Performing the autopsy should have been a straightforward task. The patient had a history of advanced cancer, which seemed like the obvious cause of death. However, upon further inspection, my colleague and I couldn’t find a clear reason for his sudden demise. There were no signs of a heart attack, blood clot, or ruptured bowel. It left us wondering why he had died on that specific day. Perhaps there were subtle changes in his blood chemistry or his heart’s electrical signaling that we couldn’t detect? It was frustrating not to have a definitive answer.
As a hospital pathologist, my job is to provide explanations for the end of life. But even with thorough medical examinations, there is always uncertainty. Take the recent wave of heat-related deaths during the summer. Record-breaking temperatures in Phoenix and other places have led to tragic fatalities. However, determining the exact cause of these deaths is challenging. There isn’t a precise way to measure “heat-related” deaths, and it often involves subjective judgment. Some people may die directly from the heat, while others may have preexisting conditions that are worsened by oppressive temperatures.
The field of mortality is complex and involves conflicting types of knowledge. In some cases, like in Clark County, Nevada, coroners spend weeks investigating possible heat-related deaths. They consider various sources of information, conduct interviews with families, inspect death scenes, and perform medical tests. These examinations are necessary because a single autopsy finding cannot definitively diagnose a heat fatality. It’s a meticulous process, but not all deaths undergo such extensive forensic examination. Most of the time, primary-care doctors or hospital physicians complete the death certificates based on straightforward circumstances.
However, heat can silently exacerbate preexisting conditions, causing organ failure. Studies have shown that even routine temperature fluctuations can subtly affect kidney function, cholesterol levels, and blood counts. It is challenging for physicians to determine the specific influence of heat in these cases. Epidemiologists analyze statistics at the population level to uncover hidden causes. It is clear that bad weather leads to more deaths, but it doesn’t provide a complete understanding of individual cases.
Research and common sense tell us that certain individuals are more vulnerable to climate-related risks. Factors such as poverty, physical labor, substandard housing, advanced age, and comorbidities increase the risk of heat-related illnesses. Heatwaves disproportionately affect those who are already struggling. Even a small financial struggle, like an unpaid electricity bill, can have deadly consequences in the summer. Through autopsies, I often witness the tragic circumstances of social neglect, but there is no place on the death certificate to capture these details. Climate change’s contribution to fatalities is not within my jurisdiction.
Assessing deaths from a public health perspective presents its own challenges. It can be confusing with numerous scientific studies reporting on different risk factors for mortality. Sultry weather and various other factors have been labeled as major killers. Making matters worse, statistics are often politicized, with different groups emphasizing certain causes of death based on their beliefs. The current heat wave, for example, has ignited debates about climate change, with liberals urging action while conservatives dismiss the concern. It’s important to remember that mortality data is not fixed and can be subject to interpretation.
Regardless of how we count the bodies, extreme weather leads to suffering, particularly among vulnerable populations. The ongoing heat wave has already claimed many lives. Their deaths are not simply coincidental. It is imperative to recognize the impact of extreme weather on individuals, especially those who are most at risk.
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