October 18, 2007

Suicide as a Status Symbol?

Autumn winesThis week on CNE I discuss an empirical study of slippery slopes in physician-assisted suicide. It is based on Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups by Margaret P Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D Onwuteaka-Philipsen (Journal of Medical Ethics 2007;33:591-597).

They find no evidence that vulnerable groups like the elderly, women, uninsured, people with low educational status, poor, physically disabled or chronically ill, minors, people with psychiatric illnesses, or racial or ethnic minorities were making use of the suicide option. The exception were people with AIDS. They also found that the people who used assisted suicide were better off socially, economically, educationally and professionally.

Maybe higher socioeconomic status promotes more liberal views and more of a patient autonomy? I looked at the correlation between opinions about suicide and self-stated social status in the GSS dataset, but found no correlation. Self-stated political views appear to become more polarized at the higher and lower social ranks, but that could just be an effect of too few sampled people.

On the other hand there is a very strong link between the POLVIEWS scale ("do you think of yourself as liberal or conservative?") and views on suicide. In the case of incurable disease every group above "conservative" (including the slightly conservative) had a majority for suicide. In the case of other reasons (bancrupcy, dishonor, tired of life) there was a sharp transition at "moderate" where the minority opinion (in favor of suicide) became statistically significant. Overall, this somewhat dated data suggest that we cannot simply explain it as well-off people being more liberal about suicide.

A fun observation was that the HEALTh variable (how healthy people felt) had a strong link to views on suicide for health-related reasons: people in fair and poor health were against suicide, people in good and excellent health felt that it was a good idea.

I noticed that people who were not in the "homosexuality is always wrong" category were in favor of illness-related suicide. Looking loosely at civil liberties questions, it generally looked like people in favor of civil liberties are also liberal about suicide. So the reason more AIDS-victims were using physician-assisted suicide might simply be that they belong to a more liberal (in the civil and personal liberties) sense group, not that they are politically liberal or well-off.

Income had no effect on the views on suicide except at the very highest level (+$20000 family income) where there were a noticeable suicide-liberal majority. They were also noticeably more liberal towards homosexuality. This is interesting, because politically there is a shift towards political conservatism as income increases.

Nothing too surprising. But if suicide is seen as a status symbol or "upper class" it would likely be a more powerful liberalising argument than any ethical reason. As Sappho wrote in an early immortalist poem:

If death be good,
Why do the gods not die?
If life be ill,
Why do the gods still live?

If love be naught,
Why do the gods still love?
If love be all,
What should men do but love?

Posted by Anders3 at October 18, 2007 09:41 PM