The View from Hell

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Archive for the ‘compassion’ Category

Costs of Coercive Suicide Prevention (and an outline of an alternative)

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One of the themes of my project thus far has been to point out that coercive suicide prevention practices do nothing to prevent or decrease actual suffering, and often increase suffering by forcing people who genuinely want to die to stay alive. Coercive suicide prevention, far from reducing suffering, serves the socially negative purpose of masking suffering, so that the true level of suffering is less apparent.

My hypothesis, which I plan to flesh out in greater detail in the coming weeks, is that if the same public funds that are currently spent toward coercive suicide prevention were instead spent on reducing acute suffering in suicidal people though non-coercive means, both suffering and suicide would be reduced.

I am currently in the stage of collecting data on how much money is spent on coercive suicide prevention.

Preliminary data: In the state of Georgia, a 2005 study showed that $40 million was spent in 2002 alone on hospitalization and emergency room treatment of suicides and suicide attempters. 900 people completed suicide that year, 2800 were hospitalized, and 5400 visited emergency rooms for intentionally self-inflicted injuries. Assuming that completed suicide attempts are proportional to attempted suicides and self-inflicted injuries, we can calculate a per-completed-suicide cost in Georgia of about $44,000 (which is not the cost of treating a successful suicide, but rather the average medical expense for suicide treatment per completed suicide). Assuming nationwide costs mirror Georgia’s, that would give a national expenditure of around $44,000 times 32,595 suicides for 2002, which comes out to $1.4 billion for the country.

The Washington State Department of Health gives a higher figure – $4 billion for medical treatment of suicides nationally – though I can’t immediately trace the source.

Of course, these estimates leave out many other hard-to-measure costs of coercive suicide prevention, including police response, the cost of the government maintaining lists of formerly suicidal gun buyers (as in California), and costs associated with preventing would-be suicides from accessing lethal drugs.

Now imagine what things would be like if even a fraction of this money were spent on genuinely trying to reduce the suffering of suicidal people (and even non-suicidal people, for that matter). My proposal, as I now see it, would involve

  • ceasing automatic interference with suicide attempters, and publicizing this policy, to destroy the dangerous “fantasy of rescue” that might cause many people who do not genuinely want to die to make a suicide attempt
  • setting up a procedure for medically assisted suicide (prescribing a lethal dose of, say, barbiturates to a competent adult requester)
  • which procedure could have a waiting period, like gun purchases or marriage or divorce, and even require multiple requests
  • requesters, to be competent, must understand the nature of death and be able to articulate a non-delusional reason for wanting to die
  • a diagnosis of Major Depressive Disorder would not suffice to render someone incompetent to request suicide assistance
  • upon requesting suicide assistance – and, ideally, even if suicide assistance is not requested – some of that aforementioned money could be deployed to provide help with any problems identified by the suicide requester
  • any assistance (counseling, social worker consultation, housing assistance, bankruptcy assistance, etc.) must be offered without conditioning the eventual suicide assistance on the requester accepting the assistance

It must be recognized that coercive suicide prevention is harmful, in that it increases suffering while masking the suffering experienced by the population. And, despite drops in suicide associated with reduction in gun ownership, a high percentage of suicides are ultimately unpreventable through coercive means, as noted in a 2005 UK study tracking the increase and success rate of suicide by hanging (the lethality is around 70%). Hanging requires no special equipment – the study noted successful hangings conducted with belts, sheets, shoelaces, tights, bra straps, shirts, shower curtains, and pajama trousers – and has a 70% rate of lethality, even when the suicide is not fully suspended. (Of course, of the 30% who fail, how many will be subjected to the treatment suffered by the unidentified patient in the Annals of Neurology article?)

But we must consider whether, if there were a comfortable medical option widely available, many of those gun suicides, hanging suicides, and cutting suicides might opt to request it, instead – and, ultimately, many of them might get help solving the problem they originally thought suicide was the only answer to. For many people, of course, it would mean, not rescue from suicide, but a less horrible death – which, I would argue, is a good thing in itself.

For those suicides who really want to be rescued, my proposal serves to provide genuine, 100% certain rescue – before the suicide attempt is even made. And for those who have considered all options and only desire a comfortable death, my proposal would not humiliate or coerce them into accepting questionable “treatment” to which they have not consented, but would provide a way for them to end their lives with minimal harm to themselves or others.

Written by Sister Y

June 14, 2008 at 10:44 pm

Problems with Compassion

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Suppose you are a member of one of the Christian sects that believes that everyone who does not believe according to the teachings of that sect will suffer eternal punishment in Hell. What is compassionate behavior on your part? One view is that, “knowing” what you do, it is your duty to convert as many people as possible to your sect, to protect them from Hell – by argument, by harassment, even by force, if possible. No violation of others’ “rights” to live as they choose can compare to the eternal damnation they face in Hell. The only compassionate thing to do is to convert everyone by any means possible.

Another view of compassion is that even though you might choose to save yourself from Hell by believing as you do, and even though you might use persuasion to try to convert others, it is wrong to impose your beliefs on others.

The second view is that which I believe is most common in our culture – certainly among atheists, but even among believers, it would be seen as wrong to convert a person to a belief system using force or other improper means, even though the believer might feel that failure to do this will result in the unbeliever spending eternity in Hell.

People who feel that their own lives are meaningful and worthwhile often assume that living is necessarily a great thing for everyone, and if anyone seems to want to die, it isn’t really his wishes – or, even if it’s what he wishes now, he will eventually come around and see that life is great fun, meaningful, and worthwhile. Protecting him from his own liberty is in his interest in the long run. These folks subscribe to the view that forcing every person to live, even against his wishes, is the compassionate thing to do. I propose that this is like saying that the compassionate thing for a Christian believer to do is to convert all non-believers at sword-point.

Written by Sister Y

April 21, 2008 at 5:25 am

Posted in analogy, compassion, Hell

Compassion, Motivation, and Cognitive Bias

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There is a major cognitive barrier preventing most people from taking suicide seriously as a right, rather than classifying it as pathology. The barrier is that most people cannot imagine wanting to die.

Because people cannot conceive of wanting to die, they come up with all kinds of far-fetched explanations for suicide-related statistics. For example, Eva Schernhammer and Graham Colditz’s review of twenty-five studies about doctors who committed suicide revealed that women doctors commit suicide at about twice the rate of women in the general population. In some studies, the women physicians’ suicide rate approached parity with the rate of men in the general population (men commit suicide about four times as often as women, though women attempt suicide more often). Schernhammer proposed that a possible reason for the result could be gender bias in the medical profession. However, this theory does not explain the study’s other result, which is that male doctors have a 41% increased risk of suicide over men in the general population. When we see more data – for instance, that British veterinarians have a suicide rate four times that of the general population, or that women chemists also commit suicide at an increased rate (as do male chemists, though not as much) – a more sensible answer presents itself. Physicians, like veterinarians, have access to comfortable, sure methods of committing suicide. A small minority of the populations wishes for death, but lacks appropriate means of achieving it – unless they happen to be doctors, vets, or chemists. (Incidentally, studies like these probably tell us approximately what the suicide rate would be if comfortable means were generally available – that is, still quite low.) It is ludicrous to suppose that people in these professions – but not, for instance, finance – are driven to suicide by gender bias or other career pressures. However, people naturally search for explanations like gender bias or job pressure, because they can’t conceive of people in the general population wanting to die and not being able to do it.

In general, people find it hard to understand motivations of others that they do not share. Last night, for instance, four people shared a fish head casserole. Why did they eat this? If you have strong feeling against eating fish heads, your first thought is probably that poverty or desperate circumstances forced them to eat this dish. Or perhaps they ate it on a dare, or they were contestants on Fear Factor. But none of these is true. Three of my friends and I ordered the giant fish head – a Hunanese delicacy – and eagerly awaited it for thirty minutes while it steamed in a rich, garlicky poaching liquid with hot peppers. We had read a review of this dish and sought it out, and we ate it eagerly when it arrived. Neither coercion nor pathology is the proper explanation here – we did it because we wanted to.

A common reaction to an act motivated by a preference the observer finds mysterious is to attribute the act not to a preference, but to pathology, coercion, or some other motivation. In trying to understand the behavior, the observer thinks, “what would cause me to engage in that act? I’d have to be crazy, or someone would have to force me. Therefore this person must be crazy, or experiencing coercion.” Perhaps this attempted-but-failed empathy and the confusion it generates could explain the hostile reaction to sexual practices the observer does not share, in a similar way to that posited by Nagel in his Personal Rights and Public Space.

Ultimately, of course, this principal explains why compassionate, kind people often have a hard time accepting suicide as a right. It is an empirical fact that most people do not want to die. They must find it very hard to imagine that others do want to die, that death is their genuine end. They use their own preferences as a model, and assume that the suicidal desire is a product of pathology (depression, a type of “crazy” conveniently defined to include almost anyone with suicidal thoughts) or coercion of some sort (temporary, remediable life problems, such as the “job pressures” mentioned above). The most important thing for the compassionate reader to realize is that some people genuinely want to die, and can’t.

Written by Sister Y

April 8, 2008 at 9:45 pm