He shouldn't just accept this. There has to be something to be tried. With his notoriety, the option to try some experimental new treatment should at least be considered.
He knows it's terminal (it's spread all over the place), and if he chooses to live the rest of his life on his own terms and not enduring the significant side effects of chemo, then it's his choice and good luck to him.
My grandmother refused chemo (cancer in bowel, liver, lymph nodes) and I think she made the right choice.
He doesn't have a chance of lasting more than a few months, most of which will be painful and with rapidly decreasing functioning. With the type and severity of his cancer, an experimental new treatment will simply ensure that his last days are more painful than they need be.
This reminds me of an interesting article I read about Doctors being more likely to refuse cancer treatment - on the knowledge of trading quality of life for a shorter period rather than hanging on for longer.
Most physicians that I have talked about all agree that quality of life is more important than the quantity in this types of cases. Every treatment of late stage cancer is very invasive and rarely successful. If he wants to spend a month as healthy as possible with his widow to be instead of two vomiting and feeling miserable that is his choice and the correct one in my opinion.
There are few things that prolong life, most of them prolong the suffering and increase the emotional drain on the loved ones.
The BBC article (http://www.bbc.co.uk/news/uk-scotland-22015175) states that he may undergo chemo once his jaundice clears up, so it doesn't seem like he's planning to just go entirely quietly, but the reality is that he has to make a tradeoff between possibly making his last months or year (or hopefully a bit more, if we're lucky) total agony to extend it by what is unlikely to be more than months, or try to be comfortable for as long as possible.
Cancer treatments is still ridiculously primitive, unfortunately, largely boiling down to doing lots of damage while trying to keep the patient alive longer than the cancer.
Sorry, but there is a lot of assumption and ignorance in reply to your comment.
1. Modern supportive care means that chemotherapy does not involve constant vomiting, pain and torment. Some patients work and look after their family in between having chemotherapy. For example, in a large study on the efficacy of chemotherapy in biliary tract cancers including gallbladder cancer the rates of severe vomiting were only 5% (http://www.nejm.org/doi/full/10.1056/NEJMoa0908721). And when it does happen, it doesn't go on for 'months'.
2. If you shrink the cancer people feel better ie treatment can improve quality of life, that's why we do it.
3. Some cancers are indolent. This means that people can live for a long time with them, whether they have treatment or not. See Stephen Jay Gould's essay for example (http://www.cancerguide.org/median_not_msg.html)
4. Participating in clinical trials is a standard part of cancer management. You don't have to be famous to receive experimental therapies if you want them.
Having said all that, chemotherapy IS primitive and doesn't work as well as it should, and hopefully we won't still be using the same stuff we are now in 50 years. But it can help people, and trying it is not crazy or hopeless, and an extra couple of months might mean a lot to a particular individual.
It depends completely on which chemotherapy you get, which cancer you have, and sheer dumb luck. Both "chemotherapy" and "cancer" are blanket terms covering a multitude of radically different things.
Best case: your cancer is contained to a single organ and susceptible to antibody therapy. Practically no side effects, and you'll most likely be healed.
Worst case: your cancer has spread to multiple organs, requires the use of cytotoxics and your body reacts badly to those. You're better off setting yourself on fire - at least then you'll have to endure at most a few days of excrutiating pain before you die. No, that is not an exaggeration.
Source: my girlfriend who works as a nurse in a cancer ward specializing in chemotherapy.
Most importantly: make that decision yourself while you can! Don't leave it to the doctors (who only learn ways to keep patients alive at all costs, not ways to decide whether it's better to let them die) or your relatives (who'll tell the doctors to do everything humanly possible to assuage their feelings of helplessness and guilt).
That plainly isn't true. Why come to HN to make hyperbolic generalisations about cancer therapy? There are many people with advanced widespread disease who choose to have treatment. Are you suggesting that they are all foolish or coerced by doctors? Really? Would you be happy to come down to my cancer hospital and tell the 33 year old woman with 2 young children that she is better off "setting herself on fire" than having chemotherapy?
Your last statement also is incorrect. I spend just as much time talking about stopping therapy and options that don't involve chemotherapy as I do about giving chemotherapy.
> That plainly isn't true. Why come to HN to make hyperbolic generalisations about cancer therapy?
That was not a generalization; I explicitly labelled it as "worst case", but what actually happened to one of my girlfriend's patients is that as a reaction to the cytotoxics, his entire skin started to dissolve. This may have been an extremely rare special case, but it did happen, and the doctors in charge didn't stop the therapy even then. The patient died after suffering effectively as a burn victim for 2 weeks.
It's great to hear that you are willing (and presumably trained) to consider non-therapy as an option as much as whatever the newest miracle cure is, but that's definitely no the case for all oncologists everywhere.
You should read a little more carefully. He is not suggesting anything like what you read into it.
Having seen a bad reaction to chemo up close, I can confirm that it is pretty awful, and that I'd certainly have to think before choosing between a bad chemo reaction and setting myself on fire.
I've seen my grand mother die from gallbladder cancer. Weeks leading to her death she was miserable, she didn't have a minute of rest. Since then I understand why some people choose to end it early instead of prolonging the suffering...
Going through chemo isn't free of suffering. And in cases like Iain's it's often a question of having a "normal" 6 months of life or a miserable 8 months via chemotherapy.
Wow this got a lot more responses than I expected. I say this for two reasons:
My dad died in 1990 when I was 10 from cancer. He fought until the end. I spent 2 years from the time I was 8 till March 1990 watching this man do what he could to survive. I've sworn that if I ever develop cancer, I too will do whatever I can to survive. The point is that if there's a remote chance of me beating it, I can deal with temporary suffering for long-term survival.
The second reason is more that Ian Banks is one of my favorite authors. My imagination has been shaped by the worlds and stories he's created ever since I was a boy. I was introduced to his Consider Phlebas while my dad was sick and have read nearly all of his work since then. For me, this is all closely tied together emotionally.
Either way, I can respect his choices. They won't be my choices, but I can understand why.
