Columnist Art Buchwald died last week, after nearly a year of life his doctors did not expect him to have. Buchwald had chosen to avoid the extension of life promised by kidney dialysis, instead choosing to live his last days on his own terms.
Death is not something we like to think about, but in medicine it is a regular reality -- particularly in oncology. For many patients, thnase choices offered by the current state of oncologic medicine are not easy to accept: disfigurement, chemical warfare agents, extreme nausea, hair loss, memory loss, persistent loss of feeling or constant pain, complete ablation of the immune system, etc. Yet, when the other choice is death, how could anyone choose otherwise?
The answer, of course, is complicated, and each person makes their own choice as to their path. A good exploration of this topic is Sherwin Nuland's book, How We Die. Nuland is a wonderful writer, and he uses many personal stories to trace the topic. The first chapter describes the gradual decline of his beloved grandmother. Particularly poignant for me was the story of a friend of his who was diagnosed with cancer. Nuland recommended an extremely aggressive course of treatment. At the end of his life, the friend basically said "thanks for your concern, but please don't do that to anyone else" -- the small amount of time wasn't worth the agonizing side effects. It is a sobering message.