Jeremy Laurance: 'Even the doctor can't tell us just how long we've got left to live'

Medical Life

The diplomatic row over the release of Abdelbaset Ali al-Megrahi, the Lockerbie bomber, casts interesting light on how doctors judge the length of our lives. The Libyan national, aged 58, was released on compassionate grounds from a life sentence on 20 August last year after being diagnosed with terminal prostate cancer. It was said that three months was a "reasonable estimate" of how long he had left to live. Almost a year later, he is still alive.

Doctors have to be optimists. "Oh dear, it looks bad" is not a helpful response for any patient, however grave their condition. Keeping up the spirits of those they minister to is a fundamental part of care.

But they must also avoid unduly raising expectations, only to have them dashed. When asked how long a patient with a terminal illness has got, most doctors will play it cautiously. Better to say three months and have them live longer than to say six months and witness the shock of a family surprised by an unexpectedly sudden death.

In Megrahi's case, the situation was complicated by the public interest in having him die sooner rather than later. Normally, no one would be likely to protest if a patient lived longer than expected. Here, it mattered. Perhaps his doctors, rightly judging that their duty was to the patient in front of them, failed to recognise the public impact of their advice. But the most important lesson from the case is what was meant by that "three months to live" estimate. Did the doctors really put it like that? I wonder.

The best estimate of how long a patient has to live is based on the median survival of patients with their condition. But being a median it means half die sooner and half live longer – some much longer. The statistical distribution has a long tail.

The evolutionary biologist Stephen Jay Gould wrote a wonderful essay, "The Median isn't the Message", which is worth reading by anyone diagnosed with cancer. He was diagnosed with abdominal mesothelioma, a rare cancer caused by asbestos, at the age of 40 and told the median survival for his type of cancer was eight months. That was in 1982. He lived for another 20 years, dying in 2002 of an unrelated cancer. In his essay, Gould described how our emphasis on "clear distinctions and separated immutable entities" leads us to view statistical measures, wrongly, as "hard realities", when they are anything but. "All evolutionary biologists know that variation itself is nature's only irreducible essence."

He concludes with a message of defiance to all those who try to predict the end. "It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die... For most situations, however, I prefer the more martial view that death is the ultimate enemy – and I find nothing reproachable in those who rage mightily against the dying of the light."

Suggested Topics
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
Life and Style
love + sex
Arts and Entertainment
Victoria Wood, Kayvan Novak, Alexa Chung, Chris Moyles
tvReview: No soggy bottoms, but plenty of other baking disasters on The Great Comic Relief Bake Off
Sport
Ashley Young celebrates the winner for Manchester United against Newcastle
footballNewcastle 0 Man United 1: Last minute strike seals precious victory
Life and Style
Tikka Masala has been overtaken by Jalfrezi as the nation's most popular curry
food + drink
Arts and Entertainment
Seth Rogan is one of America’s most famous pot smokers
filmAmy Pascal resigned after her personal emails were leaked following a cyber-attack sparked by the actor's film The Interview
News
Benjamin Netanyahu and his cartoon bomb – the Israeli PM shows his ‘evidence’
people
Arts and Entertainment
80s trailblazer: comedian Tracey Ullman
tv
News
i100
Life and Style
A statue of the Flemish geographer Gerard Kremer, Geradus Mercator (1512 - 1594) which was unveiled at the Geographical Congree at Anvers. He was the first person to use the word atlas to describe a book of maps.
techThe 16th century cartographer created the atlas
Arts and Entertainment
Stephen Tompkinson is back as DCI Banks
tvReview: Episode one of the new series played it safe, but at least this drama has a winning formula
News
i100
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: UI / UX Designer

    £25000 - £35000 per annum: Recruitment Genius: This firm are focussed on assis...

    Recruitment Genius: General Processor

    £7 per hour: Recruitment Genius: A vacancy has arisen for a General Processor ...

    Recruitment Genius: Outbound Sales Executive - B2B

    £18000 - £22000 per annum: Recruitment Genius: A great opportunity has arisen ...

    Recruitment Genius: Online Sales and Customer Services Associate

    £14000 - £16000 per annum: Recruitment Genius: Full time and Part time positio...

    Day In a Page

    War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

    Baghdad fights to win back Tikrit from Isis – but then what?

    Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable
    Living with Alzheimer's: What is it really like to be diagnosed with early-onset dementia?

    What is it like to live with Alzheimer's?

    Depicting early-onset Alzheimer's, the film 'Still Alice' had a profound effect on Joy Watson, who lives with the illness. She tells Kate Hilpern how she's coped with the diagnosis
    The Internet of Things: Meet the British salesman who gave real-world items a virtual life

    Setting in motion the Internet of Things

    British salesman Kevin Ashton gave real-world items a virtual life
    Election 2015: Latest polling reveals Tories and Labour on course to win the same number of seats - with the SNP holding the balance of power

    Election 2015: A dead heat between Mr Bean and Dick Dastardly!

    Lord Ashcroft reveals latest polling – and which character voters associate with each leader
    Audiences queue up for 'true stories told live' as cult competition The Moth goes global

    Cult competition The Moth goes global

    The non-profit 'slam storytelling' competition was founded in 1997 by the novelist George Dawes Green and has seen Malcolm Gladwell, Salman Rushdie and Molly Ringwald all take their turn at the mic
    Pakistani women come out fighting: A hard-hitting play focuses on female Muslim boxers

    Pakistani women come out fighting

    Hard-hitting new play 'No Guts, No Heart, No Glory' focuses on female Muslim boxers
    Leonora Carrington transcended her stolid background to become an avant garde star

    Surreal deal: Leonora Carrington

    The artist transcended her stolid background to become an avant garde star
    LGBT History Month: Pupils discuss topics from Sappho to same-sex marriage

    Education: LGBT History Month

    Pupils have been discussing topics from Sappho to same-sex marriage
    11 best gel eyeliners

    Go bold this season: 11 best gel eyeliners

    Use an ink pot eyeliner to go bold on the eyes with this season's feline flicked winged liner
    Cricket World Cup 2015: Tournament runs riot to make the event more hit than miss...

    Cricket World Cup runs riot to make the event more hit than miss...

    The tournament has reached its halfway mark and scores of 300 and amazing catches abound. One thing never changes, though – everyone loves beating England
    Katarina Johnson-Thompson: Heptathlete ready to jump at first major title

    Katarina Johnson-Thompson: Ready to jump at first major title

    After her 2014 was ruined by injury, 21-year-old Briton is leading pentathlete going into this week’s European Indoors. Now she intends to turn form into gold
    Syrian conflict is the world's first 'climate change war', say scientists, but it won't be the last one

    Climate change key in Syrian conflict

    And it will trigger more war in future
    How I outwitted the Gestapo

    How I outwitted the Gestapo

    My life as a Jew in wartime Berlin
    The nation's favourite animal revealed

    The nation's favourite animal revealed

    Women like cuddly creatures whilst men like creepy-crawlies
    Is this the way to get young people to vote?

    Getting young people to vote

    From #VOTESELFISH to Bite the Ballot