What Will The Coroner Write in the Blank for the Cause of Death When You Die? A Suggestion

Introduction: Global Health Trends

A research center at the University of Washington has found that, for perhaps the first time in human history, the obesity-related death rate is greater than the rate from malnutrition. Translation – more people are dying from obesity-related illnesses than from lack of food. In an editorial last month, a major newspaper proclaimed that this was good news. (Chicago Tribune, Living longer, with a catch: Rising life spans – despite some unhealthy choices, December 26, 2012.)

I may be overlooking something, but this does not seem news likely to set off a ticker tape parade celebrating human progress. The research group cited, the Institute for Health Metrics and Evaluation (IHME), is funded by the Bill & Melinda Gates Foundation and the state of Washington. Its mission is to improve population health by providing the best evidence possible to guide health policy. I think the next IHME project should study and identify the cause of death that most accurately reflects population health. This could be a very effective way to guide health policy.

What IS a Good Cause of Death?

Most people, myself included, consider it better to die from gluttony and satiation than from malnutrition and starvation. Not a great choice but one that seems relevant to the IHME research the Chicago Tribute viewed as good news. For one thing, you last far longer eating too much than you can with too little food; for another, excess consumption is more satisfying, at least until the multiple adverse consequences of doing so become manifest and suffering commences. These extremes, fortunately, are not the sole candidates for best mortality indicators in ranking healthy populations. Before suggesting a better health status cause of death indicator – for a city, state or nation, a summary of the IHME study seems in order.

Chronic Disease Advances, Infection Disease Recedes

The IHME report showed a global trend of elderly people increasingly dying of heart disease and cancer. These factors are considered rich-country ailments, as both causes of death are associated with survival into later decades of life. This only happens when nations succeed in reducing the incidence of infectious and communicable diseases. Such mortality factors (e.g., diarrhea, tuberculosis, malaria and measles) are dramatically lower than two decades ago thanks to advances in sanitation, greater availability of medicines and wider and more effective inoculation campaigns. In addition, living standards have improved. Increased food supplies reduce the incidence of malnutrition.

While all this is good and encouraging, it seems fair enough to note that the goal for IMHE researchers and others (i.e., the United Nations) concerned with population health status should not be the promotion of conditions wherein death rates due to heart disease and cancer predominate. (Nor am I suggesting this to be the case.)

The Best Cause of Death

Since everyone will die sometime, sooner or later and most prefer later, what cause of death best reflects population well being? For purposes of gathering data on global health trends, what cause best reflects positive quality of life experienced?

I think the first thing we can agree on is that starvation/ malnutrition rates are definitely not optimal for this purpose. The second point of agreement might be neither is the rate of deaths from heart disease! Or cancer!

Then what?

AIDS? This cause accounts for fewer deaths than a decade ago, but still claims 1.5 million lives worldwide every year. Cancer? Tens of millions still die from lifestyle choices like tobacco use. Diabetes? Diet abuses are still estimated by the IMHE researchers to claim six million lives a year. Sedentariousness? I made up this cause of death. Why not have an indicator for insufficient exercise? We know that sloth kills. It’s a pity there is no vaccine for aversion to exercise.

Cause of Death in Your Case

Even if you have extraordinary random good fortune throughout life and are favored by nature with fabulous genes and live from cradle to exceptionally late life as a very model of a modern major REAL wellness general, some or all of your parts will fail, eventually. When this happens, you will die. But, what will go first? Something will, you know, even if you live your life as a paragon of wellness, with amazing luck regarding random events while benefiting from great genetics? (Needless to add but I will anyway, there are no such major general REAL wellness models. Life is such that while good genes, good luck with random fate and great lifestyles are possible, nobody gets close to anything remotely like a life embodying the hypothetical very model of a very modern major general REAL wellness ideal. I know you knew that.)

So, think about it. What might a doctor/coroner at some point in the future enter on your death certificate as the cause?

There are several broad categories of death causes now available for doctors to enter on death certificates. These include accidental, violent/homicide, natural or undetermined/unexplained. Doctors have different ways of making cause of death determinations, depending on observations, local law and so on. Autopsies and other tests are commonly done to determine the cause of death.

Let’s agree that you would not want the cause to be starvation/malnutrition or, for that matter, heart disease or other chronic conditions brought on by morbid obesity. Furthermore, if you are at all like me – and you must be so in some respect to be reading this, you probably don’t want the entry on your death certificate to be AIDS, diabetes or sedentariousness, either.

What then?

A REAL Wellness Alternative Indicator: Completion

How about a new cause of death, one that signals that the deceased decided that enough was enough, a cause we might term completion? This would indicate that sufficient data or other evidence were available at the time and scene of your death (e.g., a fare thee well note) that would enable the doctor signing your death certificate to consent that you, the deceased, died believing that you had crossed the finish line of life, having gone the distance and determined that there was no point going farther.

Of course, before completion can catch on locally, let alone on a global basis, a lot of study (IMHE – please note), discussion and reflection will have to be undertaken (pun intended). In addition, you can be sure that there will be religion-based resistance, which will have to be overcome. Personally, I’m going to do my part for a vastly improved mortality-based indicator of health status by living my remaining days, and putting a fitting end to them, following a lifestyle course (while hoping for the best re genetics and random chance) that will earn a completion entry on my death certificate.

That would be a better cause as far as I’m concerned than any other I can think of. What’s more, if I could, I’d frame it.

Getting Started Toward Completion

Maybe it’s time to develop a general decision-making support tool that assists people determine when the time is right.

Let’s start immediately with readings about existential philosophy and discussions with others, especially those who have done some thinking about this great topic. Let’s be careful about the metaphors we use to communicate the issues involved. For instance, let’s not talk so much about when or even if to pull the plug. There’s too much history with this phrase associated with sad, medically-based situations of ending life for others no longer seemingly viable.

Let’s think of completion something like this – that moment when we cheerfully take the proverbial bull by the horns and, with a smile on our face and joy in our hearts, with gratitude to family and cherished friends gained along the way, give those horns a firm but epic and triumphant squeeze and bid adieu to life well lived.