The Unethical Damage Done by Forcing People to Die Alone
The lack of sound leadership during the Covid-19 crisis harms many.
Posted Apr 26, 2020
In New York, Steve Kaminski was taken to the hospital and died a week later of Covid-19. Alone. In London, 13-year old Ismail Mohamed Abdulwahab died alone in London’s King’s College Hospital. Many hospitals have no visitor policy, so thousands of people are dying alone. These people have been forced, often against their will, to remain isolated and die alone. Their loved ones have also been forced against their will to remain away from their loved ones. Doctors don’t like it either and report being traumatized by watching people die alone.
The rationale for forcing people to die alone is that isolation and social distancing will slow the spread of Covid-19 and prevent deaths. My opinion is that this must be true. However, the evidence supporting my opinion is mixed. In any case, it is possible to implement a great deal of isolation and social distancing while at the same time not force people to die alone. If a close family member agrees to take the risk of contracting Covid-19 and agrees to self-isolate for a period afterward, they should not be stopped from being with their loved ones who are dying of Covid-19. In fact, forcing people to die alone violates all four ethical principles (do no harm, help the sick, autonomy, and justice).
forcing people to die alone violates all four ethical principles
It violates the requirement to ‘do no harm’ because being alone is damaging to psychological health, and forcing someone to stay home when they know a loved one is dying in the hospital is tragic. It violates the requirement to help because the health benefits of social connection have been proven beyond a reasonable doubt. Forcing people to die alone is most obviously a violation of autonomy, since people do not want to die alone, and many people are willing to take a risk and agree to self-isolate. The elephant in the room is the way in which forcing people to die alone violates the ethical principle of justice. Because the vast majority of those who are being isolated at the time of death are elderly, the policy to refuse access to loved ones is unjust towards the elderly. As a society, we may be committing what amounts to geronticide.
Thankfully, things are starting to change. The end-of-life charity Marie Curie urged clinicians to make efforts to allow close family to be with loved ones, saying it was required by compassion. In Israel, hospitals are allowing loved ones to say goodbye. It is time for others to follow suit, in short order. It’s an ethical imperative.
Samantha K Brooks, PhD Rebecca K Webster, PhD, Louise E Smith, PhD, Lisa Woodland, MSc, Prof Simon Wessely, FMedSci, Prof Neil Greenberg, FRCPsych et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Published:February 26, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30460-8.
Jeremy Howick, Paul Kelly, Mike Kelly. Establishing a causal link between social relationships and health using the Bradford Hill Guidelines. https://doi.org/10.1016/j.ssmph.2019.100402