When we hear someone has died we often unconsciously begin the process of deciding how distressing their death was. We do this by answering questions such as, how old were they, did they have children or other dependents, did they help and support others, was it expected, how did they die, were they a good person…
This type of thinking is common, we generalize to make sense of information, however, by thinking this way we are deciding how worthy a life was in comparison to other lives. This line of reasoning can be detrimental to the health and well-being of communities and cause political, social and financial divides as decisions are made about funding and care.
Christina Hughes works as the Lead RN at the Guelph Consumption & Treatment Services (CTS) site, and has seen firsthand how the decision of worthiness affects people and communities in problematic ways.
According to the Guelph CTS website , a CTS site offers health services where community members who use substances receive wraparound treatment and support. They provide low barrier, life-saving care that aids in the response to the current opioid and overdose crisis facing many communities. Clients of the CTS are able to consume substances in a facility staffed by medical professionals and peers with lived experience.
According to Hughes, “These are people who are historically left on the fringes of society. At the CTS, they become engaged in valuable processes, learn about safer injection techniques, are warned about trends in contaminated supply, and are taught about safe disposal of injection supplies post-consumption. They are afforded some dignity, autonomy, and respect in the safe space we are providing”.
Hughes states she is all too familiar with people dying from substance use being treated as a statistic, instead of someone’s child, sibling, spouse, friend, or valued community participant. “These numbers continue to climb in the pandemic, in Guelph alone we have seen a 242% increase in fatalities due to accidental opioid poisoning. That’s 24 human lives in one year compared to 7 lives lost in 2019. In spite of this, we still don’t see communities or public health measures responding to this with impactful measures. Ultimately, it feels like an entire group of people forsaken because of how their lives are being perceived or measured; but these were beautiful souls that someone loved”.
It is as though these deaths are not seen as tragic, but rather as something inevitable and indicative of either a moral failing or the conclusion to a series of bad choices. Hughes assures us, “Not a single client that I work with, got here by choice, and they don’t want to die, they want support, they want help, they want to live a life with purpose and meaning, just like the rest of us”.
Hughes goes on to say, “I have seen clients that I am sure many others would have deemed a ‘lost cause’ become active community members; they are connected to housing and employment services and aren’t spending their days fixated on addressing the very real concerns of withdrawal that can lead them to participate in criminal activity. The only way this happens, is if they can stay alive, which is precisely what harm reduction and the CTS make possible”.
Measuring the merits of a life worth living and saving, comes at a cost. If what we value socially is economic success or riches, are we really weighing what matters? What does a life lived well look like? Is grief not as real for the parent who lost their child to substance use as the grief of the parent who lost their child to a car accident or cancer?
When we categorize life in this way, not only are we stigmatizing the individual lost, we are also alienating and stigmatizing those people left to mourn. We are sending a message that they should hide their grief, and mourn less. We are sending a message that they cannot reach out to their communities for the support and assistance they deserve, because their communities were unwilling to support and assist those they lost.
It is a natural inclination to organize the particulars of a death, and to have a natural curiosity about how someone died. This helps us understand and figure out how the death relates to our life, and our values. But could we not take this further and consider the implications of prejudice and stigma? Does it not benefit humanity to recognize the interconnectedness of all life?
A recent trend is emerging wherein families who are grieving the loss of someone to a substance use disorder are using clear and respectful language to talk openly about the death and how it happened. Historically families would try to avoid identifying the cause of death in these cases, thinking they were being respectful, however actually perpetuating shame and stigma around substance use and the death of their loved one.
Using secrecy and non-specific language blames the individual instead of the systemic factors and biopsychosocial influences that put people at risk. Furthermore, it robs families of the opportunity to educate about substance use and entrenches people with shame, disallowing them to celebrate and grieve the life of the person they loved.
Like any other health care service, visitors to the CTS have their health information safeguarded by health privacy legislation; staff are trained to take great care in ensuring that privacy and confidentiality is afforded to all CTS visitors. That said, Hughes notes that the silence, or omission, that happens in families and in the community about overdose deaths is not driven by this same privacy, but rather by stigma and shame that we continue to place on the perceived “value” of the life of those struggling with addiction.
When asked what advice she had for people, Hughes said, “Although we may not intend to cause harm when we measure the worthiness of someone’s life and death, we should stop and think about the harm caused by stigma and what we can do to end stigma now.”