Saturday, February 14, 2009

Liberty and the "Real" Decision Maker

One of the really interesting ethical questions about suicide (among other actions) is, what counts as the choice of the real person - especially if a person making a decision is shown to have conflicting desires and motivations?

Most of the time when we make decisions, we have conflicting motivations - such is the nature of a decision. Cognitive science research suggests that, most of the time, we don't even know why we make a particular decision. We may feel that we are carefully weighing the pros and cons of action and inaction based on carefully considered criteria, but most of the time that is not how our brain apparatus actually works. (In fact, some suggest that decisions based on instinct are usually better than decisions made based on more rational criteria.)

Given this background of conflict, should we sometimes forcibly prevent a decision maker from acting until he is certain?

With many decisions and consequent actions - whether to eat a cheeseburger, whether to go to work, whether to get a divorce - people have many conflicting motivations, conscious and unconscious. There's some value to waiting to make a decision until one is sure - which could include a friend forcibly preventing someone from making a decision until the decision maker is sure - especially since many decisions, like suicide, are irrevocable. But there's also a cost to waiting to be certain (e.g. time spent being hungry until you eat the cheeseburger or being miserable until you get a divorce/commit suicide).

Taking an action is a decision between two options - acting and not acting. Both have consequences. Forcing someone to not act is making a decision for him and imposing the costs of that decision upon him without his consent.

I think a waiting period for serious decisions (like California's 48-hour waiting period for marriage) - which amounts to forcing someone to take more time to think about a decision (and imposing the costs of that time on him) - is acceptable if the costs of the waiting period were found to be, on average, smaller than the costs of poor decisions without the waiting period. But this would have to be from a perspective of maximizing happiness, rather than promoting liberty. Waiting periods are paternalistic - I'm not a hardcore libertarian, so I think that can be okay at times where it's not very intrusive. Ultimately, though, I think not only the decision of whether to act, but the decision of how long to wait before acting, should rest with the actor. And the costs (in terms of suffering) of being forced not to commit suicide are substantial - the longer the delay, the higher the potential costs.

The weirder question, which I've been struggling with, is what to do about people whose desire to commit suicide changes over time? If I sign something at age 18 that says I want to be forcibly prevented from committing suicide if I ever try it, should that be enforced when I'm 80 and want to die peacefully? If I want to die at 18, should it make a difference that I might change my mind later? I don't have much of a framework from which to answer that one.

Chip's suggestion - that we go with the "one that's speaking, whenever" - is attractive in its simplicity, humanity, and apparent respect for liberty. But if our society followed it strictly, it would prevent us from ever increasing our happiness by binding ourselves. The whole idea of a contract (from sales to employment to marriage) is to increase our overall happiness by binding the actions of our future selves. Similarly, if I had a fairly happy life but very occasionally went into a despairing funk and wanted to die, I might think I'd be better off if I could prevent myself from committing suicide during that period. (Just as I, in my real incarnation, would feel myself better off if I could prevent my future addled self from docilely swallowing the activated charcoal if a future suicide attempt proved unsuccessful.) Are present and future benefits and costs allowed to weigh against each other?

Do I owe anything to my future self - since, in a sense, it is me? Can I take anything from my future self - again, since it is me - by either imposing suffering by not committing suicide, or removing its "chance at life" by committing suicide? Ethically, do I stand in relation to my future self as toward my present self, or as toward a totally different person?

In response to an email from reader Elizabeth, who also pointed me to the Wilson book - thanks!

Sunday, February 8, 2009

No Death With Dignity for Potential Breeders

From The Guardian:
The Italian government has been plunged into a constitutional crisis over the fate of a 38-year-old woman who has been in a coma for the past 17 years. Eluana Englaro was left in a vegetative state after a car crash in 1992. After a decade-long court battle, doctors reduced her nutrition on Friday in preparation for removing her feeding tubes, which her father claims would be in accordance with her wishes.

But in an extraordinary turn of events, the country's prime minister, Silvio Berlusconi, after consultation with the Vatican, has issued an emergency decree stating that food and water cannot be suspended for any patient depending upon them, reversing the earlier court ruling. On issuing the emergency decree, Berlusconi declared: "This is murder. I would be failing to rescue her. I'm not a Pontius Pilate."

Justifying his campaign to save Englaro's life, the prime minister added that, physically at least, she was "in the condition to have babies", a remark described by La Stampa newspaper as "shocking". Giorgio Napolitano, Italy's president, has refused to sign the decree, but if it is ratified by the Italian parliament doctors may be obliged to resume the feeding of Eluana early this week. [Emphasis mine.]

Christ. Really? (Thanks nil.)

Friday, February 6, 2009

Is Webcam Suicide Ever Appropriate?

The cause of suicide rights seems to suffer anytime someone commits or attempts suicide on camera with folks on the internet watching. When a suicide is completed, the public demands to know why no one intervened. When intervention appears to prevent a suicide, the public unquestioningly gives its support to the intervenor. (In the most recent such case, Chris Matyszczyk cheerfully informs us in rather Orwellian terms that "The police arranged for [the suicide] to receive the appropriate care.")

Perhaps this is as it should be, since most of the time, someone who attempts suicide in front of a camera is clearly a victim of the dangerous fantasy of rescue, hoping to be "saved" before his suicide is successful. (Of course, changing the law to forbid intervention with suicide attempts would be better than the current situation for both those who genuinely want to die and for those who engage in potentially self-lethal behavior in order to be saved.)

Is there ever a good reason to die on camera? I propose two possibilities, both with limits.

1. Not wanting to die alone

It is understandable for a human being who genuinely wishes to die to also not want to die alone. Many people call suicide hotlines for this purpose, rather than in hopes of rescue. Suicides regularly seek each other out in order to die together. In his book Why People Die By Suicide, Thomas Joiner refers to a 2004 Chicago Tribune article about people who commit suicide by jumping in front of trains:
Almost always, suicide victims [sic] peer into the locomotive cab in their final moments. They stare right into the eyes of the engineer, perhaps reaching for a last human connection.

. . . [Metra engineer Raymond Baxter says] "I've heard other engineers say [people committing suicide] look at you. I don't know why they do it. I sure wish they wouldn't, because the picture stays with you. You try to forget about it, but you don't ever, really. It ain't easy."

The desire for human contact at the last moment is poignant and understandable - but it is awful to force this attempt at connection on an unwilling train engineer. It would be much better if a suicide could agree with a willing person beforehand to be with him while he died - even if it only meant watching over a web camera. This would spare the feelings of unwilling witnesses, such as the poor train driver, yet it would not force upon a suicide the cruelty of dying alone.

As it is, there are major problems - most of them legal - faced by people who would comfort a suicide in his last moments. In a 2007 This American Life episode (How to Rest in Peace, at 39:35) a son ("Edward") describes helping his mother to commit suicide, at her insistence - but not being able to be with her while she died, for fear of being prosecuted for having a role in her death. His mother was forced to choose between dying alone and staying alive against her will - and chose to die. But she should not have been forced to make this choice.

Barring major changes in laws against assisting suicides, pre-arranged company via web camera offers a measure of comfort to a dying person. (Still, allowing one's suicide to be viewed by one person or a few people seems more justifiable than publicly broadcasting one's suicide to the entire internet.)

2. In the interest of providing information

Despite hysterical claims to the contrary, there is very little information available about dying certainly and comfortably. (Even The Peaceful Pill Handbook is not ultimately helpful without access to barbiturates.)

However, if a suicide were to demonstrate a method in the interest of increasing available information, it would be a public service to other would-be suicides to share the method and experience - good or bad. Others would be able to see first hand the use of the method and its apparent effects. While some viewers might find this disturbing, I think it is ethical as a civil disobedience against the unethical suicide prohibition, especially if the video could only be accessed by those who specifically sought out such information.

From the This American Life episode mentioned above, at 51:20:

Ira Glass: It just seems so sad that she has to be alone at that moment. It seems like that's the moment where, of all moments, she would want somebody with her to hold her hand and comfort her.

"Edward": It was terrible. It was terrible. Exactly. That was probably the worst part of it, that she had to do it alone. Me and her other family members could not be there, because we live in a society that does not respect people's desire to control the end of their life.

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