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
Arts and Entertainment
Lou Reed distorted the truth about his upbringing, and since his death in 2013, biographers and memoirists have added to the myths
musicThe truth about Lou Reed's upbringing beyond the biographers' and memoirists' myths
News
people
News
Ed Miliband received a warm welcome in Chester
election 2015
Life and Style
Apple CEO Tim Cook announces the Apple Watch during an Apple special even
fashionIs the Apple Watch for you? Well, it depends if you want it for the fitness tech, or for the style
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
  • Get to the point
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: Project Implementation Executive

    £18000 - £23000 per annum: Recruitment Genius: They work with major vehicle ma...

    Recruitment Genius: Chiropractic Assistant

    £16500 per annum: Recruitment Genius: A Chiropractic Assistant is needed in a ...

    Recruitment Genius: Digital Account Executive - Midlands

    £18000 - £26000 per annum: Recruitment Genius: They work with major vehicle ma...

    Recruitment Genius: Web Developer

    £28000 - £30000 per annum: Recruitment Genius: This company provides coaching ...

    Day In a Page

    NHS struggling to monitor the safety and efficacy of its services outsourced to private providers

    Who's monitoring the outsourced NHS services?

    A report finds that private firms are not being properly assessed for their quality of care
    Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

    Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

    The Tory MP said he did not want to stand again unless his party's manifesto ruled out a third runway. But he's doing so. Watch this space
    How do Greek voters feel about Syriza's backtracking on its anti-austerity pledge?

    How do Greeks feel about Syriza?

    Five voters from different backgrounds tell us what they expect from Syriza's charismatic leader Alexis Tsipras
    From Iraq to Libya and Syria: The wars that come back to haunt us

    The wars that come back to haunt us

    David Cameron should not escape blame for his role in conflicts that are still raging, argues Patrick Cockburn
    Sam Baker and Lauren Laverne: Too busy to surf? Head to The Pool

    Too busy to surf? Head to The Pool

    A new website is trying to declutter the internet to help busy women. Holly Williams meets the founders
    Heston Blumenthal to cook up a spice odyssey for British astronaut manning the International Space Station

    UK's Major Tum to blast off on a spice odyssey

    Nothing but the best for British astronaut as chef Heston Blumenthal cooks up his rations
    John Harrison's 'longitude' clock sets new record - 300 years on

    ‘Longitude’ clock sets new record - 300 years on

    Greenwich horologists celebrate as it keeps to within a second of real time over a 100-day test
    Fears in the US of being outgunned in the vital propaganda wars by Russia, China - and even Isis - have prompted a rethink on overseas broadcasters

    Let the propaganda wars begin - again

    'Accurate, objective, comprehensive': that was Voice of America's creed, but now its masters want it to promote US policy, reports Rupert Cornwell
    Why Japan's incredible long-distance runners will never win the London Marathon

    Japan's incredible long-distance runners

    Every year, Japanese long-distance runners post some of the world's fastest times – yet, come next weekend, not a single elite competitor from the country will be at the London Marathon
    Why does Tom Drury remain the greatest writer you've never heard of?

    Tom Drury: The quiet American

    His debut was considered one of the finest novels of the past 50 years, and he is every bit the equal of his contemporaries, Jonathan Franzen, Dave Eggers and David Foster Wallace
    You should judge a person by how they peel a potato

    You should judge a person by how they peel a potato

    Dave Hax's domestic tips are reminiscent of George Orwell's tea routine. The world might need revolution, but we like to sweat the small stuff, says DJ Taylor
    Beige is back: The drab car colours of the 1970s are proving popular again

    Beige to the future

    Flares and flounce are back on catwalks but a revival in ’70s car paintjobs was a stack-heeled step too far – until now
    Bill Granger recipes: Our chef's dishes highlight the delicate essence of fresh cheeses

    Bill Granger cooks with fresh cheeses

    More delicate on the palate, milder, fresh cheeses can also be kinder to the waistline
    Aston Villa vs Liverpool: 'This FA Cup run has been wonderful,' says veteran Shay Given

    Shay Given: 'This FA Cup run has been wonderful'

    The Villa keeper has been overlooked for a long time and has unhappy memories of the national stadium – but he is savouring his chance to play at Wembley
    Timeless drama of Championship race in league of its own - Michael Calvin

    Michael Calvin's Last Word

    Timeless drama of Championship race in league of its own