Intended for healthcare professionals

Editorials Christmas 2011: Editorial

Death can be our friend

BMJ 2011; 343 doi: (Published 21 December 2011) Cite this as: BMJ 2011;343:d8008
  1. Murray Enkin, professor emeritus1,
  2. Alejandro R Jadad, professor and chair 2,
  3. Richard Smith, chair3
  1. 1McMaster University, Canada
  2. 2University Health Network and University of Toronto, Toronto, Canada
  3. 3Patients Know Best, London SW4 0LD, UK
  1. richardswsmith{at}

Embracing the inevitable would reduce both unnecessary suffering and costs

“As birth and death actually occur, and our brief career is surrounded by vacancy, it is far better to live in the light of the tragic fact, rather than to forget or deny it, and build everything on a fundamental lie.” (George Santayana)

“Oh build your ship of death. Oh build it!

for you will need it.

For the voyage of oblivion awaits you.” (D H Lawrence)

Would you like to die the way your patients do, doctor? We suspect that many of you will answer no. Too many people are dying undignified graceless deaths in hospital wards or intensive care units, with doctors battling against death way past the point that is humane. Because too many doctors have forgotten that death is a friend, people are kept alive when all that makes life valuable has gone. Denying the inevitable comes with a heavy price. We believe that doctors and their patients need to adopt a much more positive attitude to death to reduce suffering and costs.

Death is one of the two great events of our lives. Beyond early childhood we must live with the certain knowledge of death; until medicine began its unwinnable war against death, coming to terms with your death was one of life’s most important tasks. Ars Moriendi (The Art of Dying) from the early 15th century was a best seller for 200 years, and William Caxton printed 100 copies …

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