbye… if only she had wanted to, considering she decided to stop seeing everyone except my parents and me from one year before passing away, “so that nobody will remember me like this when I’m gone”.

    I will just not give much importance to what this idiot says anyway, as it is more than obvious he never saw a loved one passing through a cancer. Though in that case, he should hold his tongue. I just can say that what hapened within my family, I don’t want it even for my enemies. What he says is just bull###t. I expect the next will be this guy saying suicide is so romantic and great if you commit it from a cliff in a stormy day with Wagner music in the background. Stop watching romantic movies and have a walk through real life instead.

  • Amanda Jones

    And I still would have taken the unwarned thing. To put it otherwise, what is your preference: you being unwarned or your loved ones suffering for a longer time so that you can get used to the idea? Do you think you are really going to suffer less? I really am sure of what is my preference, so please don’t state your way of seeing things as a universal truth. Wanting to be “warned” at my loved ones’s expense, in my opinion is nothing but selfish. And believe me, I have experienced both options with the two people I loved the most in my life and, even from a selfish point of view, I prefer not to be “warned” at all -and eventually traumatised for life after having seen my sister suffering for three whole years which were too much of a “warning”. That was the most horrendous nightmare you can imagine, and I wish I just had a call one day saying she had died in a car crash when she was back from a holiday or a party, instead of what she, me and the rest of the family had to go through -and that has traumatised us forever.

  • Amanda Jones

    Not accepting every comment we are, huh?

  • Sylvina Tilbury

    Did he die from starvation, vomiting up his bowel contents?

  • Matthew B

    It is a romantic view but I can understand what RS is saying. I guess many people think of cancer as the worse thing that could happen to them. I’d imagine they would feel very unhappy when they receive the news that they have the illness.

    RS is right. To die suddenly could be a massive burden to the people around you. It may also leave a lot of loose ends that should have found some resolve. That can never now happen.

    Provided there are a good amount of painkillers available and perhaps more importantly, an accepting mindset of the individual (which is usually the case when an individual has accepted their fate), I agree that this is indeed the best way to pass over.

  • Gary

    46% of all cancer patients die of malabsorption. YES he did starve to death. Poor guy got the wrong advice from beginning to end

  • Gary

    I will not comment on how foolish Dr Smith is because most everybody has spoken to it. What strikes me about all these comments is how so many of you just march like sheep into chemo
    and the hands of the establishment and sit back and hope. Read, do your research. There are thousands of people around the world surviving and thriving after a cancer diagnosis. My wife has stage 3 ovarian. I immediately started reading about cancer the day of her diagnosis. We changed our diet, are taking immuntherapy nutraceuticals to build up her immune system during chemo. Her CA125 marker blood work gets better every three weeks. My wife addressed her MIND,BODY and SPIRIT. We follow Dr Joe Dispenza. You need to believe you are healthy and getting better. You need to face and forgive all past and present negative things in your life. You have options, you have more power and control over your recovery than you realize. Eliminate the fear of cancer and move on. Follow other survivors. Its your choice. Live life with love. God Bless

  • Louise Dotter

    American Indians have a saying “Do not judge a person until you’ve walked a mile in their moccasins.” As someone who has spent the last four and a half years dying from untreated cancer I say Smith is SPOT ON! Particularly his advice to “stay away from overambitious oncologists”, as most of the pain and suffering I’ve seen in fellow patients has come, not from cancer, but treatment side effects! I rejected all the slash,poison, burn treatments (and also all the kooky alternative ones) and had four great years with outstanding quality of life. When the pain started I went on home hospice and they have controlled the pain with Fentanyl and morphine quiet nicely thank you. I am still active but limited by fatigue that is a natural result of advanced cancer and not an unnatural way to “wind down” – though I do get frustrated at my lack of strength some days. I try to remember what my 103 year old neighbor says “Don’t grieve the things you can no longer do, be grateful for what you can.” I have had time to complete my will, say goodbye to family and friends and make all the arrangements that would have been left to my children. All in all, since we all have to die I’m actually glad my modus operandi is untreated cancer! http://www.caringbridge.org/visit/louisedotter

  • Melimax97

    Calm down on Dr. Smith, everyone!

    Yes, losing someone to cancer is terrible. Having cancer at an early age is certainly very terrible.

    We tend to view this topic from a personal, visceral level.

    Dr. Smith has taken a broad view that, from having treated and seen many, many people die from all all four death options, cancer may not be the worst. I don’t see any CHF, COPD, Diabetes or dementia responders to this blog.

    I would take the “sudden death” option myself, but I do understand his POV that organ failure and dementia REALLY suck, and, as an RN working in long-term care facilities, I see all too many people suffering for years on end with these conditions. I believe this is the point that DR. Smith wants us to think about.

    Coming to terms with our mortality is very difficult. I applaud Dr. Smith and other physicians like Atul Gawande for making us think about how we die and initiating the conversation.

  • Melimax97

    Thank you, Dr. Smith for your insights as a physician. I did not see many comments from those who had lost loved ones to CHF, COPD or dementia here.

    Noboby is happy about dying, but from my personal experience working as a nurse in long term care facilicities, there is a lot of truth to what you say: lingering for years on end from dementia and chronic illness puts cancer in perspective.

  • P. Olsen

    People probably differ in how they wish to die. My husband died of colon cancer, knowing he was terminal for about 21 months. He reminded me of an Orthodox prayer, “God, save me from sudden death.” He was glad that he had time to prepare and to say good bye. He spent months reading many of the books he’d collected but never had time to read. He heard from and had a few visits from old friends he hadn’t seen for years, He did have quite a few day to day struggles because his cancer was on his sphincter, so elimination was painful and he didn’t have much control. At the end, however, he was almost comatose and not in pain. For me, it was a very difficult time, watching someone I loved age 30 years in six months. I had cancer at the same time, diagnosed a few months later (we’d only been married a few months). So I was taking care of both of us. It was a surreal time.

    My own cancer recurred ten years later (I got cocky and went off my anti-cancer diet). I was incredibly sick, and for a long time. The cancer had spread to several organs. I endured the treatments and to the surprise of my doctors, I not only survived, I’m still in remission four years later. I stick to a pretty strict low-carb, mostly organic diet. Frankly, after enduring the chemo and the surgeries and the incredibly boring sitting around for all those months, if I had died anyway, I’d have been pretty annoyed. But I survived, and I’m glad of it. I have a new perspective on life, have learned a great deal, and intend to have some fun in retirement.

    My hope is that our medical community can get with the better nuritional information that is out there now so that we can prevent more cancers, (and strokes, dementia, heart disease, diabetes, etc.) and at the very least, so many recurrences. Cancer is a drag. My husband died the way he wanted to. Personally, I’d rather be like Jack LaLanne and live to a vibrant 96, or so, and die of a brief illness like pneumonia. Barring that, I’d just as soon get hit by a truck.

  • Prai

    Richard Smith reflected his perspective and quoted Bunuel
    and Jean-Claude in support. It is not necessarily the same for others as reflected in the replies here.

    He mentioned 5 ways to die. A death during the course of cancer illness can fall into any category mentioned.

    Is anybody ready for death though death is certain? Nobody
    wants to die as survival is natural. To be ready to die any time as Smith writes, live every day as your last. Live in the present moment whether you want to die or live.

    Though some change their life with accepting outlook to live in the present moment when diagnosed with a terminal illness and embrace, rather romance death.

  • Keith Budden

    Having battled with cancer for over 10 years including all the trauma
    of last year, I have always said I would never wish cancer on anyone.

    Having been pointed at this article by a fellow cancer survivor,
    for the first time I am tempted to make an exception since this
    supposedly qualified ‘expert’ has said cancer is the best way to die
    (read article for details). Well all I can say Richard Smith is that if
    you think cancer is the best way to die, you are very much welcome to it.

  • Vivek Monteiro

    Death is a part of life. If we decide to live as we choose best, then we must also decide the best way to die, when that time comes, because death is a part of life, and not beyond the realm of choice.

  • Jo Marsh

    Crikey! What planet are you on? Let’s leave the Queen out of it, eh? At a base level, the Richard Smith’s misty version of ‘death’ was dealt with from his ‘ivory tower’ from where he sat and reeled off his thoughts picking quotes from here and there that seemed to qualify his thinking – wrote his testament. What RS wrote was of no medical insightfulness at all. Rating: disappointing – must try harder!!!!!!

  • Pavel Faigl

    No he did not. He died peacefully. RIP.

  • Pavel Faigl

    Take care as there is a hole in your logic. Have you made a decision to Live? Likely not, it was your Parents. Hence leave your choice of Death carefully out.

  • Pavel Faigl

    A deep, wonderful reflection on Life and Death. And a deep reflection on the meaning of Life, sor simply on Living. I wish you, dear P. Olsen, still many years of good health and a rich harvest of wisdom. Be well!

  • Pavel Faigl

    Thank you Louise Dotter for sharing these thoughts with us, so freely and so generously. There is so much wisdom in what you say that I started to cry (perhaps not with envy). Please accept my best wishes for your next part of this exciting journey. Good on you and greetings from Australia. (I will check the link you sent also).

  • Pavel Faigl

    Great advice Gary, well tested. The medicos should read it and not be imprisoned by their concepts. While I agree with you on many points, allow me to strongly disagree with you on RS (“how foolish”). He is not, not at all. Better read him again. Good day

  • Vivek Monteiro

    Pavel, I respect your disagreement with my view. But I do not agree that there is any hole in my logic.

  • Sylvina Tilbury

    I’m very glad to hear it, but my mother did – on both counts – as do very many cancer patients. Hence I would respectfully suggest that your cousin was one of the lucky ones, and that many relatives of the not-so-lucky ones would strongly disagree that a death from cancer is a “good death”.

  • Sylvina Tilbury

    I replied above before seeing this. From what I know you do not describe a typical cancer death. Many cancer deaths are brutal. Something like a third of cancer patients eventually die from a total bowel obstruction. I can think of very few worse ways to go.

  • k hood

    I am glad I have found people having this deduction I have felt for a long time that society’s obsection with no one should suffer the pain of a loved one dying from whatever course , and we must cure every cancer very short sighted and I fear for grandchildren and if I live to see them my great grandchildren. If we manage to cure every cancer in the world and prevent every other death what will become of the world, in the 50 years until the turn of the centory the worlds population trebeld what of the next 50 and that was in the days before all the advarnses I think the Doctor is right in a lot he said and we should stop and yes I have just been told I have bowl cancer and no I don’t know what my future holds

  • Sylvina Tilbury

    Or on the other hand you have someone like my mum, desperate to eat to build up her strength, hungry, but unable to keep a single thing down. Fully aware of what was happening and witnessing herself helplessly starving to death. And then as the cancer progressed even further eventually vomiting up her bowel contents as well.

  • Lucia Tommasini

    Why have the words of Richard Smith, ‘Dying of cancer is the best death’ had such a huge impact on people? Why should cancer necessarily cause death? Any so-called cause of death is simply
    imaginative because death happens simply on its own. We can’t control the time of death, it comes when it will. However, we can modify the quality of life before death. It is a fascinating and extremely difficult job to perform for oneself and others.
    Many people, scientists and laymen still believe that physical illness has an exogenous origin. When the evidence of that is not there, the layman and the scientist turn their attention to the organs, to the tissues, to the system where the disease appears. Usually, they do not consider the function. We understand the function but it is difficult to control it because it represents an action of the body deeply connected with our way of thinking, feeling and living. If dying of cancer is the best way to die, we should understand that we are not speaking of the illness as such but of the time which is given to us before death. No one knows when this will happen. Everyone of us will die. We are afraid of the
    quality of life before death. Cancer, in Greek, is called neoplasia and it means new life. We were born with a neoplastic cell staying somewhere in the body up to when it is called to manifest itself.
    A recent scientific report stated that through autopsia of persons deceased for reason other than cancer, scientists found calcinated cancers living in the body without causing any discomfort. Why are we so afraid of death? Why not take care of
    the quality of life? And on what to base the quality of life? Science proposes medicines to maintain this quality and the evidence is proving that this is not always the case.As a naturopath with a classic and Eastern approaches, I have been close to several people ill with cancer who made an autonomous decision to live with the illness, using it as a teacher, and who were asking help to understand the teacher, the cancer. Few were cured by themselves, through their understanding, others died within a framework where suffering was there with the full understanding of it and consequently taking benefit of the remedy and medicine available. The words of Dr Richard do not ask us to take into account personal experiences of cancer. They call for reflection, they should not be the object of an attack.
    They ask for a different way to view the problem. Why don’t we speak, communicating our different experiences, instead of waiting for the Centre of Oncology Research to find the cure for cancer? Why we do not understand that any illness is a mirror of something else living in ourselves, in our mind and emotions?

  • Pavel Faigl

    You know, Sylvina, thanks for
    your reply and input into discussion. May I say that he (LM, the late cousin) was
    initially in terrible pain; he could not stand on his feet. As if pins and
    needles were inserted into his soles…and the “medicos” were treating
    it with Panadol and (assuming just neurological pain) with Quinine. It took
    them sometime to realize that it was cancer which they identified in his bowels
    2 years previously and exorcised with surgery and powerful chemo. The pain, as
    he and us found later, was a result of chemo…they used platinum poisons and
    this is the “side effect”. LM told us that he should never consented
    to chemo but should have tried different alternatives…

    Once he realized that the
    Death is approaching, he embraced all pain-relieving medications and died
    relaxed and happy.

    As Death is invincible, it is
    still a better way to die while you can say bye-bye to your family and not be
    cut-off in an accident. Analogy could be found in Nature: a fruit should ripen
    and not be harvested while still green. Then we are ready for the next stage,
    fully ripe. And we are not the ones who harvest, as the harvest is not ours.

  • Lucia Tommasini

    Why have the words of Richard Smith, ‘Dying of cancer is the best death’ had such a huge impact on people? Why should cancer necessarily cause death? Any so-called cause of death is simply imaginative because death happens simply on its own. We can’t control the time of death, it comes when it will. However, we can modify the quality of life before death. It is a fascinating and extremely difficult job to perform for oneself and others.
    Many people, scientists and laymen still believe that physical illness has an exogenous origin. When the evidence of that is not there, the layman and the scientist turn their attention to the organs, to the tissues, to the system where the disease appears. Usually, they do not consider the function. We understand the function but it is difficult to control it because it represents an action of the body deeply connected with our way of thinking, feeling and living. If dying of cancer is the best way to die, we should understand that we are not speaking of the illness as such but of the time which is given to us before death. No one knows when this will happen. Everyone of us will die. We are afraid of the quality of life before death. Cancer, in Greek, is called neoplasia and it means new life. We were born with a neoplastic cell staying somewhere in the body up to when it is called to manifest itself.
    A recent scientific report stated that through autopsia of persons deceased for reason other than cancer, scientists found calcinated cancers living in the body without causing any discomfort. Why are we so afraid of death? Why not take care of
    the quality of life? And on what to base the quality of life? Science proposes medicines to maintain this quality and the evidence is proving that this is not always the case.As a naturopath with a classic and Eastern approaches, I have been close to several people ill with cancer who made an autonomous decision to live with the illness, using it as a teacher, and who were asking help to understand the teacher, the cancer. Few were cured by themselves, through their understanding, others died within a framework where suffering was there with the full understanding of it and consequently taking benefit of the remedy and medicine available. The words of Dr Richard do not ask us to take into account personal experiences of cancer. They call for reflection, they should not be the object of an attack.
    They ask for a different way to view the problem. Why don’t we speak, communicating our different experiences, instead of waiting for the Centre of Oncology Research to find the cure for cancer? Why we do not understand that any illness is a mirror of something else living in ourselves, in our mind and emotions?

  • Jo Jo

    Just one point I would like to make. It may be ok to say this at 83 but many suffer from cancer at a very young age and that is nothing to be grateful for

  • Chandan Das

    I am a thalassaemia major patient in Odisha,India, who was in danger of immediate death in 1983 when I had a chance meeting with the late Prof. R G Hendrickse,then Professor of Tropical Paediatrics at the School of Tropical Medicine, Liverpool. He arranged for my lifesaving treatment.Much improved,I am now 49.I have led what to me has been a wonderful life,& I cannot but believe that much lies ahead for me.
    In Dec 2014 I was diagnosed with hepatocellular carcinoma,went through 2 transarterial chemoembolizations,refused further invasive procedures,& am now on oral chemo.
    I wrote a poem in response to my condition shortly after –

    Even Cancer can be Beautiful
    ————————————–

    You see sea creatures through the electron microscope:
    A ball,golden,with tentacles:now a dandelion: again a sunflower
    And you reflect how brazenly these products of your own body
    Can just take over your own body,skull and crossbones fluttering and full,
    Pirates of the South Seas holding a merchant ship to ransom
    And such a wealth of riches in the ship!

    Cancer
    Creates its own world,its own ways
    Of living,breathing,thinking,feeling
    Shunting you from yourself into someone else.

    The road
    Offers no destination but it must be taken
    And the course you had planned when you set out from home
    Has swept you back to your own doorstep
    In an unaccustomed homecoming.

    find that in seeking the many answers I have in mind,for so long,
    I have long forgotten the answers: either that
    Or there are too many for answers.

    But one thing I do know
    The loveliness of gentle people
    Eases so much pain that even
    Cancer can be beautiful

    I was therefore surprised to come across your somewhat unusual
    statement(in a news report in The Times of India),which roughly corresponds with my view.But my poem was personal:to take it as a generalization would be forgetting two things:
    1) This cannot be a one-size-fits-all dictum.
    2)How can there be a “best way to die” when the very mention of death itself is appalling to those who commonly find little identification with Socrates?
    If anyone is interested I have analyzed the life-death paradox,social and legal principles & the euthanasia/ suicide issue, and my own struggle to survive with thalassaemia in detail from my own perspective in my autobiography.Just Google
    “Dr Chandan Das ‘The Road Taken’ LifePositive.”(It’s also on Facebook)
    Thanks & have a nice day!
    Chandan Das)

  • MARK KELLIS

    I am writing from the perspective of a loved one watching his father die a long death from cancer. Our family has long lived in a shroud of silence, due in large part to the addictions and the emotional neglect of my father. When dad was diagnosed with stage 4 cancer seven months ago, I thought I’d see a change. That the man I’ve never known might emerge through the tough veneer. 

    Yet, I sit still waiting for pieces of advice and reflections. Even as his cancer has progressed, the silence continues, and it becomes more deafening day by day. 

    Yesterday, my wife and daughter left on a day trip to visit family, and I stayed to care for my dad. Before long, I could tell it was going to be a long day for us both, as his diarrhea grew worse, he began vomiting, and he had a near fall. Hours later, after 4 conversations with the doctor, the storm started to pass slowly. The house was quiet and dark. I was sitting at the dining room table; my dad was sleeping in the living room. At first, I could hear him snoring, but he later fell into a deep quiet sleep.

    I started wondering if this would be how he would pass, alone, “on his own terms.” Do we die the same way we live our lives?

    Back to your point: “Death from cancer is the best.” Despite what I observe from my dad’s mostly steely exterior, I do believe the wheels are turning. And I’m not sure if poking or prodding him will hasten that process. Is it even my place? 

    Perhaps the prolonged death will ultimately be of more value to me. I have spent more time with dad in the last 2 months than I’d spent in the previous 5 years. My wife and I have all but abandoned our home to move in with him. Out of necessity, my focus has narrowed, and I take life as it comes, hour by hour.

    After dad’s death, I think I’ll be able to piece all of these things together. The silver linings may become more evident. For now, questions remain, so on to my daily task — to court patience and make it my friend.

  • Odishanews Insight

    I really appreciate to read this post. Odisha News

  • Merkava

    No. The best way to die comes in two flavors—1) the fashion of Attila the Hun, or 2) “Dr. Kevin G___, age 88, died today, while attempting to pass a truck by passing in a no pass zone, on his brand new Harley. He was exceeding the speed limit by 25 miles per hour. His fifth wife Emmy Lou, age 21, a famous supermodel in her own right, was also tragically killed in the accident.”

    Slow death by Cancer stinks.

  • Lucia Tommasini

    Why have the words of Richard Smith, ‘Dying of cancer is the best death’ had such a huge impact on people?

    Why should cancer necessarily cause death? Any so called cause of death is simply imaginative

    because death happens simply on its own. We can’t control the time of death, it comes when it will. However, we can modify the quality of life before death. It is fascinating and extremely difficult job to perform for oneself and others.

    Many people, scientists and laymen still believe that physical illness has an exogenous origin.

    When the evidence of that is not there, the layman and the scientist turn their attention to the organs, to the tissues, to the system where the disease appears. Usually, they do not consider the function.

    We know the function but it is difficult to control it because it represents an action of the body deeply connected with our way of thinking, feeling and living.

    If dying of cancer is the best way to die, we should understand that we are not speaking of the illness as such but of the time which is given to us before death. No one knows when this will happen. Everyone of us will die. We are afraid of the quality of life before death.

    Cancer, in Greek, is called neoplasia and it means new life. We were born with a neoplastic cell staying somewhere in the body up to when it is called to manifest itself.

    A recent scientific report stated that through autopsia of persons deceased for reason other than cancer, scientists found calcinated cancers living in the body without causing any discomfort.

    Why are we so afraid of death? Why not to take care of the quality of life? And on what to base the quality of life? Science proposes medicines to keep this quality and the evidence is proving that this is not always the case.

    As a naturopath with a classic and eastern approaches, I have been close to several people ill with cancer who made an autonomous decision to live with the illness, using it as a teacher, and who were asking help to understand the teacher, the cancer. Few were cured by themselves, through their understanding, others died within a framework where suffering was there with the full understanding of it and consequently taking benefit of the remedy and medicine available.

    The words of Dr Richard do not ask us to take into account personal experiences of cancer. They call for reflection, they should not be the object of an attack. They ask for a different way to see the problem. Why don’t we speak, communicating our different experiences without waiting for the Centre of Oncology Research to find the cure for cancer? Why we do not to understand that any illness is a mirror of something else living in ourselves, in our mind and emotions?

    (I would like to add this other para related to ayurveda)

    In Ayurveda, although described with different words, we find evidences of this illness. But our ancestors did not have the facility of scientific researches and findings. But they realised the existence of this degenerative state of life of the body considering prakruti, mind behaviour and style of life.

    Ayurveda teaches us how to maintain health and prevent illness. Jivaka was unable to find anything that couldn’t be a medicine and having an health restoring effect. I suggest that nowadays we are looking for remedies, medicines, therapies because we are unable to take the responsibility of ourselves, it does not matter if we are scientists or laymen.

  • Paulo Sousa

    A good description of living with a terminal pancreatic cancer diagnosis.
    But……

  • Ali

    Hi Guys

    I have just stumbled across
    this blog so not sure if it is still alive for discussion.

    I am an intensive care nurse and I guess a lot of you are right, those of us in the medical profession are a lot more accepting of death as we endure peoples last moments on a frequent basis. I believe Richmond Smith’s article is the start to allowing us to accept
    death even if it is from cancer. Because the hard fact is not one of us gets to choose our fate/death…. but we are all born to DIE…. If culturally we allowed death to be celebrated and controlled where we can 1. Those left behind would not feel the need to not live and enjoy the precious time they have left… and
    2. We would be able to help those dying in pain with any form necessary.
    I think we are concentrating on the wrong parts of death and that we have the resources now that no one should have to experience excruciating pain.

    I don’t believe we should stop research into curing cancer however we should also spend some of those resources on changing our culture so those left behind have coping skills to not hate death.
    We all have our own view on death (by cancer) and these usually come from personal experiences hence why there is so much hate, grief and sadness in a lot of the responses… Perhaps it would be
    nice to hear what would have made death by cancer a better experience for both the patient and the family they are leaving…. what I would luv to see come from such a gutsy article is if all of us to try and either learn or takeaway somethingfrom someone else’s view instead of just condemning it…….

  • Corfusalus

    I am currently battling colon/rectal cancer — both — two primaries — one in the rectum, a second higher in the colon. Caught relatively early (stage II for the rectal, stage I for the other, so recovery is probable, but from the time I first started contemplating the reality, I came to the same conclusion. Because I am/was in relatively good condition otherwise, the doctors recommended a VERY aggressive program of simultaneous radiation/chemo, followed by surgery. The result, however, is some REALLY intense pain, sometimes continuing unabated for as long as 60-hours at a stretch, and utterly impervious to some VERY powerful drugs for pain. Even in my case, knowing that the payback may be an actual CURE, there have been times when I questioned whether it was worth it, so I definitely would not want to be in a position where the duration and decision was in the hands of others, but overall, I agree with the philosophy expressed. I have been given an opportunity to review my life, tie up loose ends, evaluate successes and failures, make things right where necessary/possible …. Most of us tend to blunder through our lives as if they will continue forever. This circumstance forces us to continually ask the question: If I have time to do only one more thing, what is that going to be? It’s a question I wish I had started asking myself far earlier, but am grateful for the opportunity to have started asking it at all.

  • andre

    Modern medicine has suppressed Evolution by curing diseases. We are actually becoming a less advanced cellular creature

  • Marsha Coupé

    Found this superb article referenced in Dr Ranjana Srivastava’s Guardian column. I could not agree more with everything you’ve written.

    My late husband was over treated for osteosarcoma of the jaw. He died in slow motion over three-and-a-half years, at the age of 57. He suffered one of the most protracted and excruciating deaths imaginable. Modern medicine made our lives a living hell.

    Far better for us to have accepted the cards we were dealt and LIVED the time Richard had remaining rather than allowing ourselves to be talked into one crippling treatment after another.

    Thank you for an excellent essay on a topic deserving a lot more discussion.

  • Bruno

    This is soooooo wrong. You don’t have the faintest idea what you are talking about

  • I wholeheartedly agree with you, Mike. Cancer is not the best death. Cystic Fibrosis (which I have) is also a horrible death. I’ve lost over 70 of my friends to CF and have watched many die in great pain and suffering. I think that Dr. Smith is beyond an apology now because he believes his own BS. As soon as you start doing that, it’s impossible to recover and be a good doctor who can also be impartial and open to other opinions. Peace 🙂

  • Gerson therapy kills people. Full stop.

  • Lorna Payne

    I’m not going to join in the detailed debate …and I can see that what YOU think of this article will depend very much on your experiences with the death of loved ones. I don’t think he is saying that deaths from cancer are pleasant just weighing it up compared to sudden death or dementia. So if you had to choose a death, either for yourself OR involved in one a loved one would you choose to lose them suddenly with no warning, see them disappear into dementia, or some disease process… Of which cancer is the most common. My husband died in April last year only a month after being diagnosed with liver cancer. He was told it was much too late fpor ANY treatment….just palliative care. ( he had been quite unwell for most of the year before…but the doctors failed to diagnose anything and told him he should lose weight and get fit!) Maybe we were fortunate but he died at home with no medical intervention apart from a prescription for oral morphine 19 days later .The last seven days of his life h a form of dementia… His mind had gone but he was no longer afraid, and did not appear to be in pain though I consented to treatment treat it. His death was as good as it gets . We had been advised to sign a DNR so that in his last hours he was not rushed into hospital.
    I also lost my mother to Ovarian cancer five weeks after diagnosis. I lost my mother-in-law to brain cancer six weeks of the diagnosis. Five weeks after diagnosis. I lost my mother-in-law to brain cancer six weeks of the diagnosis
    I broadly agree with the article…..
    The trouble is in our country we are terrified of even TALKING about death, and when it comes knocking as it inevitably will we are completely unprepared. my husband and I had seen lots of people die we knew our deaths would come anythime and any how/. So we never left any relations damaged or unheralded, we never left anything unresolved between us…and we separated in as good a way as possible. I know there’s an Afterlife…science has lots of evidence. Death may be bad, sad. Painful but it’s not the end.

  • Anya Silver

    Oh my gosh, please do not lecture a woman whose daughter died, leaving her grandchildren orphans! That’s despicable. You have no right.

  • Uh…bang along? “death from cancer, where you may bang along for a long time but go down usually in weeks.” I’m not sure my sister, who died at 39, would consider the ups and downs of the pain of cancer ‘banging along’.

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