Loneliness is major public health concern, and bioethicists should rise to the challenge

By Zohar Lederman.

Loneliness nowadays poses one of the greatest threats to human health. It was prevalent worldwide before Covid and has gotten worse after Covid. It negatively affects our health, increasing the risk of depression, suicide, cardiovascular disease and early mortality. Loneliness also makes us miserable. Identifying these, several governments, the American Academies of Sciences, the World Health Organization and other organizations have taken up loneliness, investing in systematic solutions such as socializing classes as well as band-aid solutions such as the use of social robots for the elderly – New York City for example just acquired robot companions for 800 elderly individuals.

It is time (bio)ethicists think, write and do something about loneliness as well.

Loneliness first became part of my personal life. In a conscious attempt to turn it into solitude, studying it turned into a part of my professional life. As an emergency medicine physician in Israel, I increasingly noticed how patients who were technically discharged home preferred to stay in the busy and bacteria-laden emergency department. For the EM doc, every discharge is a victory; for some patients, it is dreadful. They came to the hospital to seek reprieve from the increasing black hole in their hearts and minds, and instead are returned to what their discharging physicians perceive to be their home. Little do they know however that it is not because a home is where you (should) feel physically, emotionally, and socially safe, and loneliness in its various forms is the antithesis for such feelings.

Covid made things much worse. As an emergency medicine physician, I have had patients who committed suicide because they could not hug their kids or grandkids anymore. One patient came after not eating for a week, because he did not have the ability or will to cook for himself. Patients positive for Covid now refused to be admitted for fear of the loneliness in the Covid ward – one family insisted on taking their loved one back home even though I warned in no uncertain terms that the patient will die if they do so. Admitted patients begged to allow their families to visit; most died alone. For the EM doc admitting when necessary is also supposed to be a victory, but admitting a patient to die alone is all but victory. I admitted numerous patients to die alone among strangers in white Personal Protective Equipment, and I still remember some of them. This feature article, and all of my work on loneliness, are motivated by their hurt and devoted to them.

For the next pandemic, we should do better. Bioethicists will continue to argue about the justification of lockdowns and quarantines for a long time, seeing their negative personal and societal impacts and dubitable public health benefits. Social isolation, however, does not equal loneliness nor ought it lead to loneliness. Even if the next pandemic justifies lockdowns and quarantines we should be smarter about them. We should optimize our use of technology such as social robots and virtual reality to maintain existing social connections and establish new ones. We should devise societal strategies to sever the link between social isolation and loneliness.

Societal strategies on the individual level should focus on educational campaigns to enable people to turn loneliness into solitude via physical activity, meditation and spirituality etc. Societal strategies on the communal level should emphasize and devote resources to simple and cost-effective interventions such as social visits by fellow community members and/or social workers, pet-assisted therapy, and homecare as an alternative for hospital care. Societal strategies on the communal level should also include innovative measures such as family rather than patient-only admittance to hospitals, and digital empathy training of healthcare professionals. In general, much more resources should be devoted to developing the science of loneliness with a particular focus on loneliness prevention and mitigation.

Empirical and analytical bioethicists should be on the forefront of such efforts. Not many other public health challenges are so intimately linked to the very core of what it means to be human, to be vulnerable, and to be healthy, as loneliness.


Author: Zohar Lederman

Paper : Loneliness at the age of COVID-19

Affiliations: Medical Ethics and Humanities Unit, LKS Medical Faculty, Hong Kong University, Hong Kong, Hong Kong; International Center of Health, Law, and Ethics, University of Haifa, Haifa, Israel.

Competing interests: None declared

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