LAUSR

Correspondence to Dr Rakhi Dandona; rakhi. dandona@ phfi. org © Author(s) (or their employer(s)) 2023. Reuse permitted under CC BY. Published by BMJ. The proposition of the Lancet Commission on the Value of Death is that our relationship with death and dying needs rebalancing because how people die has changed radically over recent generations as death comes later in life for many and dying is often prolonged, and has moved from a family and community setting to primarily the domain of health systems. They argue that rebalancing death and dying will depend on changes across death systems—the many interrelated social, cultural, economic, religious and political factors that determine how death, dying and bereavement are understood, experienced and managed. We support this rebalancing of death and dying and suggest a broader scope for it by the inclusion of stillbirths—babies born dead. The incident of ‘death’ (loss of one’s life) impacts the friends and family left behind in addition to the individual who loses his/her own life. We argue that this type of impact is also true for stillbirths because a stillbirth is still a birth. Despite several calls to address preventable stillbirths, the acknowledgement that these babies ‘die’ and hence are born dead, and that some of them could and should have been born alive continues to be neglected by health practitioners, policy makers and in health metrics indicators. 3 The recent UNICEFIGME report estimated nearly 2 million stillbirths globally in 2021, defined as fetal death at or after the 28th gestational week but before birth. In comparison, an estimated 2.4 million neonatal deaths occurred globally in 2019, which is the death of a newborn (live birth) between birth and the first 28 days of postpartum life. The most disabilityadjusted lifeyears (DALYs), approximately 86 DALYs, in the Global Burden of Disease Study arise from neonatal death, most of which are early neonatal deaths that occur at birth (intrapartum complications) or within the first 6 days postpartum. Notably, many neonatal deaths result from preterm birth— that is, birth earlier than 37 weeks of gestation. Therefore, in terms of the burden of disease, a baby born alive and prematurely at the 24th gestational age who dies at birth or right after birth is registered as the worst possible tragedy with 86 DALYs. In contrast, the death of a baby in the womb at 40th week of gestation just before birth (stillbirth) is not assigned any disease burden. Today’s majority view for contemporary philosophers is that death is comparatively harmful to the individual who dies, 7 and the years of life lost component of the DALY relies on such counterfactual reasoning. 9 In this philosophical reasoning, death implies a loss of a future, and generally, death at a young age results in losing a more extensive future than death at an older age. If taken seriously, such a comparative account of the harm of death implies that neonatal death is considered not just death of the neonate but death of ‘a future like ours’ with all that life has to offer. That is to say, the death of a baby implies the loss of not only the baby itself but also the child and adult person that it could have been had it not died. However, the dichotomous view that birth itself constitutes the difference between a seemingly morally SUMMARY