What is the best disease from which to die?

We can’t, of course, plan the way we’re going to die (with the obvious exception of suicide). We can, however, live in such a way that reduces the likelihood of our dying from certain diseases. Which is why it’s now almost universally accepted that we should exercise regularly, not smoke, drink only in moderation (if at all), avoid too much fat in our diet (and now probably too much carbohydrate), and not gain too much weight as we age.

Even a quick perusal of this admittedly incomplete list of healthy behaviors reveals that most of the actions within our control aim at reducing our risk of death from heart disease. Certainly, we’re lucky that we have so many ways to reduce this risk as heart disease remains the number one cause of death worldwide. But here’s a strange paradox: as we’ve gotten better at preventing death from heart disease, we’ve increased our exposure to the risk of death from other diseases that kill far less quickly and that arguably end up causing far more suffering. The older we get, the more likely we are to become ill with diseases like cancer, dementia, and stroke, to name just three of the most common illnesses that preferentially affect the elderly.

True, we’ve also become better at treating these diseases, too. And even when we can’t cure them, we can help people to live longer with them. But is this necessarily a good thing? Certainly, longer life in general is. But what kind of quality of life are the elderly now able to anticipate? We’re not nearly as good at measuring quality as we are quantity, but the data we do have paints a surprising picture: there has developed what scientists call a “lengthening of morbidity” among the elderly—meaning we’re spending more years living with chronic diseases and poor health. Though one study reports that exercising in middle age seems to increase the number of years we live into old age without developing chronic illness, we’re now more likely than ever to reach old age and thus experience suffering at the hands of disease at the end of our lives.

When I’ve had the courage to ask some of my elderly patients who suffer from chronic, debilitating diseases about the quality of their lives, I rarely hear them tell me it’s good. “I’m getting by,” some say. “I’m okay,” say others. Some, however, just shrug, as if to say, “This is the life I’ve been given. What can I do but endure it?”

Because the answer to that last question is almost always “nothing other than what you’ve been doing,” I don’t typically pursue the conversation any further. But lately I’ve been wondering if we aren’t all caught in a peculiar moment in our history, one in which we’ve made great strides in delaying and even preventing the number one cause of death but in which we’ve not yet made equally impressive advances in delaying and preventing the other diseases that we’re all now at greater risk for getting because we’re less likely to die of heart disease earlier in our lives.

Having watched so many patients die unpleasant and lingering deaths, I have little doubt that death from heart disease is better than death from many other maladies. Yet an early death from heart disease seems equally undesirable. Which has led to another uncomfortable paradox: all the work we’re encouraged to do to minimize our risk of death from heart disease actually increases our risk of having an unpleasant death.

Though ideally we’d all live to a great old age and drop dead from a heart attack, to delay such an end through healthy behaviors is likely to prevent such an end in the first place. Eventually, science will offer better treatments for the other diseases that living longer makes us all more likely to contract, but for now, we all have to live with the truth that decreasing the risk of dying from one disease has increased our risk from dying from other, arguably more horrible ones. And though realizing this hasn’t diminished my enthusiasm for helping patients to decrease their risk of dying from heart disease, it does refocus me on the quality of life that such interventions are trying to buy them.

What, then, is the best disease from which to die? Unfortunately, the one we’re the best at preventing.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.  He is the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self.

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  • DavidBehar

    I plan to be assassinated by a lawyer who cannot take me anymore.

  • Jim deMaine

    It seems to me that my quality of life in my 70′s is much better than it would have been 20 years ago. I have two new partial corneal transplants which give me 20/20 vision so I can still play tennis – hopefully into my 80′s. My Sarcoidosis is treated and quiescent. Friends are having new hips and knees by the dozen. I play bridge against women in their 90′s who can trounce me every time. Now we all aren’t like that so when we do need it we now have robust hospice and palliative care. In my state we have the POLST which very well puts our wishes into standing medical orders. Also about one in five hundred avail themselves of the death with dignity law in Washington State. So it’s not all gloom and doom. And remember, there’s the next great adventure awaiting us. Our time here so brief as Jacques reminds us in Shakespeare’s “As You Like It” – (All the world’s a stage, etc.)

  • John Noeil

    Even heart disease won’t make you die suddenly these days. 20 years before when I started my clinical career it was not rare for me to see sudden deaths of “undiagnosed causes”. But not even a massive MI can’t your life just like that. We, the Physicians won’t let it do. We are stretching the duration of life and its our duty to improve up on its quality. It will happen sooner or later

    Dr.John Noel


    It’s not how you die, but how you live.

  • ninguem


  • katerinahurd

    Do you think that the unease of pysicians with dying and death started in medical school? Do you think that haonoring a DNR order from a patient reflects the patients quality of life that is more than the recordings of vital signs and is synoimous for the patient of the recognition of the futility of certain medical interventions? Do you think that a physician who is believes in the ethical principle: first do no harm, will unquestionably honor a DNR order.

  • http://www.facebook.com/tersia.m.burger Tersia Oelofse Burger

    I have decided no more dieting, exercising or anything remotely restricting, I would hate to develop AD or something as debilitating or degrading.

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