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Victims of the Suicide Prohibition: Mark & Julie James

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Debbie Purdy may be about to get an answer to her legal question. But probably not.

Mark and Julie James, the parents of British rugby player Dan James, are under investigation for helping their son to end his life. Dan James travelled to Switzerland last month to end his life. How, exactly, his parents may have “assisted” his quest has not been released. The case may – or may not – shed light on how the British legal system will treat those who “assist suicide” in incidental ways. If the Jameses are prosecuted, that is one kind of answer. If the Jameses are not prosecuted, however, it is no assurance for Debby Purdy’s husband.

Update: authorities have declined to prosecute Mr. and Mrs. James. (Thanks, Steven.)

The QC, Kier Starmer, is quoted as saying:

This is a tragic case involving as it does the death of a young man in difficult and unique circumstances. While there are public interest factors in favour of prosecution, not least of which is the seriousness of this offence, I have determined that these are outweighed by the public interest factors that say that a prosecution is not needed.

I would point to the fact that Daniel, as a fiercely independent young man, was not influenced by his parents to take his own life and the evidence indicates he did so despite their imploring him not to. I send my condolences to Daniel’s family and friends. [Emphasis mine.]

Starmer seems to articulate a rule that it’s okay to assist in a suicide as long as one does not influence the decedent to commit suicide, and as long as one “implores” the decedent not to do it. Precedent based on apparent attitude and feeling seems strange to me. In addition, Daniel’s act wasn’t criminal – even if his parents had influenced him to commit suicide, “influencing” someone to do something that is not a crime is a strange sort of crime. It does seem cruel and impolite – even I don’t go around influencing people to commit suicide (quite the opposite, despite my belief that suicide is often rational) – but the requirement that those assisting a suicide must be, at the same time, fighting against the suicide, seems strange to me.

Perhaps it matters that it’s the parents or caretakers doing, or not doing, the influencing. Then it is a matter of undue influence or improper use of one’s authority. A regular person may influence another to have sex with him, and it is not a crime – but if a person in power (doctor, lawyer, caretaker, parent) uses his power to influence another (patient, client, charge, child) to commit the same sexual act, it may rise to the level of a tort or even a crime – almost as if physical force were used.

But nobody seems to be talking about autonomy here.

At any rate, it’s not much guidance for Debby Purdy.

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Written by Sister Y

October 17, 2008 at 4:48 pm

Cheery Social Policy

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The “cheery,” frequently alluded to by David Benatar in Better Never to Have Been, might be defined as those people experiencing optimistic bias, who are as a result untroubled by, or overly dismissive of, serious problems involving human suffering. Cheeriness is an extremely common trait, and the cheery certainly make up a majority of the human population and exert a major influence on social policy.

The fundamental problem with cheeriness is the assumption that a good life – a pleasant life – is relatively easy to achieve. This assumption is, of course, true for the cheery, but the cheery are able to ignore – and perhaps can’t even conceive of – the suffering of a significant minority of the population. A good life is not easily achieved for many of us.

The cheery do not need to use extraordinary means to achieve a tolerable life. Behaviors that others engage in, perhaps in pursuit of a tolerable life – weird sex with lots of people, say, or using steroids or marijuana or LSD or benzodiazepines – strike the cheery as unnecessary and harmful. And, for a cheery person, these behaviors are wholly unnecessary – life is perfectly tolerable without them. And they increase the risk of harm! Who wants harm?

What the cheery cannot imagine is the importance, the function of these behaviors, and others like them – the pursuit of the interesting, and the temporary suspension of the intolerability of existence, which intolerability (for many) the cheery do not even perceive, and therefore do not properly weight as a problem.

I suspect that the same cheery social policy is at work with the question of suicide. Groundless faith that anyone can have a good life, bar none, leads to a general policy of suicide prohibition. A more mature understanding of the seriousness of suffering, and a more realistic evaluation of the possibility for its amelioration, would lead at least to a policy with more exceptions.

Written by Sister Y

August 28, 2008 at 11:45 pm

Incentives Will Fail: Why Procreation is Like Prostitution and Drugs

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In a previous post, I said that an outright prohibition on birth would be a moral horror, because given our current level of technology, it would mean forced abortion, forced sterilization, or both. While a pure consequentialist might still argue that the harm of later generations being born might outweigh the extra suffering a “forced abortion generation” had to undergo, there are strong agent-relative reasons to not forcibly perform abortions, even though by not doing so, we allow a greater violation of rights to occur.

In attempting to formulate an example to illustrate this, I noticed that all the examples in the anti-consequentialist literature (people like Thomas Nagel and Bernard Williams) feature an agent faced with a choice of harming someone himself, or having someone other than his possible victim do much greater harm. The antinatalist forced abortion dilemma is different: one would be faced with a choice of harming someone, or allowing that person to do harm to another person. The forced abortion case has a great deal more in common, perhaps, with defense-of-others cases than the typical anti-consequentialist examples. (It should give us pause, however, that anti-abortion fanatics follow this same logic to the conclusion that it’s morally appropriate to shoot abortion doctors.)

There is an alternate political possibility to forced abortion and forced sterilization: creating an incentive structure that provides negative incentives for birth and positive incentives for not procreating (and which, one would hope, would legitimize refusing to give birth and remove some of the social and moral legitimacy of voluntary procreation.) But both an outright ban and an incentive structure suffer from the same problems as those in place to curb prostitution and drugs.

Anti-prostitution laws exist for a variety of reasons, but the most common justification in our modern era is that they exist to protect women who are or would become prostitutes from exploitation. The problem with anti-prostitution laws is that they universally seem to do greater harm to the very class of people they’re intended to protect – prostitute women. It is impossible to imagine an anti-prostitution law that would not harm prostitutes. Even laws that provide for prosecution of prostitutes’ customers only, and not the prostitutes themselves, drive traffic underground and thereby make it much less safe for prostitute women.

Anti-drug laws are, in theory, motivated by a desire to minimize harm to people, including drug users and those otherwise affected by the drug trade, such as those whom drug users might steal from to support their habits. But a consensus seems to be developing among economists and social scientists that the drug prohibition does more harm than it prevents – to the very people it is intended to protect.

Birth seems to have in common with prostitution and drugs the status of being a good with inelastic, or close to inelastic, demand, especially for the first child. China’s one-child policy has had some success, though there are reports that it functions both as an incentive structure and as an outright ban (I can’t figure out if reports of forced abortion are reliable). But the one-child policy is not an antinatalist policy but a limited procreation policy. There is reason to believe that increasing the cost of procreation in an attempt to drive procreation to zero – either through a sort of tax structure, or through positive incentives for non-procreation – would fail miserably, and, as with prostitution and drugs, would harm the very people the policy was intended to protect. Any incentive against procreation (a) would likely not significantly reduce procreation, since, based as it is in a strong biological drive, some level of procreation likely has near-inelastic demand (and supply is hard to control); and (b) would necessarily harm the children who were nonetheless brought into existence.

For example, let’s say procreation now carries a $10,000 fine or 6 months in jail if the fine is not paid. Most people would likely procreate anyway, and either pay the fine or serve the jail sentence. And a child brought into the world would be faced with parents who have either $10,000 less to spend on his upbringing, or 6 months less time to work to save money for the child’s upbringing.

I think there is one possible hope: incentives for voluntary, permanent sterilization. While, at some point, the majority of humans seem to want to procreate, humans have a notoriously high discount rate. If a great enough incentive were offered early enough in life, many might accept the incentive and be permanently sterilized; while they might regret the decision later, their children and grandchildren would never exist, and would therefore never have reason to regret their lives.

Written by Sister Y

August 10, 2008 at 6:15 pm

Concern for Truth

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Longevity-enthusiast Hopefully Anonymous proposes this definition of the “politically incorrect,” in a discussion thread on Entitled to an Opinion:

I think a useful, natural definition is where there are social mechanisms to reduce the expression of an idea for reasons other than its utility in creating the most accurate models of reality. It’s not that the idea is empirically incorrect, it’s that it’s politically incorrect.

That is, the reasons for the suppression of the “politically incorrect” statement, by various social mechanisms, are unrelated to the truth value of the statement.

The (implied) definition of the social mechanisms to reduce the expression of the “politically incorrect” idea is very close to Harry Frankfurt’s definition of bullshit: bullshit is, says Frankfurt, not a lie, but a statement which, while outwardly protesting concern for truth, is actually utterly unconcerned with truth. The liar is at least conscious of the truth enough to formulate a lie; the bullshitter eschews even a conception of the truth.

But is the “politically incorrect” really so broad? Certainly, all objections to genuinely politically incorrect ideas on the basis of political correctness are bullshit, but certainly we can’t say that all bullshit objections are objections based on political correctness. As TGGP puts it,

So, could good etiquette, which often means avoiding frankness or expressing thoughts even if others suspect we have them, be considered a form of political correctness, even when it has no connection to policy?

A few years ago, I was riding in a car with a friend (actually my lover at the time) who has Asperger’s, and another friend who doesn’t have Asperger’s. The non-Aspie friend made a kind of offhand, lame joke, and I laughed. My Aspie friend asked why I had laughed, since the joke wasn’t funny. I explained that laughing at jokes is a socially polite thing to do – like saying “bless you” when someone sneezes, regardless of a belief in God. He seemed to understand and for the rest of the ride, he practiced “polite laughter” – it was a bit ghastly, really. Anyway, my laughing at the lame joke was certainly bullshit – a response unconnected with the truth, but engaged in for some other reason (politeness). It wasn’t a lie, because I laughed even before evaluating the merit of the joke. But I think few of us would classify my response as the “politically correct” response. Only a subset of bullshit is politically correct bullshit.

I, for one, often feel the need to liberally coat my politically incorrect beliefs in charming bullshit in order to make them more palatable. I think, in this case, the motive is politeness – and an eye to genuine communication – ideas can be more or less understandable depending on their presentation and context. But even ideas that are not politically incorrect may need to be ensconced in bullshit for maximum communicative value.

We can get closer to a phenomenological definition of the politically incorrect. Folklorist Linda Dégh might be regarded as an expert on the folkloric legend, as distinct from märchen, magic stories that we might refer to as “fairy tales.” The main difference is that the legend is a personal story that invites genuine disbelief (think “urban legend”), whereas märchen are impersonal stories that are clearly not intended to be believed. In discussing the definition of the legend, Dégh says that there are some stories that she excludes:

Arguing for the disputability factor as crucial, I excluded legend-like narratives that enforce belief and that deny the right of disbelief or doubt, narratives that express majority opinion and are safeguarded by moral taboos from negation and, what is more, from deviation. [“Tape-Recording Miracles for Everyday Living,” in American Folklore and the Mass Media, Indiana University Press, 1994. Emphasis mine.]

Dégh’s examples are “religious (Christian, hagiographic, or saint’s) legends,” and the “patriotic (heroic) legends dispensed through school education by governments, confirming citizens in civil religiosity.”

I propose the following: For an idea to be genuinely politically incorrect, (a) the idea must be in conflict with majority opinion, (b) there must be social mechanisms to reduce expression of the belief for reasons other than the idea’s truth value (i.e., bullshit is set against it), and (c) these social mechanisms must have the function of a moral taboo to protect an important cultural narrative from negation.

Interestingly, my requirement of being opposed to “majority opinion” would exclude from the “politically incorrect” cases where people speak out against the narratives promulgated by their government, if the narratives are not believed by a majority of the population, as with Chinese dissidents challenging Mao’s bullshit about the man-made famines of 1959-1961 and beyond, and opponents of the war in Iraq today.

Written by Sister Y

August 9, 2008 at 5:59 pm

Posted in ethics, folklore, politics, truth

Why We Should Keep Knitting Booties

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See also, Incentives Will Fail: Why Procreation Is Like Prostitution And Drugs.

Many of us believe that everyone has a moral right not to be born, a strange sort of right that one only holds in its breach, as David Benatar puts it. But what consequences should this moral view have on our actions?

Obviously, someone who believes an action is wrong should avoid taking that action himself. But what is one to do about others who take actions that one believes to be wrong?

David Benatar addresses the political side of this question in Better Never to Have Been. Benatar concludes, and I agree, that although procreation is always a harm, a political prohibition on birth would be a greater moral horror. A political prohibition on birth would mean, with our current technology, forced abortion and forced sterilization. No matter how great the harm of birth – even though it entails death – forced abortion is worse, especially considering the widespread fear and suffering that the policy would cause to currently-living people.

So the political answer is, I think, do nothing, except perhaps to increase funding for voluntary birth control, abortion, and education. But what of the personal realm? Should we still knit booties when our friends have babies? Or should we flip off people with “Baby On Board” stickers in their windows?

Cory Doctorow is one of my heroes. His work, more than anyone’s except perhaps Michael Gondry’s, often leaves me with at least a temporary sense that there are worthwhile, interesting projects for sentient beings other than pursuing nonexistence.

As I have previously mentioned, I find Doctorow’s story I, Rowboat, the story of Robbie the sentient rowboat, extremely affecting. Doctorow displays a deep grasp of the ethical problems involved in creating new sentient beings. (In a subplot, a coral reef is brought to sentience by a chaotic-evil being, described as a “capricious upload god,” wakes up very angry, and apparently spends the rest of eternity chasing the “upload god” in an attempt to destroy it. The main plot centers on Robbie the rowboat’s poignant, lonely experience of sentience.)

Given Doctorow’s apparently nuanced understanding of the problems of coming into existence, some experienced a bit of cognitive dissonance when Cory had a baby. Some reacted with uncharitable crankiness, such as BoingBoing commenter Kyle Armbruster (re-emvowelled by me):

It’s like, just when you thought Cory Doctorow couldn’t possibly be more of a self-aggrandizing, pedantic know-it-all prick, he has a kid.

If there’s any justice in the universe, his daughter will legally change her name to get rid of the 40 extra ones her parents tacked on and become the CFO of Sony BMG.

(Kyle got “put on time out” from BoingBoing for three days for that, and that kind of vitriol probably indicates the usually-well-behaved user needs a bit of a break.)

I believe it is a serious moral harm to have children, but I think it is a great harm to be a total self-righteous cunt toward people who decide to have children. The morally correct action, in my view, is to openly espouse antinatalism, but at the same time to welcome babies into the world and knit them booties. Benatar himself leads the way with this, by dedicating his book to his parents and his brothers. We have all been harmed by being brought into existence, but once we exist, let us enjoy each other’s company.

Just as there should be no forced abortion or forced sterilization in the political realm, even though more babies will thereby be created, there should be no additional suffering heaped onto parents and children because of this wrong. We should continue to develop and spread our ideas with the hope that people will make ethical choices, but, as I have said, we should keep knitting booties.

Even a generation ago, children who had the misfortune to be born “out of wedlock” were treated horribly by the adults in their communities. My own grandmother suffered greatly from this, born into a highly religious community when my great-grandmother was not married. The horrible treatment was related, at least in part, to the moral belief that procreation is only appropriate between married people. But however strongly held, however correct even, this belief may be, it is not a license to treat babies and children badly. The mistreatment of babies and children is a moral horror. Likewise, it’s pointless, mean, and immoral to flip off the people with the “Baby On Board” stickers.

Taking a page from abortion centrists, let our movement’s slogan be this: Make procreation safe, legal, and rare. And keep knitting booties.

———-

On a related note, I want to trace the implications of a thought I briefly entertained in dealing with my own cognitive dissonance upon the birth of Cory Doctorow’s child: when a man fathers a child through natural means, how can we be sure that procreation was the man’s decision? (Again, I do not at all mean to imply that Cory’s daughter was unplanned or unwanted! By all reports, she was most wanted, and is a charming baby destined to be brilliant, creative, and highly capable.)

In most first-world countries, contraception is widely available. Effective contraception may be utilized by either partner, even without the cooperation of the other. However, in practice, men often rely on women for contraception. Also, contraception failures are frequent.

Again, in most first-world countries, abortion is the prerogative of women. A woman who becomes pregnant may choose to give birth, or to abort. But a man’s freedom not to procreate ends with ejaculation. A woman can procreate with or without a man’s consent to the procreation. A man can only procreate with a woman’s continuing consent.

Given the alternatives – forced abortion, forced birth – this is the best system. A forced abortion is worse than a man being obliged to procreate against his will. A forced birth is worse than a man being prevented from procreating against his will.

While abortion as a female prerogative is better than the alternatives, it is not without problems. The general requirement, again in first-world countries, that parents monetarily support their children until they reach majority creates a major (and undeserved) hardship for men who conceived accidentally and do not desire to have a child. And this is not to mention the emotional consequences. Is an act of sexual intercourse enough to morally justify saddling someone with an unwanted child? If not for women, then why for men?

I think people ignore the injustice inherent in our system of allocating procreative responsibility, because its obvious flaws are not amenable to a political solution. It is another limit on human happiness.

One of the implications of the de facto female monopoly on reproductive decisions, in first-world countries, is to render antinatalism primarily a female issue.

However, an example of undeniable, active male participation in reproduction (other than through artificial means) is related by Mary Beth Bonacci, professional chastity lecturer and realtor. Her 2001 article in the Arlington Catholic Herald told the story of a married Catholic couple who considered, but ultimately rejected, divorce:

But there’s more. Back in the fast-track days, Greg had a vasectomy. After their conversion, they felt called to reverse that procedure — a very expensive proposition. But, through yet another miracle, they found a doctor inspired by their story, who was willing to do the reversal — essentially for free. He did so, and on Feb. 9, 2001, Katharine Marie Alexander was welcomed into the world.

God is truly good.

Most men are not as lucky as Greg was in controlling their procreation. It is a moral issue that deserves consideration.

Written by Sister Y

August 8, 2008 at 9:35 pm

Oregon’s Law

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Oregon’s Death With Dignity Act succeeds in many ways. The Act respects patient autonomy, from its definition of “capable” to mean that

in the opinion of a court or in the opinion of the patient’s attending physician or consulting physician, psychiatrist or psychologist, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient’s manner of communicating if those persons are available.

to the way it allows patients to decide for themselves whether to notify family members and when – even if – to self-administer the lethal prescription, once requested. (Some people who request suicide assistance don’t use it until months or years after it has been provided.)

Oregon’s law is wrong, however, in limiting access to death to those with terminal illnesses. Although this flawed version is certainly the only version of the law that would have had a chance of being enacted, the fact remains that it is wrong.

First, restricting access to comfortable means of death to those with a terminal illness is actually demeaning to people with terminal illnesses. The idea that human dignity somehow requires that one be able to walk and talk and control one’s bodily functions is demeaning and wrong, as Felicia Ackerman (see Readings) and disability advocates point out. A terminally ill person must decide for him or herself whether to request suicide assistance; it is not the right decision for everyone. But what possible justification could there be for limiting this right to terminally ill people, except that their lives are somehow less valuable than those lives that will (probably) continue on for many years? The designation “Death With Dignity Act,” of course, hints at the demeaning implication of the limit: some deaths are dignified, other are not. The state will decide for you whether you are undignified enough to be allowed to die peacefully. (The Oregon law does not allow assisted suicide to be provided to non-terminally-ill disabled or merely old people, but the implications of the restriction to terminally ill people are clear enough.)

Second, the Oregon law’s restriction against suicide assistance to non-terminally-ill people is wrong because suicide is an important right for everyone, not merely the terminally ill. In fact, if anything, the right is more important for those who are not terminally ill, because their time of suffering will most likely be much longer than those who will die soon naturally. And, as pointed out by Velleman, terminally ill people are much more likely to be harmed by having the option to die than healthy people are, because they are more likely to be dependent on the care of others and therefore to feel themselves to be a burden. A more sensible restriction might be to allow suicide assistance only to non-terminally-ill people! I am not, of course, in favor of this restriction, but it makes more philosophical sense than Oregon’s law, which makes political sense, if anything.

Meanwhile, Switzerland recently extended suicide rights to those with incurable mental illnesses. Jacob Appel, writing in the Hasting Center Report, explains the basic ethical issues:

Another set of objections are from those who support a basic right to assisted suicide in certain situations, such as those of terminal disease, but do not wish to extend it to cases of severe and incurable mental illness. This resistance may be inevitable, considering the increased emphasis that contemporary psychiatry places on suicide prevention, but the principles favoring legal assisted suicide lead logically to the extension of these rights to some mentally ill patients.

At the core of the argument supporting assisted suicide are the twin goals of maximizing individual autonomy and minimizing human suffering. Patients, advocates believe, should be able to control the decision of when to end their own lives, and they should be able to avoid unwanted distress, both physical and psychological. While these two principles might explain why a victim of amyotrophic lateral sclerosis or cancer would choose assisted suicide, they apply equally well in many cases of purely psychological disease: a victim of repeated bouts of severe depression, particularly in cases where treatment has consistently proven ineffective, rationally might prefer dignified death over future suffering. [Hastings Cent Rep. 2007;37(3):21-23. Via Medscape. Emphasis mine.]

Written by Sister Y

June 24, 2008 at 3:40 am

Attempted Suicide as a Signal

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How many completed suicides are actually thwarted rescue fantasies?

The answer to this question is necessarily unknowable, locked as it is inside the minds of people about to die. But the number must be substantial, and those who favor coercive suicide prevention methods often refer to the idea of insincere suicides – people who attempt suicide only to send a signal for help – to justify their preferred policies of intervention in all cases. It is only in keeping with the principal of autonomy to do what the suicide attempter wishes, they argue, and what most of them wish is to be rescued. The National Right to Life Committee puts it this way:

It is not actually a desire to die, but rather the desire to accomplish something by the attempt that drives the attempter to consider such a drastic option. Suicide is the means, not the end.

Often, suicide attempters are apparently seeking to establish some means of communication with significant persons in their lives or to test those persons’ care and affection. Psychologists have concluded that other motives for attempting suicide include retaliatory abandonment (responding to a perceived abandonment by others with a revengeful “abandonment” of them through death), aggression turned inward, a search for control, manipulative guilt, punishment, escapism, frustration, or an attempt to influence someone else. Communication of these feelings — rather than death — is the true aim of the suicide attempter. This explains why, paradoxically but truthfully, many say after an obvious suicide attempt that they really didn’t want to kill themselves. [Citations omitted.]

Certainly, there are insincere suicides – those who use a suicide attempt as a signal that they need help – in addition to sincere suicides, those whose only wish is to die. I will argue that, paradoxically, a policy of intervention and “rescue” for suicide attempters, and a general prohibition on medically assisted suicide, are actually the worst, most harmful possible policies in their effects toward insincere suicide attempters who merely wish to send a signal. These policies ensure that the signal is reliable and effective, thereby encouraging people to “communicate their feelings” through a suicide attempt rather than through more healthy methods. Coupled with widespread ignorance about the lethality of various methods, this means that many people harm themselves and even die when they do not really wish to. A general, well-publicized policy of non-intervention, or at least the possibility to opt out of intervention, coupled with a legal assisted suicide option, would actually discourage insincere suicides from attempting suicide by destroying the effectiveness of the signal of attempted suicide, and removing the perceived benefits (the rescue fantasy) that attempted suicide is currently seen to provide.

In order for a person to send a reliable signal, the suicide attempt must appear lethal while not actually being lethal. If medically assisted suicide were legally and practically available, there would be very little value in choosing any other method, and any other method would be less lethal than the medical option. (If organ donation were available as part of the medical procedure, any other method must also, incidentally, be seen as selfish.) This would interfere with the apparent lethality communicated by a suicide attempt, thereby decreasing the motivation to make a “signal” attempt in the first place.

What an insincere suicide attempter – a “signaler” – really wants is to be rescued. That is, he wants to be forcibly prevented from committing suicide, because he does not really want to commit suicide. Remove the possibility for rescue, and you remove this insincere suicide’s motivation to make the potentially harmful attempt in the first place.

An analogy can be made to fights that break out on the popular television show Jerry Springer. Security personnel constantly break up fights and prevent participants from injuring each other – which causes more attacks, because participants feel they can reliably signal their “toughness,” without putting themselves in danger, because of the policy of intervention (rescue) by the show’s security staff. Remove the possibility for intervention, and participants would likely conduct themselves in a much less aggressive manner, as they do on other talk shows.

Of course, it might be argued that suicide intervention is justified in the case of people who are not rationally capable of making the decision to die – for instance, someone experiencing hallucinations, someone in an acute confusional state due to diabetes, or a small child (though we must be aware that people under the age of 18 and people with thought disorders and developmental disabilities still often respond to rational incentive structures, and setting up a structure that rewards them for harming themselves could itself be a cause of harm). There are two options that would at once remove the incentive for “signal” attempted suicides and protect incompetent people. One is to only allow intervention in a suicide attempt if there is reliable evidence – a judicial finding of incompetence, or underage status – that the attempter is incompetent. (Currently, the policy is to intervene in all cases, no matter what, even if reliable evidence of intent to die and competence is available.) A second option is to allow a legally effective “opt-out” procedure, so that a competent adult could legally execute a document refusing intervention in case of a suicide attempt. This option forces a choice to the would-be signaler: either execute the document, in which case one would give up the hope of rescue, hardly an option an insincere suicide would choose, or fail to execute the document, destroying the effectiveness of the signal he’s trying to express.

In addition to the policies I’ve outlined above, accurate information about the lethality of various methods is necessary to prevent accidental death by people making insincere suicide attempts. For instance, it is difficult to say whether Megan Meier, when she hanged herself, knew that hanging has a lethality rate of 70%, and can be lethal within minutes – or that, when not lethal, it often results in permanent brain damage. Had she known this – and if she intended her behavior as a suicidal gesture, rather than intending to die, which is not known – she might have chosen a less lethal method of expressing her feelings. There is a great deal of evidence that many people do not understand the lethality of hanging asphyxiation, as evidence by the apparently accidental deaths from the “Choking Game,” which kills several children every year. Paradoxically, better access to suicide information might actually save the lives of people wishing to send a signal with a suicide attempt but not to die.

As I’ve outlined above, a general policy of disallowing medically-assisted suicide, coupled with a policy of “rescuing” suicide attempters, is harmful and cruel not only to those who wish to die, but to those who do not. It encourages people to attempt suicide when they do not wish to die, but merely wish to send a signal, and contributes to the dangerous fantasy of rescue.

Posts by the intelligent, compassionate Dr. Maurice Bernstein at the Bioethics Discussion Blog, here and here, helped me clarify my thinking on this. Dr. Bernstein explains some of the difficulties facing emergency room doctors when faced with a patient who has attempted suicide and refuses medical intervention.

Written by Sister Y

June 17, 2008 at 8:37 pm