Covid and the moral dilemma of allowing patients to die alone

By Michael Cook

During the Covid-19 pandemic, many people died alone, without the comfort of having their loved ones at their bedside. Policies varied from institution to institution and from state to state in the US, but many hospitals implemented no-visitor or minimal visitor policies. Patients died in isolation wards; their only human contacts were dressed in spacesuits to avoid contamination. It was traumatic for them and for their relatives.

One woman told the BBC about the death of her grandmother:

“No-one found us to say she was dying. We found out after she had died. It was extremely traumatizing. We were all beside ourselves. bomb went off in our family. Our hearts were just aching. We all felt numb. We had nightmares for months afterwards. My mum still has nightmares now. She dreams that my nan is lost in the hospital somewhere.”

A recent article in the journal Bioethics reviews the moral dilemmas of allowing patients to die alone. Bioethicist Zohar Lederman says that “a lonely death is, by definition, a bad death and that society as a whole, as well as individuals in society are obligated to assure a certain degree of well-being, flourishing, or care among and for fellow individuals.”

He concludes that patients have a right not to die alone, without the possibility of human comfort and touch. And this right implies a corresponding duty on the part of society to ensure that lonely deaths do not happen.

Lederman point out that humans are naturally social and that we need others, especially at the end of our lives.

A lonely death is bad, then, as it may mean that the dying individual realizes she does not care about others and/or that others do not care about her. Being human in society, however, means exactly that—to care for others and be cared by others. Without care, a person cannot achieve her full potential, or be all she can be; she cannot be a wholesome person. A lonely death—or a care-less death—is bad because it deprives persons of their death as whole persons.

He suggests that legislation is needed to guarantee the right to avoid a lonely death. While this sounds almost fanciful, South Korea did pass such a law in 2021. In its ageing society, many people were dying alone and were discovered long afterwards, not necessarily because of the pandemic. The phenomenon is called “godoksa,” or “lonely deaths”. In 2021 there were 3,378 such deaths, up from 2,412 in 2017. Most were middle-aged and elderly men.

The “Lonely Death Prevention and Management Act,” is intended “to prevent personal and social harm caused by lonely deaths and to contribute to the promotion of the welfare of the people by stipulating matters necessary for the prevention and management of lonely deaths.”

Lonely deaths, says Lederman, are “a societal failure”. We need “to find innovative, creative, and at times ethically controversial solutions”.

Editor’s note. This appeared at BioEdge and is reposted with permission.