Sunday, March 16, 2014

The Social Cost of Free Disposal

An anonymous reader sends this insightful question:
Belgium and Vienna

If we look favorably upon, as a consequence of the post-60s social pandemonium, the heuristic many ancient sacred prohibitions were entirely crypto-utilitarian public policy, doesn't the taboo of suicide in both eastern and western make you want to at least want to steelman the the pro-natalist/anti-suicide position, which I've not seen on your blog? Or a piece of Freudian self-critique.

You can't remove the barriers to suicide for the terminally ill without removing them for the non-terminally ill, history has shown that the slope is slippery, and I think you want that slope to slip right? For many, the nightmare of failed suicides is a feature, not a bug. To be very generous, suppose that a state apparatus is set up so that the pills can't be stolen to commit murder and everyone not in an altered state of consciousness can use it for free on site, a perfect implementation mechanism, might there not be a domino effect? Depressed son kills self, mother follows, so does father, completely formerly healthy and well adjusted sister 1 follows, sister 2 does too, friend of sister 1 and 2, etc etc until this happens.

And now even the happiest people who don't kill themselves out of sorrow are psychologically crippled wastebaskets; In high school we talked about smart people who ended up in shitty colleges and a common pattern was "s/he had a friend who committed suicide and s/he was so depressed for a few years he only got Bs and Cs." People regret things and wish other would've stopped them from doing stupid spur in the moment things all the time.

But we haven't tried it yet. But is it not possible that the very cost of experimentation is just too damn high?

It is almost certainly the case that true Free Disposal in the Bryan Caplan sense - in which suicide actually has no cost - would result in a world no one would want to live in. For one thing, a huge reason people feel compelled to stay around is the existence of social bonds; therefore, social bonds place a major cost on suicide; a world with truly Free Disposal would not allow social bonds to form. But social bonds are among the most basic human needs; a life without them would likely not be worth living.

The chosen-ness of life is not binary but a continuum. Gruesome punishments may be heaped upon the act of suicide, making it very un-free, or it may be actively promoted, making it much more free. The suicide restrictions of old cultures give us a good idea of the degree of freedom regarding suicide that may be permitted and still maintain a functional, self-reproducing society.

Your question illustrates an important dilemma: life is unfree, and must be unfree in order for it to go on. Both at the level of culture and at the level of the individual, the freedom to end life is at odds with the evolutionary goal of self-replicaton. Some will be miserable, and societies rely on keeping miserable people alive by force in order to survive. It is my contention that they do not necessarily deserve to survive.

The Old Ways are fascinating, intricate, carefully evolved structures, and they are also not that great. Certainly they have failed us under modern conditions vastly different from the conditions under which they evolved. A person choosing to have a child now cannot really offer it a functioning, reliably self-reproducing society in which to live; but lives in past societies were not necessarily worth living, either. Keeping humans in line with evolutionary goals requires the use of both force and illusion. I am very suspicious as to whether these goals line up with eudaimonia. If the freedom to avoid the experience of life results in this, then maybe it is not such a great experience after all.

Thursday, March 13, 2014

Homicide Rates, Suicide Rates, and Modern Medicine

Homicide rates in the United States have been falling for decades. Some have attributed this to people becoming more civilized and peaceful, a hypothesis Steven Pinker expores in The Better Angels of Our Nature. From 1931 to 1998, the United States homicide rate dropped by about 25%. But during that time, rates of aggravated assault increased by about 700%. This calls the peacefulness hypothesis into question.

Homicide is a metric that links a behavior (a violent act) to an outcome (a death). Modern medicine has drastically increased the survival rates for serious injuries in the past several decades. Since death from a given injury has become less common, especially in urban areas close to high-tech hospitals, metrics attached to death - such as homicide - will drop even if there is no change in the frequency of the kind of violent assaults that would have been murders if only 1931 technology were available. Since those kinds of violent attacks have increased dramatically, it appears that using the homicide rate as a metric allows improvements in medical technology to mask a major increase in violence in recent decades.

This trend continues into the twenty-first century; violent attacks increase, but homicide deaths decrease because of improvements in medical technology (see graphic).

Keep that in mind when you consider that American suicide rates have been mostly flat since 1950 - not decreasing, like homocide rates, even though medical technology and injury survivability has vastly improved. In fact, suicide rates have been increasing since 1999. Suicides in the 35-64 age group increased by 28% between 1999 and 2010.

Suicide, like homicide, is a metric that links a behavior (a self-injury) to an outcome (a death). Like homicide, the reduction in death for a given injury should reduce the suicide rate even if self-injuries are constant. We do not see the suicide rate decreasing; in recent years, even as the homicide rate continues to drop, the suicide rate is increasing. Medical technology may be masking an even greater rise in suicidal behavior than the completed suicide rate would indicate.

Case-fatality rates are three to four times higher for self-inflicted gunshots than for gunshots inflicted intentionally by others; that is, suicide attempts by gunshot are more lethal than assaultive shootings. In 2007, 21% of intentional gunshot wounds inflicted by someone other than the victim were lethal; 80% of self-inflicted gunshot wounds were lethal. Gunshot is the most common method of suicide in the United States, accounting for 54% of suicides.

However, almost half of completed suicides have used methods other than firearms - and methods other than gunshot are only 10-15% likely to be fatal. Since 20% of self-inflicted gunshot wounds are currently nonfatal, the firearm suicide rate would "only" rise by about 25% of its current level if modern medicine were not aggresively saving lives that are unwanted by their possessors. But in the absence of modern medicine, up to ten times as many people who poison, cut, hang, or suffocate themselves might succeed in killing themselves.

Proximity to a hospital is a major factor in trauma survival. This may partly explain why rural suicide rates have leapt ahead of urban rates in recent decades: suicidal behavior may be similar, but rural people die from their injuries more frequently than urbanites.

Note: St. Rev hates this graphic as the graphs for weapon injury are of radically different scales (inter alia) and indeed it is probably seriously flawed but it provides a cheap and tasty way of immediately visualizing the phenomenon.
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