Time to address the reality of dying alone

Dear Editor,

I read the editorial Dying Alone ¹ by Peter Vanezis in Medicine, Science and the Law with a sense of shock and unease. It was an unsettling read that left me deeply affected. The sad reality of our increasingly individualistic world is that we are losing the close-knit family and community structures that once served as guardians for the elderly. With the rise of individualized thinking and a decreasing sense of community in both the East and West, we are witnessing a growing epidemic of loneliness and isolation. ² This often leads to tragic outcomes, including suicide ³ and, sadly, dying alone either due to natural causes or otherwise. The establishment of government ministries dedicated to loneliness and the recognition of social isolation as a public health issue have gained momentum in recent times. ⁴

While the issue of unknown and unidentified dead bodies is a separate concern in heavily populated countries, ⁵ we have increasingly witnessed cases of people with families dying alone. The fact that no one checks on them for 2 to 3 days before they are discovered dead is deeply concerning both personally and from a medicolegal perspective. When an elderly person dies alone, a crime pathologist cannot help but question whether caregiver neglect played a role. The possibility of an act of omission, whether through negligence or intent, can never be dismissed outright. In practice, I witnessed families grappling with the guilt of not being able to spend time with their loved ones in their final moments. And on a larger scale, as a society, we must ask ourselves: are we not responsible for this shifting reality? A world where duty and care fade into indifference, where neglect is met with a toxic silence, and where the abandonment of the vulnerable is no longer seen as an injustice—Does this not make us all accountable—ethically, legally, and morally?

As the author correctly observes, it is high time for governments to act against the growing social menace of loneliness, despite being surrounded by a large population. Sometimes, the prevailing moral compass attempts to normalize these occurrences as the new standard, but this should not be the case for the common good. The morgue, as a microcosm of society, reveals trends that are often first noticed by forensic pathologists and their teams, long before law enforcement or public health officials begin to acknowledge them. These trends serve as a grim reminder of the concerning reality that needs to be addressed seriously. As a colleague from South Africa puts it, a forensic pathologist is a “community safety pathologist,” ⁶ and one must not ignore the call of Professor Peter.

I do not intend to present a panacea for this issue, but a few measures have the potential to help prevent such deaths. Encouraging shared housing with young students in university towns, ⁷ fostering intergenerational peer community events organized by local parishes or municipalities, and creating virtual communities for daily social interaction among elderly could all play a crucial role. Furthermore, future research may explore digital health solutions like wearables for caregiver alerts ⁸ and artificial intelligence (AI) powered personal voice assistants for emotional support. ⁹ These technology-based approaches hold the promise of reducing solitary deaths by connecting socially isolated individuals to health and social services. However, to be effective, these technologies require substantial social support, including bridging the digital divide, tailoring devices to users’ needs, ensuring proper use, and safeguarding the information they generate. ¹⁰ As rightly mentioned in the editorial, addressing this issue requires an interdisciplinary, multistakeholder approach with a shared goal: preventing people from dying alone. I sincerely thank Professor Peter Vanezis for bringing this deeply poignant and often overlooked issue to the attention of the scientific community, which is often caught up in the relentless pace of the material world.