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Prepared for a good death

09 January 2015

I DO not know how I will die; although, because sometimes I forget, I often walk through graveyards to remind myself that I will. But is there a good death for me, a preferable manner of leaving?

Dr Richard Smith, a former editor of the British Medical Journal, has recently defended the indefensible by claiming that dying of cancer is the "best death", and that we should "stop wasting billions trying to cure it". So, what is good about cancer? It allows people to say goodbye, he says, and to prepare for death, which is preferable to sudden death, death from organ failure, or "the long, slow death from dementia".

Such positivity around cancer will be uncomfortable for some, echoing my discomfort with the take on the crucifixion in Monty Python's Life of Brian, where the crucified figure sang "Look on the bright side of life." The words sound callous towards the awfulness of the experience.

But it is the slow death offered by cancer which appeals to Dr Smith in his blog for the BMJ: "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."

He acknowledges that this is a romantic view of dying, but believes it achievable "with love, morphine, and whisky. But 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 people wish for a sudden death. I know a newspaper editor who wants to die at his desk, doing what he enjoys. But, despite being most people's departure of choice, sudden death can be difficult for those left behind, Dr Smith says, particularly where there are unresolved issues in a relationship which must now remain so. And "I never got to say goodbye" is a painful lament to live with.

Organ failure, he says, can leave people "far too much in hospital, and in the hands of doctors"; and a death after dementia "may be the most awful, as you are slowly erased".

I met a dynamic CEO in the pub recently - a man keen to make money on earth. But, as he ate his curry pie, he told me of the plot of land he had bought for his burial, beneath a tree and close to other members of his family.

Some might have considered the conversation morbid - there was a "look" from the neighbouring table - but it wasn't, because he was quite at peace about it all. And that is, perhaps, the secret of a good death. No terror here; although the film director Luis Buñuel did not want to die alone: "I must know whose fingers will close my eyes," he said.

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