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No One Dies of Old Age

Of all the questions we ask family members when we're gathering information for an obit, two invariably meet with the most resistance: cause of death and previous marriages. I can understand that second, third or fourth spouses might be reluctant to discuss their predecessors, but any marriage is (or should be) a big event in someone's life. We can't expunge a person's true-life experiences for the convenience of the survivors.

But even more surprising is the hesitance to reveal the cause of death. Yesterday, my colleague Pat Sullivan had a long, fraught discussion with a doctor who was quite exercised about the Post's policy of naming the specific medical cause of death, even for someone who was 93 years old. The doctor insisted that the cause was "old age," a term that never appears on an actual death certificate. Finally, when pressed, he said the cause he wrote on the death certificate was "failure to thrive," which isn't much more specific, but at least it's something.

When people don't want to tell me the cause of death, I sometimes say, "No one dies in The Washington Post of old age, natural causes or a long illness." Everyone dies for a particular medical reason, and that specific cause is what we have a responsibility to record. In chronicling the life of someone, part of our duty is also to chronicle his death. After all, when people read obituaries, the first two things they want to know are "How old was he" and "What did he die from?"

By Matt Schudel  |  February 6, 2008; 7:42 AM ET
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Both you and the doctor mentioned above have a point. Theoretically, nobody dies of "old age." On the other hand, if someone 98 years old dies of leukemia, failure to thrive (she probably quit eating---tired out after 98 years of chewing), or any of several bloodclotting problems, they really DID die of being old. Their body quit doing something necessary to life because the mechanism wore out. Leukemia in extreme old age signals a breakdown of immune responses that previously has functioned normally. Ditto other blood-related fatalities. None of these illnesses, including the failure to thrive, are infectious, invasive, or treatable. The leukemia of old age is not drug-responsive, for instance. The "failure to thrive" may well be the person deciding that it is simply time to go. Is it suicide? Or is it a simple decision that enough is enough, I'm old and it's time. A friend of mine whose grandmother made it to 100 and then died immediately thereafter said about her death, "She was determined to see 100 but I don't think she realized that getting there was going to be so boring."

Posted by: Sharon Karpinski | February 6, 2008 4:32 PM | Report abuse

Dr. Sherwin Nuland has written that in his experience, doctors don't put down "old age" as a cause of death because they think the vital statistics department won't accept it. He contends that old age is however as valid a cause of death as "cardiopulmonary arrest", "failure to thrive", or "general debility". (Of those three, the first is actually a description of how death occurs and the last two are effects of diseases. None are any more specific than "old age", but at least Vital Stats will allow them.)

Nuland also points out that most people over 85 have more than one disease process going on, and the older the person is generally the more processes are going on. Without an autopsy (rare for older folks who die of natural causes), there's no way to tell exactly what the person died of, so the doctor may simply put down what he thought was the most serious condition.

Other countries are more willing to accept old age as a cause of death. The Queen Mother's death certificate shows her cause of death to be "extreme old age".

Posted by: Charlene | February 9, 2008 6:33 AM | Report abuse

What makes you think that cause of death is "one of the first two things" readers want to see in an obit? I, for one, am more interested in active accomplishments (or failures) in life, not which particular ailment or accident finished you off. I also find death attributed to "old age" to be more than sufficiently descriptive for cause of death.

Posted by: John B | February 12, 2008 9:14 AM | Report abuse

I agree with Charlene. Furthermore, doctors are commonly not even present when an elderly person dies, especially someone in hospice care. What do they know? They are really just guessing. As Charlene said, many bodily processes begin to fail simultaneously. Cause of death becomes a guess, often rather an arbitrary one. There may be many causes, but only one is singled out. There maybe causes dating back many years that finally culminated when another contributing factor entered the picture. It's not a simple black and white matter, despite what the death certificate says.

Posted by: Allan | February 13, 2008 10:01 AM | Report abuse

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