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.
•    Quickly.
•    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.
•    Suddenly.

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
Vancouver