Comment Of The Day: “Comment Of The Day: ‘….Suicide Ethics’”

Head in the oven

Let’s get away from metaphorical national suicide for the nonce and back to more pleasant topics, like actual suicide. Rich in CT posted an excellent comment last week in the discussion, sometimes heated, of the appropriate societal attitude toward suicide and those who indulge in it.

I ended up banning a particularly obnoxious new commenter in the threads on this topic, and this is as good a place as any to point out some things. First, as is almost always the case, I should have seen what kind of participant I was letting into the fray when I let his first comment out of moderation. This is the kind of mistake you make when you are obsessing over getting more diverse commenters, and it was all my fault. Second, it was clear from the beginning that the commenter never bothered to read the comment guidelines. That’s a bad sign. Third, like so many who are moved to comment on a single issue, never to be heard from again, this commenter was ignorant of basic ethical principles and analysis, and, as with the comment guidelines, didn’t feel it necessary to educate himself on the topic of the blog before issuing his opinion in emphatic terms. Finally, his string of comments were all about how the feelings of suicidal people justified their destructive actions. That statement is signature significance for an ethics dolt. Feelings are based on emotions, and emotions don’t factor in to ethical decision-making. In Reciprocity analysis, the feelings of others may need to be considered, but the process of being ethical requires rational and objective reasoning, and this requires recognizes feelings as impediments to the process. Maybe I haven’t been sufficiently clear on this: one of the mains reasons public discourse on so many topics spins away from ethics is that ascendant view that feelings justify conduct.

But I digress! Here is Rich in CT’s Comment of the Day on David C’s Comment of the Day on the post, Sunday Ethics Picnic, 8/15/2021: Afghanistan Accountability And Suicide.

***

“And yes, as far as I know there is research that suggests that if people are fixated for whatever reason on a certain means of suicide, they will not turn to another method if access to that method is removed.”

It took me a few days to get around to addressing this point for the original post. I’ll include the comment here instead.

“Or is the goal to just make sure they give up and go home to swallow sleeping pills?”

Studies have shown this is not the case. Rather, suicide is an impulsive choice at the intersection of desperation and a particular opportunity. The ideation is often linked to a particular method (jump off bridge, pills, etc). Suicidal individuals don’t systematically engage in various methods until they are successful; rather they fixate, as David C says, on a particular method as the solution; they are at most danger when they are at a low point and their preferred method is readily available.

A famous example occurred in England, the trope of sticking one’s head into the oven to suffocate. Prior to the 1970’s, the island used primarily “town gas” for ovens (as opposed to natural gas or propane). Town gas was extracted from coal in a gasworks plant at the edge of town (hence town gas), and piped to each house. As a byproduct of the extraction process, carbon monoxide was produced, and piped directly to each home along with the hydrocarbons.

Carbon monoxide produces a painless death; one loses conscious quickly prior to suffocation. Carbon monoxide is also nearly 100% effective at causing death. Plugging up the vents in the kitchen, blowing out the pilot light, and turning up the gas became an extremely popular method of suicide between the 1800’s and 1970’s, accounting for about half of all successful suicide deaths in England (I believe these statistics hold up elsewhere, too).

When the England switched to natural gas starting in the 1970s, (ie, gas that is naturally extracted directly from underground wells), the suicide rate was cut in half. Natural gas does not contain carbon monoxide; it becomes fatal only when it displaces all oxygen in a room (or it explodes). Desperate people attracted to the easy death allowed by town gas gave up; they did not switch to another method.

This reduction was permanent, and persists to this day. Without painless poison piped to their door, the those who were attracted to this method chose not to bother with death; they chose to live.

The conversion to natural gas was entirely motivated by economics and avoidance of accidental death. It was cheaper to use gas that did not require expensive processing, and it reduced emissions at the edge of town, improving air quality. Public authorities also expected the small number of accidental deaths due to carbon monoxide would be reduced or eliminated, but simply assumed the suicidal would choose a different method; it caught everyone by surprise when it did not.

I think everyone can agree that piping carbon monoxide directly to people’s homes is a bad idea. Yet, in the US, we face a similar situation that about half of all suicides are caused by firearms. Outlawing guns could similarly and permanently cut suicide deaths in half. Importantly, however, no one has an innate right ready access to poison. The US makes a values decision that the societal utility of the right to possess a gun outweighs the public safety hazard of the suicidal.

This is a utilitarian balance, and we should admit as much. Like carbon monoxide, guns have a nearly 100% effectiveness rate, and cause a quick enough death with a shot to the head. Given this known risk, I personally for instance don’t think doctors asking about guns in a household is inappropriate, and public policy prohibiting such questions misguided. The state would have some justification in perhaps limiting such questions to being follow up questions based on responses indicating a potential suicide risk; there is still a government interest in protecting second amendment and privacy rights.

Returning to the question at hand: architecture. If an architectural design is so bad, it literally inspires people to kill themselves (har har), I think this is a legitimate artistic design consideration.

In engineering, the “health, safety, and welfare” of the public is the paramount design criteria placed before all other considerations. For architects, canon one of the AIA Code of Ethics provides a similar (though less strict) duty to “thoughtfully consider the social and environmental impact of their professional activities, and exercise learned and uncompromised professional judgment”. Minimum codes require a 42″ barrier to protect against accidentals fall. Presuming this minimum were met, no professional negligence was involved in the design of the monument.

Let us look at another purely ornamental architectural feature in New York: the observation deck of the Empire State Building. The building itself serves a utilitarian purpose of providing office space; allowing visitors to the top is purely incidental (although profitable). The deck has 8′ minimum barriers, a combination of plexiglass and wrought iron fencing. Some of this is to address the unique needs of a 1000 foot structure, namely preventing high winds from blowing people off. The bars of the fence obscure the view, and the plexiglass obscure the feeling of wind. The experience of the top is arguably diminished, but balanced against safety.

The unanticipated consequence of people being drawn to throw themselves off the monument structure is a professional dilemma. Even if we neglect an active duty to prevent voluntary self-harm, there is still at least a passive duty to protect the public from the trauma of witnessing such an event. Visiting public art should be reasonably free of the risk of PTSD. Professionals cannot ignore a known risk, but must determine a reasonable balance.

Going forward, the architects of the monument near Penn Station need to consider what are the essential elements of the experience. Is it the view? The wind? It being free and available to all visitors (I visited NYC by myself once; I’d be pissed if I weren’t allowed to visit the monument as a single visitor). Finding the correct balance of measures can very well eliminate the suicide risk for those attracted to this particular monument. Even if measures diminish the experience in finite ways, the reputation of visiting a suicide magnet itself diminishes the experience. The designers are forced to address an issue they did not create; they have an obligation to the public to do so.

Rich added in response to my comment,

There are other examples, but not as dramatic. For instance, people will repeatedly overdose on sleeping pills, only to wake up a day later with a headache. This preferred method has only about a 1/20 chance of success, but they rarely switch to a more effective method. People who survive a hanging rarely switch to pills. Even wrist-slitting survivors may make repeated attempts, but not switch for instance to stabbing themselves in the jugular. Some people by moral luck stumble onto a survival fixation. Others get stuck on a deadly method and “succeed” frequently. Others still find themselves in a uniquely stressful moment and opportunistically latch onto any available method, but may never be inclined to repeat. Suicide intervention succeeds when it delays the overwhelming urge; making the preferred method unavailable can help make that delay indefinite.

6 thoughts on “Comment Of The Day: “Comment Of The Day: ‘….Suicide Ethics’”

  1. Reminds me of an apocryphal story about a guy who decided to hang himself from a tree overlooking a seaside cliff. He brought along a gun just in case the drop didn’t break his neck, and just be sure he also took along some sleeping pills. He fixed his noose at the cliff’s edge, swallowed the pills, put the gun to his head and stepped over the edge.

    The sudden drop threw off his aim and he shot through the rope. When he fell into the sea he swallowed enough seawater to make him vomit up the pills. He swam to shore and never attempted suicide again.

    • There’s a Burt Reynold movie called “The End” on this theme. My favorite of his failed suicide attempts was the first: He takes a mouthful of sleeping pills and tries to wash it down with milk that has curdled, so he spits out everything while gagging and going “Ick! Yuck! I HATE spoiled milk!”

  2. As a public school student in NYC (circa late 50’s early 60’s) my fifth-grade class made the traditional school to the Empire State buildings. I do not recall there being plexiglass at the time. Getting off the elevator and stepping out onto the Observatory was one of the most frightening experiences I ever had. It has been present in every bad dream since. Ironically, I successfully went to jump school when in the army (101st ). Yet today I do not go out on balconies above the third floor and that requires a prophylactic dose of Xanax.

  3. I do have a problem with this statement:
    The designers are forced to address an issue they did not create; they have an obligation to the public to do so.

    The underlying belief is we are obligated to prevent any intentional adverse misuse of things we create. I don’t share his belief in that obligation and think that idea leads to a tyrannical nanny state. Every car needs a breathalyzer interlock, so no car could ever be driven while drunk. Only butter knives allowed as steak knives could be used to hurt or kill. I’m not saying we shouldn’t make things easier, but I also believe in individuals being responsible for their intentional actions, yes, including the suicidal.

    • >> The underlying belief is we are obligated to prevent any intentional adverse misuse of things we create. I don’t share his belief in that obligation and think that idea leads to a tyrannical nanny state.

      Except that’s not what we are dealing with here. We are dealing with the ethical duty to find a balance of measures to protect against a known risk. Deaths on the roadways used to be absurdly high. There was a professional duty to address this issue. It was addressed with a mix of innovation in safety design and targeted police enforcement. Adding an interlock to every car is rightly considered to be too big of an intrusion. Mandating seatbelt use was determined not to be too onerous an intrusion. Deaths on the highway have been at least cut in half we these measures. The duty to address and mitigate the problem exists, even if preventing the risk outright is too onerous.

      A very large percentage are now directly attributable to voluntary user choices (speeding and aggressive driving, alcohol, etc); the duty now exists to figure out what balance of measures can mitigate this risk. Dangerous driving can literally impact anyone, not just the at fault driver. The same is the case with suicide. The owners of the monument have a duty to address the problem. The same duty exists if they determine visitors are at increased of risk of robbery on the monument. The company may well need to increase security, or visitors will stop visiting the area and neighboring business reliant on the visitor traffic may suffer. They didn’t create the crime problem, but will be directly harmed if they fail to address it.

      With suicide in particular, a falling person could kill someone on the ground; suicides can cause directly economic losses, if the neighboring properties have to be closed during the police investigation and clean up. The owners could well determine no measures can reasonably prevent the risk; but it is a dereliction of duty to not consider potential measures to protect the safety and economic viability of their investment.

  4. My impulsive reaction to the original article about the suicide prevention restrictions added or proposed for the building in question was: “that’s dumb — suicidal people will just go find some other way to kill themselves”. But, thanks to your comment, and some additional reading, I’ve learned that conclusion is wrong.

    I’ve always been particularly nervous at subway train stations, with people jostling for position inches from an oncoming train. Indeed, in some countries, this is a common method of suicide. One ethically odd suicide prevention approach used in Japan is to hold the family of those who commit suicide by train financially responsible for the disruption caused, on the theory that suicidal people won’t want to burden their family (see the Japan section of: https://en.wikipedia.org/wiki/Suicide_methods).

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