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Death on board: What happens if you die on a cruise?

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Passengers board cruise ships at the Port of Tallinn, Estonia. (James Gately)

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Passengers board cruise ships at the Port of Tallinn, Estonia. (James Gately)

Last November, David and Martha Fitzgerald boarded a Carnival Liberty cruise ship in Rome hoping for a lavish vacation. The retired couple from Tarpon Springs, Fla., planned to spend 16 luxurious days on board, visiting the lounge shows and casinos as the ship made its way across the Atlantic and back to Florida.

But less than a week into the trip, David Fitzgerald, 76, came down with the Norwalk virus, the stomach flu that infected more than 700 passengers on the ship in what was one of the largest outbreaks on record.

Days later, Fitzgerald died. His wife left the ship at the next port, and before catching her flight home, sat in a hotel bar in Portugal and said her goodbyes to David with his favorite drink, a scotch with three cubes of ice. David Fitzgerald had sailed on, in the cruise ship's morgue.

“It was awful thinking of him on that ship,” said Fitzgerald’s daughter Susan Lyster, who was told that the paperwork involved in flying the body back could have taken months. “It was agony every day.”

With more than 12 million people taking cruises each year, and an ever greater number of people cruising into their golden years, death has become more common on the high seas.

Cruise lines won’t release statistics, and the Cruise Lines International Association does not keep records on the number of on-board deaths, said Christine Fischer, the group’s spokeswoman.

But one indication of how many people die on cruise ships comes from the coroners' offices near major ports. Between 1999 and 2007, the Broward County Medical Examiner’s Office in Florida reported 97 cruise ship deaths; the Miami Dade County Medical Examiner’s Office recorded 33 cruise ship deaths since 2004; and partial data from the Los Angeles County Coroner’s Office noted 22 cruise ship deaths between 1991 and 2003.

Most cruise ship deaths are the result of natural causes, according to medical investigators around the United States who typically board cruise ships to take bodies in for autopsy. The majority of cruise ship deaths are caused by heart disease, heart failure and strokes, with pneumonia and cancer also accounting for some of the deaths, according to autopsy reports from California and Florida, the two biggest points of entry for cruise ships in North America.

Age is a factor in many of these deaths. The average age of cruise passengers is 49, according to the cruise lines association, but on cruises that last longer than a week, the average age shoots up to 64. On Holland America’s round-the-world cruises, the average passenger is 75, said Erik Elvejord, a spokesman.

Sometimes, there are multiple deaths on a single long cruise, said Ross A. Klein, a sociologist from Toronto who writes about the cruise industry. Ship morgues usually accommodate one to three bodies, but Klein says he remembers a cruise from Fort Lauderdale to Lisbon on which there were “more bodies than the morgue would fit.”

“The morgue was filled, and they had to start finding other places to put the bodies,” he said.

Such cases are unusual. Major cruise lines say they run a tight ship when it comes to dealing with their dead.

When a passenger dies, a cruise line notifies the flagship company and sends an onboard chaplain to counsel the family.

“They are well prepared in case of death,” said Doreen Badeaux, director of Apostleship of the Sea, the Catholic ministry for passenger and cargo ships. The group cooperates with Celebrity, Holland America and Norwegian cruise lines to place an ordained Catholic priest on every ship as well as a Protestant minister and Jewish rabbis during certain holidays.

“Priests tell me people die on board quite often," Badeaux said. “You have older passengers on board, and it’s not unusual for them to have heart attacks.”

The body is generally taken off the ship at the next port of call, where it is kept until it can be flown home, or “expatriated.” But most cruise lines check out a port’s facilities before they drop a body off, Elvejord said.

“If it’s 95 degrees and there’s no morgue, we won’t take the body off,” he said. “We look at places and ask, 'Do they have a morgue? Do they have the capacity to transport the body without damaging it?' The last thing you want to do is upset the loved ones. We’re not going to leave the body somewhere where they will never know when they’ll see it again.”

A Carnival spokeswoman, Jennifer de la Cruz, said it was up to family members to decide whether to disembark with the body or stay on board until the ship returns home. “We encourage people to leave it on board," she said. It’s "easier than taking the body off in foreign ports."

In recent years, people have sued cruise lines after family members have died from drowning, pool accidents, gastrointestinal flu and allergic reactions to shellfish, as well as after having been killed during on-shore excursions. Other lawsuits against cruise lines involve injury arising from stray golf balls, malfunctioning sliding glass doors, falling bunk beds, coconut cocktails that have been thrown across a room, snapping mooring lines, open hatches and spider bites, according to Judge Thomas A. Dickerson, author of the annually updated guide “The Cruise Passenger’s Rights and Remedies,” published in the legal journal Travel Law.

Cruise lines say ship infirmaries function as fully equipped emergency rooms, and Fischer of the cruise lines association assures passengers that ships meet the guidelines of the American College of Emergency Technicians. But Dr. Richard Prager, a Miami doctor whose father died of a heart attack on a Caribbean cruise in 1993, fears that no one is checking on cruise lines to ensure that they actually abide by the guidelines.

Regardless of which cruise line you choose, it's important to prepare before you depart, said Klein, the sociologist from Toronto, who has written a book called “Cruise Ship Blues: The Underside of the Cruise Ship Industry."

This can include getting a clean bill of health from your doctor, informing the cruise line of any medical conditions you may have and setting up your cell phone to make international calls in the event of an emergency.

Klein says elderly people in particular should be cautious if they have complex medical conditions that can be more difficult to treat at sea. Many travel insurance policies, including those issued by cruise lines, will not cover passengers with existing medical conditions.

However, a typical travel insurance package will cover the costs of flying a body home or canceling a trip because of illness, injury or death.

"American passengers in particular don’t think of the importance of travel insurance," Klein said. "I would always encourage people to look into that, to avoid big regrets.”

E-mail ac2635@columbia.edu