COMMENTARY

Cancer Death the Best? David Kerr Begs to Differ

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

January 12, 2015

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I'm David Kerr, professor of cancer medicine at the University of Oxford. I would like to comment about a blog[1] that was posted recently by my friend Richard Smith, a former editor of the British Medical Journal.

Richard is a clever, provocative contrarian and we must assume that an element of his article is somewhat tongue-in-cheek. In the article, he explores the four best modes of death and concludes (and it is a personal statement) that cancer is the best way to die.

He has had a long career as an editor of some note and has had a variety of different roles in the media (including as a TV doctor), so he has had many chances to put himself in front of audiences of lay people and patients with all different types of diseases, and he has concluded that cancer is the best way to die.

Why? Romantically, he thinks it is because it gives you time to get things in order. It allows you to read last books, write last poems, revisit and perhaps rekindle old loves, and somehow get your affairs in order because the tempo of the disease, the tempo of death, is relatively slow. It gives you a chance to order that final bit of life.

He contrasts this with sudden death, which may be ideal for the dear departed. But for those who are left behind, it is difficult. In these views, I sort of understand what he is getting at. I had just started medical school when my mother died sitting at my shoulder. Her head just gently tipped forward, came to rest on my left shoulder, and she had gone. So much unsaid, so much mystery, so much more yet to know, but she had gone. Some years later, my father died of cancer—nasty, pancreatic cancer—over a period of weeks. We did have enough time then, with my brother. We talked things through. We got to know more about my father in those last few months than we did in all of our boyhood lives with him.

So I see what Richard is getting at, but he ends his article on a daft, mad note in which he says, "Beware, overzealous oncologists" (this is me he is talking about), and (using his words), "We should stop wasting the billions of dollars that are spent on cancer research trying to overcome this disease." This is just plain nutty. It is crazy and I can't imagine for a moment that in his heart of hearts he really means that.

This has offended and upset hordes of people, and he is wrong. We are here to seek, to strive, to overcome, to use knowledge, and to see what we can do to conquer cancer, and that is not going to stop. It is not, Richard, and you know that.

In terms of final modes of death, I would select a quick and sudden death, of course—to go to sleep for a moment, to nod off, to pass from one room to another (whatever one's belief or credo). That seems a cleaner, quicker, better mode of death. It's harder for those left behind, but preferable, by far, for the individual.

In terms of Richard's final comment about abandoning all hope and cancer research, that is daft. You know it is, and we are not going to stop. We are not going to be overzealous; of course, some of us are. We have talked many times before about how we can better cancer care by understanding that we can overachieve, that we can go too far. But perhaps the best sign of a mature oncologist is knowing when not to treat, when to stop treatment, when to say, "We still care for you but we will use palliative medicines rather than the harder cytotoxic drugs." I understand all that, but we are not going to stop, Richard.

Thanks for listening. I would be very interested in your comments on this.

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