Richard Smith wrote a New Years Eve opinion on The BMJ blog titled Dying of Cancer Is the Best Death. Early in the piece, he asks, “How do you want to die? You must think about it.”

As a metastatic lung cancer patient, I have spent significant time thinking about my death, which will likely come sooner rather than later.  I believe it’s important for people to accept death as a part of life and discuss end-of-life preferences with loved ones while life is still pleasant.

But Smith’s piece is not about awareness of death and treatment options.  It is about the best way to die.  And Smith gets it entirely wrong. I cannot accept his conclusion that cancer is the best death.

In Smith’s admittedly romanticized vision, a dying cancer patient “…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 …it is achievable with love, morphine, and whisky. “

The reality is that death from cancer often does not conform to Smith’s vision.  Death by cancer happens when tumors cut off your air supply, compress your heart so it can’t beat properly, block your gut so you can’t eat, cause organ failure, erode your bones, press on nerves, or destroy bits of your brain so you can’t control your body or think properly.  Sound painful?  Without pain medication – sometimes even WITH morphine and whisky – it is.  Yet according to the European Society for Medical Oncology, the majority of people in the world who die of metastatic cancer are NOT given the option to receive pain medication such as morphine. “Among patients with terminal cancer, 80% are estimated to experience moderate to severe pain due to inequitable access to medicine.” And this isn’t happening only in third world countries.

Not all forms of cancer give patients the luxury of time to set their affairs in order, resolve family issues, or tackle that bucket list.  In my too-familiar world of lung cancer, the majority of patients are diagnosed when the disease has already spread to the brain or other organs.  Among the lung cancer patients I’ve come to know online through their own posts or those of their caregivers, death can claim patients before they have established financial security for their family, raised their children, finished college — or even had time to recognize that they are dying. Many linger after they’ve lost the ability to do what they love, communicate, or think clearly. Most will eventually find themselves dependent on others for their basic needs while still aware of the emotional and financial stresses their illness imposes on their loved ones.

This is not the death I would prefer.

And then, Smith tacks on his ulterior motive: “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.”

Wow.  If you follow this reasoning to its logical conclusion, we need no medical profession.  You’re going to die at some point, and being cured of one disease just means you’re going to die of something nastier later.  When you get sick, just take the morphine and whisky and get it over with.  Too bad we wasted our resources discovering antibiotics that cured the top three killers in the USA in 1900:  pneumonia/influenza, tuberculosis, and gastrointestinal infections.  Now people must die of heart disease or cancer instead.

**Deep breath**

I’ve lived long enough to know what different kinds of death look like.  A parent died from dementia over a decade.  Friends were struck down quickly by accidents or sudden sickness.  Other friends have dealt with organ failure, cycling in and out of good health.  And too many in my online and real life community have died of cancer.  Some metastatic cancer patients pursued clinical trials and aggressive treatments in search of a cure, while for others, solely palliative care was a brave and appropriate choice.  Ultimately, only the patient can decide which approach to treatment is the best for them.  Thanks to cancer research, most have some options, and some (like me) live comfortably for years.

Few of us know for certain how or when our death will come.  It would be lovely if Richard Smith’s idyllic vision of cancer death were true:  we could all know when death was near, take time to prepare, then take a pill and die comfortably.  Those who live in states that support death with dignity can actually make that choice, but most just have to wait for the credits to know how their story will end.

If I could choose my form of death, I would live each day with full awareness, do and say what’s important while I can, enjoy life and my loved ones as much as possible, and die quickly in my sleep.

I would not choose cancer.  If I could choose.