I read the explanation you linked. May be I'll be able to digest it better with some more thought, but my initial reaction is that they seem to be splitting hairs. Just like any metaphor, it doesn't fit perfectly, but the authors seem to be making quite a bit of leaps of reasoning to try to make it a bad/harmful metaphor, such as:

> Using the battle metaphor implies that if a patient fights hard enough, smart enough, and/or long enough, he or she will be able to win the war.

I don't think that ever crossed my mind. At least in my case I always saw that metaphor as implying you and your body are fighting, and your actions do have some degree of positive influence in helping your body fight and stay alive. A battle doesn't have to be a battle that is winnable with any degree of certainty, I can accept that is a battle with very low odds of winning and that the degree of control I have over how my body will react to treatment and if it'll be effective may be close to none. I can understand that, all they have to do is explain it. It doesn't mean the battle metaphor doesn't work. It doesn't mean if you lose the battle you're a 'loser' (the word loser IMO has a different connotation and doesn't apply to just anyone that loses a fight or that chooses not to fight).

> Patients with “curable” disease are cured because treatment eradicates every last cell, not because the patient did or did not somehow fight valiantly.

I believe the point is that going through the treatment is what makes them fighters. Yes the treatment is what cured them, but that's just missing the point that going through a painful treatment is why people (or at least me) call them valiant fighters. That doesn't mean I think if you don't fight or give up at some point you're somehow a coward. I could just extend the metaphor and say instead they chose to fight another different battle, facing mortality. Who's to say what's harder? I wouldn't dare to pass judgement on either choice.

> However, thinking about it from a different perspective, the use of the battle metaphor implies a level of control that patients simply do not have.

Are they saying they don't have any control? they can choose not to do any treatment. Choosing a treatment is staying in the fight. If they're implying treatments simply don't work, ok. But if there's even a small chance they do work, it's still a battle. It's easy for the doctors not facing death to tell someone to just give up, for some people hope alone keeps them mentally alive, not sure why is that hard to understand.

> When a person runs a marathon, we credit them for their training, commitment, and aspirations. We never declare anyone from the second-place to last-place finishers in a marathon to be losers.

If someone trains and doesn't finish a marathon or finishes last, technically they lost the race, yes, I'd not dare to call them or imply they're a loser. It's the same situation for someone that loses to cancer. The only reason I think losing to cancer is appropriate is because is final, you lost your life, which is not the case for a marathon, where you actually accomplished something that you can later be proud of and share with your family.

> As they turn from treatment to treatment, they are not spending time with loved ones; rather, they are chasing the illusive “win,” a path that affects not only them but also their family and caregivers, as well as family finances.

That's all good and fine, and it should be clearly spelled out and given as an option, it has nothing to do with whether the battle metaphor is accurate or good for some people or not.

> Did she lose her battle? Or did she choose to control how she spent her final days?

She chose not to keep fighting and that's fine, no need to pass judgement, it's a very hard fight after all, so even if we say she lost her battle to cancer, she chose to fight and win the battle of facing death in your terms and that also deserves my utmost respect. The authors instead choose to imply that saying someone lost a battle is calling them a loser.

> We firmly believe that health care professionals owe their patients the difficult and honest discussions that come as patients grapple with their mortality. We also believe that patients’ decisions should be honored and supported by their health care team.

That is one thing I agree with.

> Let us focus on the life that people enjoyed before being told “you have cancer” and remember them as victors in life, not losers in death. Let us stop letting cancer appear to be the winner.

It's fine to focus on the good stuff, doesn't magically mean you weren't dealt a sucky hand and that it's fine to grieve and feel the loss. Would you tell a father that lost his small son to cancer to move on and celebrate his life (as short as it was)? it's a loss, stop pretending is not, it's healthy to acknowledge the loss and grief before you can move on.