Remember the words “there are only two things you have to do: die and pay taxes?” Too many don’t pay taxes but no one gets away from the first. But it is here that families and even professional groups may be interfering with the legal obligation of correctly completing a death certificate.
During my years in graduate school, I decided to write a term paper on suicide in New York City. I suppose my interest was based on Emile Durkheim’s book as well as one other by Schneidman and Faberow I’d seen.
The data was readily available online and it was a topic I believed would be useful for my course fulfillment. I never suspected that the data would be skewed not only by local requirements but professional societies and life insurance. Eye-opening time for me and now it is occurring again, but not as before.
One of the roadblocks I hit while researching for my paper was found in professional journals that listed physician obituaries. I should mention that suicide among physicians is such a serious topic that has resulted in a yearly seminar for suicidal physicians (run by Dr. Pamela Wible) and many online articles. The American Psychiatric Association provides stats on the depth of this issue.
Death notices in professional journals never stated suicide in a move for family concerns and also to ensure payment of life insurance benefits. Most policies have a two-year requirement that excludes payment if it’s by suicide.
I recall requesting a referral from my opthalmologist for a specific eye condition. His response was, “I would refer you to someone, but he committed suicide.” The physician in question was extremely successful, taught worldwide, and was opening a hospital in Brazil.
When I was writing my class paper, New York City changed its requirements for listing suicide on a certificate. If there were no notes found indicating an intention to commit suicide, that cause of death was never on the certificate. I think they said something like “unknown” or used similar terminology. Previously, they had listed suicide.
The Request for Change
Why are there requests for changes to the cause of death on certificates now? Previously, medical examiners understood when families indicated a wish that certificates not indicate the person had died of AIDS. Now, there is a push from some families that Covid-19 be on the document as the cause of death.
In an interview, Dr. James Gill, the chief medical examiner for the State of Connecticut, indicated that change is “because there’s the FEMA [Federal Emergency Management Agency] relief money for burial expenses for COVID deaths. The federal government will reimburse, I think, up to $9,000 for funeral expenses.”
The element of fraud doesn’t seem to be an issue with them. Finances may be key because the average cost of a funeral begins at about $7K and goes up from there. People have lost their jobs, finances are tight, and changing the cause of death may lessen the burden of burial. And there’s one other factor; families may feel guilty that they didn’t do more to prevent the death.
As it was when I wrote my paper on suicide, death certificates may not reflect the true extent of the virus’ ruinous path of destruction in our society. But physicians are placed not in an uncomfortable position, but one that might put their licenses in jeopardy. For himself, Dr. Gill does not comply with changing a certificate’s cause of death.
If death certificates are changed in record numbers, how will we know the extent of the current or future pandemics? Should FEMA increase their vigilance prior to making burial payments?
The guilt portion, of course, needs professional attention and so does the pandemic as we see it affects students’ mental health.