The acceptance of death can be a gift

I have a dear friend named Phil whose wife died after a long battle with breast cancer, leaving behind two young daughters. Always the good patient, she remained strong throughout her treatments. When ultimately moribund, she resisted the inevitable with all her strength. Everyone felt helpless.

Eventually, a close friend took Phil by the arm and said, “She is in such discomfort ... maybe she needs to be given permission to die.” As if awakened, Phil returned to his wife’s bedside and said, “I love you very much ... if you feel the need to go ... if you see God’s hand reaching out to you, it’s all right to leave. We will be OK.”

She indicated “thank you,” and with a long sigh, her tension dissolved. Two minutes later, Phil was called back to her bedside. She was unresponsive and died in less than five minutes.

People with illnesses are expected to be “good patients,” remain positive and be willing to take on the next challenge no matter how daunting. Maybe it is time to rethink this expectation. After 25 years in medicine, I would have to question whether an extra year or two of life would be worth the potential suffering that goes with treatment. Patients should be respected for thinking the same.

A recent full-page newspaper advertisement showed a patient saying, “No way am I going to just give in to lung cancer. There’s nothing I like better than a good fight.” Cancer treatment as “sport,” with victory for the strong-willed, might be inspirational for some, but probably insults others. Meanwhile, obituary pages tell of those who “fail,” some of whom suffered considerably through their final chapter.

Perhaps society needs to be given permission to consider “no treatment” as an option; to discuss death openly and supportively; to choose dying over more therapies with low odds of success and high odds of misery. Hospice and palliation centers recognize this, but patients are often referred to them too late. Ideally, even earlier, a patient’s medical team would fully explain cure and remission rates and expected complications and help direct those who decide “just make me comfortable.” The latter decision is not a failure.

Acceptance of death may be a challenge for many, but as one of more than 6 billion people in the world, I know that my time will come. I will consider it a blessing to die of natural causes.

When the time comes, I think I’ll open the best wine and share it with all who will spend time with a dying friend, have a cigar with my brother, have family time and just observe the weather: whole seasons of it, if I am granted seasons.

I’ll always be inspired by the words my mother spoke on the day she died, when the paramedics came into the house and saw her lying on the couch, weak and short of breath. They knelt down and asked, “What seems to be the problem?”

In a voice almost inaudible, she said, “My tennis game is no good.”

James Channing Shaw is a physician at the University of Toronto.