Dying with love, morphine, and whiskey

A Dec. 31 blog post on The BMJ (formerly The British Medical Journal) Web site by a former editor of that journal has the medical community abuzz.  Richard Smith, M.D., concludes that “death from cancer is the best.”  He admits that his view of dying of cancer is romantic:  "You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a 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.

"This is ... achievable with love, morphine, and whisky," Dr. Smith writes.  Further, he warns to stay away from “overambitious oncologists” to avoid overtreatment.

He compares what he considers four main ways to die:  sudden death; the long, slow death of dementia; the “up and down death of organ failure”; and death by cancer, “where you may bang along for a long time but go down usually in weeks.”  He observes that death from organ failure -- respiratory, cardiac, or kidney -- has you in and out of hospitals and too much in the hands of doctors, and he describes the failure of one organ after another as the “most horrible medical death.”

Many physicians were aghast at his suggestions, and I can understand some of their criticisms.  Many of us have known someone with cancer who suffered greatly, sometimes for many months, despite the best efforts of hospice (including lots of morphine!).  But there’s a lot of truth in his observations about the way we humans have to die.

I thought about Dr. Smith’s article in the context of pets.  My observations of companion animals over the past 38 years lead me to conclude that there is no “best” way for them to die.   Some pets with organ failure fall asleep and never wake up, dying a peaceful death, while some are clearly uncomfortable or in severe pain.  Ditto for cancer patients.  

Our clients with sick pets are given choices for treatment, including no treatment.  Most of them are loath to put their very ill pets “in and out of hospitals and too much in the hands of doctors.”  They are relieved that when we can no longer alleviate their pet’s suffering, we have the advantage of performing euthanasia.  I don’t necessarily advocate euthanasia for humans, but I think our pets are lucky not to have to experience a “most horrible medical death,” as many humans do.  We don’t achieve this with morphine and whiskey, but with a strong sedative and pentobarbital.  And love.