Friday, 2 January 2015

In response to Richard Smith's BMJ blog "Dying of cancer is the best death"

"let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death."


So who's the idiot that said this? Richard Smith, former editor of the BMJ, in a BMJ blog post published on 31 December 2014, entitled "Dying of cancer is the best death".

What Smith says about dying

According to Smith there are five ways to die.
  • Suicide - but he doesn't want to discuss that.
  • Sudden death - great for you but rubbish for the people you leave behind, especially if you weren't organised enough to have your death and funeral all sorted out in advance.
  • Dementia - maybe the most awful, long, slow death.
  • Death from organ failure - you'll be in hospital and in the hands of doctors waaaaay too much.
  • Cancer - the best death!
And here is what Smith thinks death from cancer is like:

"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."

What a load of rubbish!

Dying from cancer - the reality

I'll give my mom as an example. Without going in to personal details, in a nutshell, here is the story of her death from cancer, starting just before we knew she was going to die. (She'd been diagnosed with breast cancer 6 years earlier.)
  • Saturday: She came to my house to dog sit for the evening while we were out. She was complaining of a headache and was not well. She stayed overnight.
  • Sunday: She was unwell and behaving strangely - drowsy, complaining of severe headaches, not "with it". She refused to allow an emergency doctor to visit - she wanted to see her own oncologist the following day - she had a check up already booked in. She stayed overnight.
  • Monday: She left my house to go to her oncology appointment - I phoned the hospital to tell them she had been unwell over the weekend - I was worried she wouldn't tell them. They gave her a brain scan and wanted to keep her in hospital. We visited that evening, and her oncologist privately told me the scans he had seen indicated the cancer had spread to the lining of her brain. She would have a few months to live. He didn't want to tell her until the next day when he had all scan results.
  • Tuesday: she had been having seizures in the night, was given lots of medication, and spent the entire day unconscious in hospital.
  • Wednesday: She was conscious in hospital but the oncologist was not in that day.
  • Thursday: In the afternoon the oncologist visited her and gave her the news. She didn't want to talk and went to sleep.
  • Friday: She was unconscious all day. I got home in the evening, and the hospital called me to tell me she had died in her sleep shortly after we left.
There was morphine, and there was love. But she did not get to say goodbye or leave last messages. She didn't get to visit special places for a last time, or listen to favourite pieces of music, or read loved poems, or anything else lovely like that. She had been turning up to the office and working the week before she died.

My mom isn't the only person I have watched die from cancer. Another example is my granddad who went in to hospital with a urine infection, and they found he was riddled with cancer. Over the following 5 weeks he died slowly, painfully, wasting away both physically and mentally bit by bit, day by day.

Death from cancer isn't the way Smith describes. It is incredibly painful - that's why you're given morphine. It is traumatic - for the person who is ill, and for their loved ones. It often involves multiple organs failing. The combination of chemical changes in the body as organs shut down, and the drugs given for pain, to stop seizures, etc mean the person you love can be replaced with a stranger. Death from cancer can make a person confused, aggressive, cold. They might not recognise their loved ones, or care any more about the things they once loved.

Death from cancer is cruel and frightening, for the person dying, and for the people around them. There's no amount of love, morphine or whisky that can change that. What Smith wrote is ridiculous, and very wrong.

"Lets stop wasting billions trying to cure cancer"

He doesn't stop there though! He takes it a step further and says that because cancer is the best death we should stop wasting billions trying to cure it because potentially that could leave us to die a more horrible death.

Seriously? Seriously?!

I wish that I could discuss this with Smith face to face. I have some questions I'd like to ask him.
  • Does he think the money spent on my treatment is a waste? I'm 33 years old and I have breast cancer. The NHS has done a wonderful job in enabling me to fight and get rid of the cancer, meaning I can go on and live a full life. Is the money spent on my treatment - the drugs I've been given, the salaries of the doctors and nurses treating and looking after me - a waste?
  • How about when children have cancer? Does he think the money spent developing treatments for cancer is a waste when it saves the lives of children who have their whole lives ahead of them?
  • How about the money spent on developing treatments for cancers with the best prognoses? For example, nearly all men with testicular cancer are cured. Is the money spent on curing testicular cancer a waste?
  • Can he not see that his statements about the different ways to die are so broad they are completely meaningless?
  • If he were diagnosed with cancer himself, would he refuse treatment, on the basis of his argument that dying from cancer will potentially save him from a more horrible death?
  • Similarly, if someone he loves is diagnosed with cancer, will he encourage them to refuse treatment on the same basis?

My alternative suggestion

Lets raise more money for research in to cancer, cancer treatments, and genetics. Let's do all we can to fight this disease that causes so much pain and suffering and save as many lives as possible. These are people we are talking about. Mothers and fathers, daughters and sons, sisters and brothers. Husbands and wives, boyfriends and girlfriends. Friends, neighbours, colleagues. Let's fund as much research as we can to keep the people we love well and with us for as long as possible.


  1. Sarah this is a brave blog post. After watching my Father die slowly, painfully over 6 months.. go from a 13 stone strapping 52 year old fella to an 8 stone skeletal man who had to wear a nappy (saying it how it is) with no dignity, pumped full of morphine, no control over his life and unable to eat, or move for the last 3 weeks, the only saving grace was he was at home receiving 24 hour care from the people he loved. We have often discussed how you wouldn't have put a dog through it, but he fought RIGHT until the end to LIVE - which is why your alternative suggestion is TOO BLOODY RIGHT! Sat here so angry at that idiots words .. but f-in proud of you for bringing it up ... xx L xx

    1. Thanks love, it made me so mad. I know so many people who have watched someone they love die slowly, and suffer far too much, as a result of cancer - and the kind of death it creates. The man is an idiot.

  2. I bloody love you xxxxx AJ xxxxx

    1. I love you back! Assuming I have guessed right who you are AJ! x

  3. You've just described my Mum's death from a brain tumour three years ago -- she never got to say goodbye and we didn't get to either. 3 years later and I am still haunted by her death.

    1. I'm so sorry Marie. Cancer is just so cruel. I am still reeling at Smith's comments and how far from reality they are. Cancer is a traumatic, painful, and difficult way to die - for the person and for all around them. Lot of love x