Did you catch this fantastic article in this month’s edition of the BMJ?

“If we don’t die of cancer, what are we going to die of?”

“Would it signify success if no more deaths were caused by cancer? Maybe; some cancers are particularly nasty, causing pain and disability, fracturing life, and causing early death. But other cancers barely cause a blip on our existence.

And what should we die from instead? It’s worth asking, because the cause may well affect the kind of death we have—and we should rightly be concerned about that.

Do we want a sudden death, from a heart attack or a stroke, with no warning and with little pain or suffering? We could live in good health until that moment, unburdened by worry about what lay ahead. But such a death would give us no time to acknowledge the end of our life. Would we miss having the time to draw our families and friends together?

I’ve had the pleasure of witnessing this type of living wake, where the dying person is comfortable, often infused with morphine, central to the room, having their feet rubbed by a son or daughter as food, drink, and bittersweet conversation fill a room already stuffed with love.

Would we prefer a slower decline into frailty—fracturing our hip, being in hospital for weeks, coming home to develop pneumonia, and recovering only to have a stroke—with a sliding loss of independence?

Certainly, we should not want our lives to be cut short. But in medicine we are often taught to see death as a failed medical endeavour. It can be hard to believe that death can involve anything other than fault and blame—that is, we see it as something that could have been averted with an earlier diagnosis, a quicker scan, or a better treatment.

But thinking like this only makes dealing with death harder. I’m still struck by my own distress about death—whether at home or at work, and even when it’s expected—despite my knowledge of its inevitability and the fact that it’s often a relief. Seldom, in medicine, do we seem to celebrate good deaths; perhaps it’s time we allowed ourselves to.”

Margaret McCartney, a general practitioner in Glasgow

BMJ 2014;348:g3380

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