WE know we all have to die one day, since dying is a part of the life cycle. However, if you had a choice regarding your mode of death, how would you choose to die?

An article written recently by a former editor of the British Medical Journal is causing quite a stir, as it suggests a preference for dying from a particularly feared disease over other ways of dying. In reflecting on the many ways humans can die, including sudden death, the slow decline with dementia, and stepwise organ failure, the former editor concluded that “death from cancer is the best”.

The author, a medical doctor, proposed that when cancer is the cause of death, there is time 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 yourself, according to your beliefs, to meet your maker or enjoy eternal oblivion. This is achievable with love, morphine and if one wishes, even marijuana. The author also advised staying away from overambitious oncologists to avoid overtreatment and a death that is “kept at bay by the miracles of modern medicine”.

Since he considered this mode of death to be the most humane, he advised against spending billions trying to cure cancer, thereby leaving us to die a much more horrible death.

A plurality of views

We live in a pluralistic society where varied values exist, and so, such sentiments would naturally find both support and antagonism. Some people gave opinions from one side of the issue, without considering whether alternative modes of dying would have been better and if so which one? They opined that their relative’s death from cancer was slow and horrible, and some cancer patients said they were very grateful that research into cancer was keeping them alive.

The widow of a patient who died from pancreatic cancer said her husband was diagnosed at age 48, after being healthy all his life. During his illness, she said he was in severe pain, especially when lying down, and so he could not sleep and therefore had to simply pace the corridors and outdoors. Yet, she said his treatment allowed him to survive 27 months after diagnosis and gave him some amount of time that was pain-free as well as a chance to live life outside work. However, she admitted to being traumatised as she watched her husband starving to death because he had no appetite.

Another criticised the author for suggesting that research be done away, saying that tremendous strides have been made in treating childhood leukemia and breast cancer. This person admitted that, while there were overzealous oncologists, many of them did a lot of good.

Despite these views, others supported the cancer-preference view. These people considered dying from cancer a more humane way of dying in modern times, when compared to drowning, burning to death, of being kidnapped and killed. They quoted the possibility of care in a hospice or at home, surrounded by family, and getting the best drugs and painkillers to ease the journey. That way, everyone get a chance to say goodbye.

The four ways to die

The author suggested that there are only four main ways to die: sudden death; the up and down nature of organ failure where it is hard to identify the final descent into death, thereby tempting doctors to go on treating for too long; the long, slow death of dementia or similar brain disease; and death from cancer, where people may die after a few weeks, or be around for some time.

For people who would choose sudden death, including suicide and motor vehicle accidents, they often do not contemplate its terrible effects on those who are left behind, and particularly those with whom they had a strained relationship who would have wanted a chance to put things right. Persons who die from organ failure, whether respiratory, heart or kidney, will spend far too much time in hospital and in the hands of doctors, with massive financial expenditure.

For those with dementia (for example Alzheimer’s), the long, slow death may be the most awful as the individual’s personhood is slowly erased and relatives are agonisingly tortured as helpless bystanders in the process. Consequently, the argument went, “death from cancer is the best”.

So, when we take this holistic view of the many possible ways of dying, perhaps we will come to have less fear about cancer. We all perhaps would prefer not to die, but since death is inevitable, if you consider the ethical perspective of minimising harmful effects on others, given all that you now know – what mode of death would you choose?

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the Ethicist at the Caribbean Public Health Agency — CARPHA. (The views expressed here are not written on behalf of CARPHA)