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Every Cause of Death Matters

This piece continues from last week's Which Deaths Matter?, and contains discussion of death statistics some people may find distressing.

PangbornThe principle that every cause of death matters is not, and cannot be, a scientific concept. Indeed, the idea that any death matters cannot be a scientific claim, because from the point of view of the sciences, at least in terms of research communities striving for 'objectivity', nothing could strictly matter since it takes a being (not an object) for anything to matter. Assertions of a required detachment are prevalent in the contemporary sciences, but it would be implausible to assume that this detached point of view was necessary rather than merely traditional. Indeed, as this entire philosophy of science 'campaign' has served to stress, the risk of continuing to pretend that the sciences can be pursued in a 'value-neutral' stance is that this is a blatant self-deception, and one that leads directly or indirectly to the wilfully ignorant state of pseudoscience.

If we were to attempt to construct a scientific value for death, rather than a scientific understanding of a specific aspect of dying, it would surely have to be that we do not increase our understanding on any topic by ignoring any of the data. Thus, to scientifically explore causes of death, we must know what the key causes of death are. We may find it helpful to categorise these causes, and having done so we are then in a position to collect data and report upon those causes of death. This, in fact, is one of the primary functions of the World Health Organisation, and very nearly the sole purpose of providing shared diagnostic categories for disease (which the WHO facilitates) is that it permits us to build a global perspective on causes of death, so that, for instance, we can know (as discussed two weeks ago) that 3 million of us die globally each year from respiratory diseases.

We do not, as it happens, 'die of old age' in the eyes of conventional medical logic; rather, old age leaves us vulnerable to various causes of death of which heart failure and respiratory infection are by far the most common. We could approach this differently; it would not be unscientific to do so. But at the moment, 'disease' is the preferred framework for medical thinking, and that sets the agenda for scientific thinking about death. The landscape of death that the WHO reports upon annually would look radically different if we were to separate out these kinds of end-of-life diseases from other causes of death that affect young and old alike, and to do so would not be unscientific but merely require different values to be incorporated into the scientific communities, which is always permissible provided these assumptions are kept clearly in view.

Therefore, while 'every cause of death matters' cannot be scientific, since it is a principle based upon values that are not inherent to scientific practice, the sciences could incorporate this value, if that is what we wanted. Prior to 2020, I would have thought that this actually was a value that all scientists shared, indeed, that it was a value that could be inferred from the Hippocratic oath for doctors. One of the most revelatory aspects of the global debacle that was the response to SARS-CoV2 was that it revealed that there are many people working in the sciences who do not believe that every cause of death matters. I find this hard to understand in many respects, but it is also undeniable, since (for instance) UK scientific advisers could not have acted as they did if they did not reject the maxim that every cause of death matters, or (at the very least) were temporarily lured away from it.

This principle does not mean that we are wrong to care about some causes of death more than others - on the contrary, it would be reckless to replace it with a principle that 'every cause of death matters equally'. A man in New York state was killed in 2001 when an oxygen cylinder was magnetically pulled into an MRI machine, fracturing his skull. That's tragic, but it is not in anything like the same league as the 9.6 million global cancer deaths each year that the MRI can help in diagnosing. But even a freak occurrence leading to a fatality such as this matters, it matters in this case because a metallic oxygen tank must be kept away from a giant electromagnet like an MRI because otherwise someone might die.

However, what 'every cause of death matters' should mean, if it is accepted, is that we cannot dismiss a cause of death from consideration without any attempt to place it into a wider context - a world and a way of life where that cause of death takes on a meaning for either certain people, or for everyone. We violate the principle that ‘every cause of death matters’ whenever we exclude, by accident or design, certain ways of dying from holding any importance, or accept one cause of death as entirely dwarfing the significance of all others to the point that they can simply be ignored as trivial in comparison. In pushing back against this, I do not seek to impose some singular set of values on other people - this is the exact opposite of my purposes. Rather, I am merely making a call to resist the dismissal of those causes of death we are lured, fooled, or distracted into ignoring.

The Shield of Normalcy

The late Mary Midgley, who was the closest to a mentor I had in philosophy, made the point that we’re acutely aware of injustice ‘above us’ - billionaires, royalty etc. - but we barely notice injustice below us - sweat shops abroad making cheap clothes for us, immigrant poverty etc. This shield of invisibility conceals not only economic disparities where we are the beneficiaries, but also causes of death where we are just as likely to be the victim yet cannot imagine this actually happening. This is because exceptions are glaring as long as we can place ourselves into the comparison, but norms go unnoticed. Hence our dismissal of cars as an important cause of death, hence our ignoring the ongoing massacre of poor, non-white people in barely-noticed countries by a nation that was once the founder and standard bearer of human rights, both of which were explored last week.

For many years now, I have bit my tongue in shocked disbelief that self-proclaimed advocates of social justice felt their political voice and time was best spent complaining that their entertainments didn’t feature the right mix of approved diversity. Does representation matter? It certainly can. Was film, TV, and videogame representation the burning issue that needed immediate redress? That’s rather harder to believe, and I would love to know what assumed principle of action made this appear to be so. It is fashionable to talk of privilege... can there be any greater privilege imaginable than to be free to bitch about how we are entertained while others die from our nation’s action or inaction? I consider myself just as guilty as everyone else in this regard, and every excuse I have feels woefully inadequate.

Last week’s piece engaged with a number of different causes of death - the novel coronavirus, the killing of George Floyd, drone assassinations, civil war in Yemen - to try to demonstrate the that the principle 'every cause of death matters' is not only just, it is a requirement for justice. What COVID-19 and George Floyd’s death have in common was that both stories were picked up by journalists and reported as news. That’s fair, because they both warranted reporting. But it is also highly problematic because much less attention was given to drone assassinations, and almost none at all to the humanitarian crisis in Yemen, both of which were directly or indirectly attributable to the actions of the US as a nation.

Given that ‘the news’ is the collection of stories with the apparent sole power of determining where political action might be taken, and given the penchant of journalists for doom propheteering, what are we to make of the millions dying each year as road fatalities, the seven million deaths attributable to air pollution, the grotesque transformation of warfare into grim extermination, and the humanitarian disaster in Yemen that we all share a collective responsibility for, but about which neither news nor political action intersects? If journalists excuse themselves from responsibility in this regard on the basis that their audience isn’t interested (and I have indeed heard this sincerely lamented by people who work at the BBC), what are we to make of the news except that it is merely another form of entertainment, another way of distracting ourselves from asking about what matters?

Every cause of death matters.

It’s a simple idea, but it’s also a revolutionary one, because it asks us to stop saying ‘this cause of death matters, but this one does not’. I do not believe this change requires political reform, but it does require either journalistic reform or the creation of a new avenue for the exchange of perspective that is neither news nor entertainment. This is unlikely to be our current academic systems, since these have also disastrously failed, although academics could be among the people to facilitate what is required. Perhaps all that is needed, as the piece on doom propheteering foreshadowed, is a different relationship between universities and news media. Or perhaps both need to be entirely reformed.

As one small example of what might help address this problem, consider a weekly, monthly, or even daily ‘death report’, akin to the weather forecast, that compares national and international causes of death. Such a report would be difficult to produce because statistics on causes of death are slow to propagate, and complicated by many deaths having multiple causes - as well as being open to political gerrymandering by redefining categories for counting deaths. But without some means of putting all causes of death into our consideration, we will continue to focus disproportionately upon small details, and consistently fail to see the big picture. Perhaps we are not even willing, or indeed able, to take it all in. But we could certainly try.

Most likely such a report would not be enough... It probably would not, for instance, help us to begin recognising automobiles as the major cause of death that in actuality they have been for more than half a century. We would simply see those deaths on the 'leaderboard' and continue to dismiss them as we always have. Neither would it be likely to illuminate how COVID-19 deaths compare to deaths from other respiratory diseases, and thus how stories that foreground these tragic deaths for dramatic, doom propheteering effect ignore comparable deaths from other, similar causes of death that we have traditionally chosen to entirely ignore despite causing a roughly similar number of deaths. According to a recent government report, 72,178 people in England died of "laboratory-confirmed COVID-19" in 2020; an alternative source reports 73,444 for England and Wales for 2020. This has been reported as a catastrophe. Yet the 71,674 English and Welsh deaths from respiratory diseases in 2019 raised zero headlines, caused no panic, no dramatic posturing by cowardly politicians about the "millions grieving", nor any attempt to seize unwarranted emergency powers to undermine liberty and criminalise protest.

It is true that there are millions grieving... this statement is heartbreakingly true every day of every year, and the majority of those loved ones were and are lost to heart disease and cancer, of which there were tragically even more deaths in 2020 owing to the disruptions and panic caused by long-term lockdowns. And it is becoming painfully clear that these extreme measures had limited effect on SARS-CoV2 mortality, which still killed roughly 0.1% of the population of every European country regardless of which interventions were deployed. This is not the same as saying we should have done nothing, but this should never have been permitted to become the nature of the dispute - 'do everything' versus 'do nothing' is about as far from sane thinking as could be imagined, and yet we not only made this the battlefield, we committed to it so fully that we became convinced that the specific insanity we chose was clearly the only reasonable choice. But neither of those choices was reasonable, because the important question was which actions could save lives when we consider all causes of death, and this discussion we have in fact refused to have, and continue to lie to ourselves about the ghastly things we have done as a consequence.

It is admirable that so many wanted to commit to the maxim 'we should do whatever it takes to save lives' - I truly wish we had been willing to engage with the scientific and political challenges in a way that made this laudable goal even remotely plausible to safely pursue. Instead, we politicised COVID-19 and dangerously nullified not only civil liberties, but the very ability of the sciences to investigate. Without these safety measures we were empowered to unleash rash cybernetic interventions that went on to destroy a great many lives and livelihoods, casualties not of a disease but of our collective madness in the face of a disease. Not to mention that for the first time in human history, our loved ones died without having a chance for us to say goodbye to them, making each and every one of those dreadful deaths far more anguished, desolate, and lonely than they needed to be. The disease was indeed terrible, but the catastrophe was not the disease but our response to it, a tragedy that happened because we were fooled into thinking that only one cause of death mattered.

Closed Minds

Over the last year, dreadful things were happening. Never one to turn a blind eye on anything, I committed to using my skills and experience to study the literature and ongoing research on the interventions being proposed or deployed in order to be able to provide advice and insight that I hoped might be helpful. But, as they say, "a prophet is never welcome in their home town", and during this time I have been pilloried, snidely dismissed, treated as "one of them", told that "you're wrong because I have a friend who's a scientist", told "that may be what some scientists say, but its not what the science says", and other things equally bizarre and nonsensical, all by well-educated, compassionate people who have been acting as if they were neither of these things. In short, despite the care I have taken in my scientific analysis, despite my judgements being informed by the medical debates I have followed closely, despite my claims aligning with those made by eminent epidemiologists, I (and indeed they) have been told that this well-informed, scientifically-grounded perspective doesn't count because it doesn't align with the beliefs of those who zealously committed to "saving lives".

You cannot claim I don't care about saving lives; I have spent seven years trying to save the lives of those who die because of our current automobile designs, and the lives of those killed as 'collateral damage' in drone attacks. During this time I have been almost unilaterally dismissed via dozens of excuses that I have accepted, albeit with great sadness, because I accept everyone's freedom of speech and belief, and place this value above all others as the necessary foundation of all other freedoms. I grieve for everyone who has died, but I weep hardest for this politically-fuelled breakdown in discourse, for it has plunged us into a state of pseudoscience that has not only resulted in unnecessary deaths, it has savaged civil society and removed any ambiguity over whether we are still committed to human rights. It is precisely because I am committed to saving lives that I must speak out about the harms caused by the interventions chosen... I could be mistaken in my claims, errors are a perpetual risk in all scientific work. But there is no such risk for those who are defending a position based on political commitments.

Political battlefields destroy the work of the sciences because they polarise discussions in ways that preclude the evaluation and re-evaluation of evidence that is required for the slow and careful work of legitimate scientific enquiry. Once there are two vehemently opposed sides, evidence can either be converted into ammunition or dismissed out of hand. Yet whatever rubbish your "opponents" have said will not make your position magically correct, it simply feels that way because you have made it about "fighting an enemy" instead of uncovering the truth, as happens with every politicised issue. Complex issues are always rendered poorly when presented solely in polar extremes. So it has been with the claim that "public health trumps human rights" - an incoherent maxim that entails there are no human rights, since the very purpose of declaring such rights was that they were supposed to be inalienable, as the US constitution memorably puts the matter. And while we are living in a state of pseudoscience there is no legitimate public health either, just a string of dreadful mistakes divorced from all responsibility for their horrific consequences.

If you are willing to accept the proposition that ‘every cause of death matters’, you can at least do this one small thing: stop dismissing deaths. Stop treating SARS-CoV2 as a more significant cause of death than the inadvertently fatal measures rashly deployed against it. Stop pretending guns are a bigger problem than cars, when the latter results in six times as many preventable deaths. Stop acting as if unjust deaths inside our country’s borders are more important than those that our nations inflict abroad, when both ought to be wholly preventable and worthy of protesting. In short, just stop pretending that only some causes of death matter. Even dying peacefully in old age matters because this, after all, is how many of us would prefer that we eventually die. Whatever your values, whatever your commitments, if you care about anything, you ought to care about how we die. We can die with dignity and respect, or we can die horrifically and unjustly. The more we recognise that every death matters, the closer we will creep to a world worth saving.

The opening image appears to be a detail from a Dominic Pangborn painting, but I have been unable to source the title. As ever, no copyright infringement is intended and I will take the image down if asked.

My Spring social media break begins tomorrow, so please accept my apologies in advance for the slowness of my replies. Only a Game returns later this year.