A recent Wall Street Journal article discussed how some members of the medical profession regard their own dying. The point of the article was that some physicians, aware of their own prognosis as well as the difficulty and/or futility of chemotherapy and surgery, elect to live their remaining days without any of it.   

There truly is value in seeking quality in the days of your life rather than the quantity.

It is a fascinating look into the practices of some physicians.  I, for one, can understand how this might be the best approach to my own dying process.  But life is often more complex and difficult than that.  Some physicians, equally aware of the scientific data and literature on survival of various cancers, may still elect to be "very" aggressive when it comes to the health of themselves or their loved ones.

In his book Healing Lessons    by Sidney Winawer, well respected professor of gastroenterology details the trials and tribulations of his own wife's struggle with gastric cancer.   Well aware of the evidenced-based recommended treatments, the undocumented alternative options, the radical and unsubstantiated claims of other modalities, Winawer could not refuse his wife any of them.  Knowing the unlikely outcome from such alternative treatments, he agreed to them.  He could not allow his wife to lose ALL hope.

So the topic is far from closed.  Some doctors will choose to die without the toxicity and suffering that often accompanies chemotherapy.  Others will try any treatment that is held to be of some use.  

All of us pray for the day when therapy will be more tolerable–when the benefit of treatment outweighs the risk and suffering.  And there has been great progress made in targeting treatment to specific cancer proteins, selectively killing malignant cells rather than ravaging the entire body.

The truth is that we are like everyone else.  Knowing better doesn't mean doing better.  But we can do better for ourselves and others.  Objectively look at the evidence.  Does a "response" to chemo mean one year, one month or one week.

What is the toxicity and more specifically how will WE react to treatment?  If there is one observation that more than 30 years of clinical practice has demonstrated to me it is this—everyone is unique.  Everyone responds differently to every treatment.

We (patient and doctor) must respect that truth.  Can we begin a course of therapy and then choose whether or not to continue?

Unfortunately for doctors as well as everone else, we are humbled in the face of death.

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