Monday, April 6, 2009

Disincentives, Time Horizons, and the Irrational Continuation of Life

Social science researcher David Phillips was a pioneer in the theory of suicide contagion. His research has also focused on other fascinating correlates of suicide (and other fatalities), such as day of the month, public holidays, and birthdays.

As these last few professional interests suggest, identification of dates has been important to Dr. Phillips. A 1988 paper * focused on potential difference between deaths from suicide and the suicidal acts or injuries that preceded them. A significant difference in date of suicide attempt and date of death would, of course, be relevant to Dr. Phillips' studies on how date affects suicide rates.

The motivation for the paper is a 1985 study on a San Diego population that found a whopping 22% difference between date of injury (suicide attempt) and date of death in cases of suicide. The San Diego study analyzed 204 cases of suicide; its findings cast doubt on whether date of death was a good proxy for date of suicidal act.

Phillips and Sanzone, however, studied a much larger sample - 42,698 suicides throughout California - and found that 92.6% of suicide deaths occur within one day of the precipitating suicidal act. In terms relevant to my project, that means that only 7.4% of people who commit suicide have to suffer more than a day before dying.

7.4%. About one in fourteen.

To a potential suicide, this is terrifying - not least because these are the people who succeed. This doesn't even include the suffering of those who attempt suicide but fail - and are left miserable, with grievous injuries, trapped in a life worse than the one they attempted to leave.

If life is so bad, though, wouldn't it be worth the risk?

The problem is a possibly irrational time horizon perceived by the potential suicide.

When we decide whether to commit suicide (to shoot ourselves in the head, say, or mix up some community-endangering hydrogen sulfide gas), the risks and benefits of suicide should, rationally, be weighed against the risks and benefits of continuing to live. But "continuing to live" for how long? One rational-sounding candidate would be "continuing to live out one's natural life span." Indeed, for most of us, continuing to live our natural life span is unthinkably horrible - much, much worse than the considerable risks of a careful suicide attempt.

But one's natural life span is difficult to consider. The more tempting, and probably irrational, option - one I find myself preoccupied with - is to weigh the risks and benefits of a suicide attempt with the risks and benefits of living another day or week. Perhaps next week drugs will be legalized. Perhaps next week one will die in an automobile collision or be diagnosed with a fatal illness. Living another day, another week, another month, even six months, is certainly no worse than the alternative - risking extremely serious harm from a suicide attempt. As Dr. Phillips and others demonstrate, even the ones who succeed risk extreme and prolonged suffering.

This is yet another way in which the suicide prohibition encourages irrationality. This is neither just nor compassionate.

*Phillips, David, and Anthony Sanzone. "A Comparison of Injury Date and Death Date in 42,698 Suicides." American Journal of Public Health 78:5:541 (1988).

Rich, Charles, Deborah Young, Richard Fowler, and S.K.S. Rosenfeld. "The Difference between Date of Suicidal Act and Recorded Death Certificate Date in 204 Consecutive Suicides." American Journal of Public Health 75:7:778 (1985).

1 comment:

  1. Here's a story about a failed suicide attempt that may result in death-by-torture, depending on a court ruling:


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