Thursday, October 23, 2008

THE IMMEDIATE CAUSE OF DEATH

Jane Gross, NY Times - According to the federal Centers for Disease Control and Prevention, the leading causes of death among those ages 65 and over are, in descending order, heart disease, cancer, stroke, respiratory disease, Alzheimer's disease, diabetes, influenza, kidney disease, accidents and infection. Maybe so. But that's because people are not allowed to die of old age - at least, old age cannot be listed as the cause of death on the official documents, according to both the C.D.C. and the World Health Organization, repositories of the world's mortality statistics.

Neither should "infirmity" or "senescence" appear as a cause of death, according to the C.D.C. handbook on how properly to fill out a death certificate. Why? These words "have little value for public health or medical research," the agency says. Plus, "Age is recorded elsewhere on the [death] certificate." . . . Instead, every death must be attributed to a single disease, which is the immediate cause of death. A second disease may be cited as the intermediate cause, and a third as the underlying condition. Even in situations "when a number of conditions or multiple organ/system failure resulted in death," the C.D.C. instructs that "the physician, medical examiner or coroner should choose. . . a clear and distinct etiological sequence," a "chain of morbid events."

It sounds orderly, doesn't it? But 80- and 90-year-olds don't usually die of one thing. Little by little, the wheels fall off the bicycle. The first few times, you patch everything up. But it's never quite the same. Each setback is a little worse than the last. Bad stuff happens more often. Eventually, as with all machines, the human body simply wears out. . .

But being old isn't the same as having a heart attack. Frail, weak, bedridden old people don't get cured, ever. . .

What would it mean to medical science, I wonder, if death certificates did not describe us all as dying of something that could have been treated, and perhaps was, but instead of something inevitable and universally shared?

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