Intended for healthcare professionals

Editorials Christmas 2011: Editorial

Death can be our friend

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d8008 (Published 21 December 2011) Cite this as: BMJ 2011;343:d8008

Re: Death can be our friend

Richard smith in the rapid response to his editorial poses a thought provoking question of huge practical relevance on this issue. (1)(2) What do doctors do when facing imminent death? Are they more accepting of death and avoid futile treatments? Or do they fight for life by every means possible.

I suspect most doctors practice what they preach to their patients. They fight the disease and in fact, go one step ahead, and use all possible avenues of treatment.

Richard smith’s anecdote of an orthopaedic surgeon with pancreatic cancer who embraced death and avoided futile treatment reminds me of two doctors of international repute who took the contrary approach.

One of them is a Nobel Prize winning doctor. Ralph Steinman, posthumously, won the Nobel Prize for his work on dendrite cells. He, like countless other cancer patients ‘was determined to fight—and to win'. He in fact 'devised his own experimental immunotherapies using dendritic cells'. He was given a dismal prognosis in 2007 and he was aware that 95% of pancreatic cancer patients die within a year. He eventually died 4 years later in September 2011 a few days before the Nobel Prize announcement was made. It is possible that various therapies, both conventional and experimental, prolonged his life expectancy significantly more than the lay patients. (3).

The former editor of NEJM is another doctor who on diagnosed with oesophageal cancer sought the expertise of the great and good. In fact, he felt overwhelmed by the information overload.(4)

Like these two doctors, most expert doctors probably do use their expertise and knowledge to fight the disease and prolong life.

Quite possibly, one person’s futile treatment is another person’s ray of hope.
Doctors have been trained to choose hope over futility. (and by the way who defines futility?).

References
1. Enkin M, Jadad AR, Smith R. Death can be our friend. BMJ. 2011;343:d8008.
2. Smith R. Do doctors die differently? [Internet]. BMJ rapid response. 2011 Dec 22;Available from: http://www.bmj.com/content/343/bmj.d8008?tab=responses
3. Stafford N. Ralph Steinman. BMJ. 2011 Nov 23;343:d7497–d7497.
4. Ingelfinger FJ. Arrogance. N. Engl. J. Med. 1980 Dec 25;303(26):1507–11.

Competing interests: No competing interests

28 December 2011
S SUNDAR SANTHANAM
Consultant Oncologist
Nottingham University Hospitals NHS trust
Hucknall Road, Dept of Oncology, Nottingham NG5 1PB