Re: How our leaders want to die—A call to action
As a long-time and avid reader of the BCMJ I look forward to reading the Proust questionnaire. These probing questions give us insight into the minds of some of our most prominent medical leaders.
I have recently joined the board of Dying with Dignity and head the Medical Advisory Council. I have also been involved in a number of legal cases in BC that have to do with the right-to-die issue.
I have been very impressed with a book I read recently, titled Ending Life: Ethics and the Way We Die, and in particular with a quotation that is attributed to Seneca: “Living is not the good, but living well. The wise man therefore lives as long as he should, not as long as he can… Just as I choose a ship to sail or a house to live in, so I choose a death for my passage from life. Moreover, whereas a prolonged life is not necessarily better, a prolonged death is necessarily worse.”
A number of famous Canadians have recently addressed this issue as well. David Suzuki was recently quoted in the Globe and Mail as saying, “If I get Alzheimer’s, frankly, I would just as soon be put down, because when my mind is gone, I’m gone. I’m just a body—a physical thing.”
Dr Donald Low, a prominent Ontario physician who led the campaign against SARS, released a nationally distributed video a few days before his death, seeking help with an assisted death.
Even more recently, respected BC physician Dr Marco Terwiel wrote an editorial in the Medical Post outlining his medical conditions and stating, “I do not fear death, but I have witnessed too many times where I and my colleagues felt helpless to relieve the suffering of patients as they begged to be allowed to die.” [Dr Terwiel died 4 January 2014; see the article on page 36. —ED]
It is in this context that I reviewed the Proust questionnaires that address the question, “How would you like to die?”
The following is a brief summary of the responses:
• Reminiscing with my wife and family.
• Having a glass of beer.
• Not knowing how and when it happens.
• No nasty symptoms.
• In my sleep (three responses).
• Shot by a jealous husband.
• In my bed at home.
• Instantly, no pain or suffering.
• Quickly and with dignity.
• In any fashion that would not inconvenience my family.
• Quietly with all my marbles.
• Skiing at Whistler.
• Reading Cicero.
• After a cigar, a glass of Bordeaux, and in my sleep.
There is a theme to these comments. Prominent doctors who have answered the Proust questionnaire all want to die quickly and painlessly after having enjoyed a full and complete life and perhaps while enjoying their favorite pastimes. What I find fascinating is that doctors frequently see exactly the opposite types of death, marked by lingering symptoms, dementia, ongoing pain, and misery. My sense is that there is more of the latter than the former available to us as we approach our end.
I was most dismayed when the CMA at the General Council 2013 voted not to even debate the end-of-life issues when it came to physician-assisted death. I find this appalling, given what we know and knowing how we would like to have our own lives end.
I would like the BCMA to take a leadership role on this issue and deliver on some of the wishes of the prominent physicians who answered the Proust questionnaire.
—Derryck H. Smith, MD
Derryck H. Smith, MD, FRCPC. Re: How our leaders want to die—A call to action. BCMJ, Vol. 56, No. 1, January, February, 2014, Page(s) 12,47 - Letters.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org
I so enjoyed reading Dr. Smith's comment on dying with dignity and the Proust Questionaire. It's not something I necessarily thought about 10 years ago. As an aging boomer yuppie I think Dr. Smith very wise in bringing increased medical attention to a topic which we as physicians have so long considered with regard to our patients but might well need to consider for ourselves. Great read. Thank you.