“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 the last time, listen to favorite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.”……Richard Smith ( BMJ blog). Just like many other survivors, I am also distraught after reading Richard Smith’s blog titled “Dying with cancer as the best death.”

I understand that this is his opinion and he has a choice to express his thoughts. What is wrong is drawing a conclusion about a disease process based on one or two stories that he quotes, sidelining the slow painful deaths that are caused by cancer and the agony of those who love the ones with cancer and seeing them suffer.

When I was young, I also thought that slow death is better than sudden death. I also thought that having the time to say goodbyes and to do some of the things from the bucket list would be great. Now that I am in my forties, with two young children, a husband, numerous friends, and patients, I don’t know if I can take a position on my death and how it should be and as a matter of fact anyone’s death.

Death and dying is a very personal experience. Knowing viscerally that you will die after the diagnosis of cancer is the hardest part of accepting cancer. The word “cancer” feels like an engine to which death cars are always attached. Life with cancer means living in full view of possible death. Thinking about it, worrying about it, accepting it. Death with cancer means prolonged suffering. The psychological distress that occurs after cancer diagnosis is relentless. Dark thoughts are always around. Physical pain and stupor of death approaching are gruesome, slowly but surely.

Knowing that you have cancer and that too the kind that will kill you in a few months, is not all about reading love poems and traveling. It’s about trying hard to find hope every day to get through from morning to evening despite the heavy weight on the chest. It isn’t just about going to Eiffel tower for one last trip, it is also endless appointments and sad encounters.

Dr. Smith cautions, “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.”

Most of the time death is horrible. Yes, there is something to be said about letting go gracefully of life when death seems inevitable, but living to ripe old age is the way of nature for the majority. That is how we are designed to think.

Letting go, for someone in their 80s, whatever the cause of death might be, is different than letting go, for someone in their 30s after dealing and fighting with cancer.
He seems to have no clue about so many that live with the pain of metastatic illness, knowing that death is on its way, but the wait is excruciating.

Love, morphine, and whiskey is his recommended path to the bliss of cancer death.
I wish it were a trick that would work for all. It’s hard for a dying person to continue to love life and allow others to love him or her knowing very well that their grief is impending. Many disengage emotionally in the face of impending death. Not all medications mix with alcohol and not everyone tolerates morphine.

It is a shame that he, a doctor, thinks that he can decide what a “good kind ” of death is. We, physicians, at the most get a small window into the pain of prolonged death. We write orders, comfort the patient and move on. We know only when explained, what the intensity of bone pain is like. We can only measure pain and disability on a scale that is subjective for each patient.

Pain is also very personal, just like death. Having had cancer, pain scares me more than death. Prolonged painful death with cancer metastasis in the bones or other organs. A state in which pain would make me want to accept the other alternative — death.

Dr. Smith’s take on cancer death is highly irresponsible. Maybe for an old person in their 70s, with tons of money and resources and no human attachments, death with cancer may be fairly romantic. That it would come with increased vigor to live the life that is left, find inspiration and meaning, read love poems, and say prolonged goodbyes.

As a mother of two children, 4 and 7, I am unsure how prolonged my goodbye should be. Ideally for it will last a lifetime. My children make me want to wake up every morning and fight cancer with all my might. Yes, I have more inspiration to live life and am more accepting of my life circumstances but dying from cancer is not my fantasy, neither do I feel this privilege having been bestowed upon me as a possibility.

I accept death as an inevitable consequence of being born but at the same time I don’t have an opinion on exactly how I want it. Neither should anyone try and convince another about what is the best way to die.

Cancer has been called a blessing and gift by many that find meaning after their diagnosis and now cancer-death is the best death. Well, I am apparently in such good position for this kind of death, according to Dr. Richard Smith. Thank you for your insight, your flowers should be arriving shortly.


  1. You wrote a beautiful wonderful comeback to Richard Smith’s deplorable article. My mother’s death was physically agonizing just to watch. There comes a point where no amount of morphine will ease the pain. I wish cancer death really was romantic like in the movies where I could die with long flowing hair, full make-up on, gently whispering words of wisdom to my loved ones. Unfortunately for most patients dying of cancer, the reality is much more ugly. Thank you for your insightful writing on this important issue.

  2. I have thought about the contrast between my mother’s death and my grandmother’s, and have come to the conclusion that this man is an idiot.

    I was a teenager when my grandmother died of MBC, 2nd oldest grandchild. My younger cousins missed out on really knowing that wonderful lady. She was sent home with pain meds to die within months. We did say our goodbyes, but the rest of what Dr. Smith says was pure hogwash. She was too sick to go anywhere and had no problems with people or God that needed mending.

    Contrast that with my mother’s sudden death in her sleep in her 80s. Her grandchildren all had the privilege of knowing her. She did not suffer. Like my grandmother, she had no fences to mend with God or people. Unlike my grandmother, she did not go through months of pain and disability.

    As for saying goodbyes, that is more for the people left behind. I do not think we will feel bad in Heaven that we left too quickly to say goodbye. (Of course, as someone who suggests cancer research is wasted, perhaps Dr. Smith’s future reservations are for a much warmer place.)

    I have metastatic breast cancer. Apparently, I will follow my grandmother’s path. But, with treatments, from research Dr. Smith considers wasted, I have a few years instead of a few months. Hopefully, the pain meds have improved. But I’m sure cancer will deprive me of my dreams of watching my grandchildren grow up. And considering how many people are deprived of even seeing their children reach adulthood, how can anyone find anything good about cancer?

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