A Public Death: Certificates without causes aren’t worth the paper

Ireland is about to embark on an experiment of questionable need that is certain to do harm.

Joan Burton, the deputy prime minister of Ireland is pushing for a new regulation that would allow people to request a death certificate that can omit any reference to a cause of death.

Daniel McConnell at the Independent in Dublin wrote:

Ms Burton has said she is "very much aware" of the distress caused to families of those who died in tragic circumstances and the impact of having the cause of death on the certificate. As a result, she said that drafting of the regulations to allow for the omission of the cause of death from a death certificate is at an advanced stage. "I hope that this will provide some comfort to families where the details of the cause of death registered are upsetting," Ms Burton said.

McConnell wrote that Burton’s move was in response to Richard Boyd Barrett, a member of parliament from the People Before Profit Alliance. Barrett “specifically called on her to address the hurt caused to families who have lost someone to suicide,” McConnell wrote.

Birth and death records are called vital statistics for a reason. They play the same role in a society as vital signs such as a heart rate and body temperature do for individuals. They tell us about the overall health of our communities and provide us warning signs that allow us to take action against fast-moving health threats like viruses and slow-moving threats like diabetes and heart disease.

Public health officials have long known that hiding causes of death can become a major hurdle in getting accurate reads on health problems. Cindy Uken at the Billings Gazette, a California Endowment National Journalism Fellow, wrote about suicides in Montana and about how officials there have had a hard time getting a good read on the problem because some counties make access to coroner records difficult.

Calling suicides something else on death certificates or striking the word “suicide” from the public record will have a similar effect. How can a community properly respond to high suicide rates if it has no idea that they are high? Similarly, how can communities learn from what is working in places that have low suicide rates?

Two years ago, Greece went through a period of high suicide rates following its economic meltdown. Greece had for years enjoyed some of the lowest suicide rates in Europe, but the rise in rates prompted responses from academia, religious institutions, and governments.

The Archbishop of Athens published a newspaper column calling on people to reject suicide as an option for their despair. "The universal principles of personal freedom and self-determination cannot be called into question,” he wrote. “But they do have limits. They cannot remain unlimited when, applied in a certain way, they cause so much pain."

A pair of researchers from the University of Portsmouth’s Business School in the United Kingdom and  Vienna University of Economics and Business in Austria did an extensive look at death data and police records to publish a study linking the rash of suicides to the economic downturn. “While, from a health policy perspective, specialized suicide preventions programs focusing on the most distressed and vulnerable citizens in Greece should be established, as the empirical literature supports the idea that the correct diagnosis of suicide determinants, and the creation of suicide prevention programs can lead to a reduction, if not prevention, of suicides,” wrote Nikolaos Antonakakis and Alan Collins in the journal Social Science and Medicine.

And the country’s health ministry, which had been cut dramatically like all Greek agencies, pulled together enough resources to set up a suicide hotline.

New York City’s Office of Mental Health also monitors suicide rates. It went beyond hotlines and created a mobile app that provides support during times of personal crisis. Kate O’Connell at WXXI in Rochester wrote:

The ‘Safety Plan’ app is designed to enable people to quickly access a customizable prevention plan that can help them manage suicidal ideas and periods of extreme depression. Based on a method proven to lower suicide rates, the application allows someone to identify personal warning signs or stress factors that can lead to a crisis. They’re also able to create a list of coping strategies that can help lift their spirits, something that they can look at to remind themselves of activities or places that help level their mood.

I recently heard restaurateur and radio host Tom Douglas talking about chefs experimenting with ways to cook dirt. So if we have a death with no cause, we can also have a funeral with no mourners. And the dirt from the empty grave can be trucked to the nearest deli to be served on rye with a dash of mustard.

Sound ridiculous? Yes.

Messing around with death certificates also has been deemed illegal in the past. I’ll write about that in my next post.

Image by William Murphy via Flickr.