Limiting Free Speech (47): Incitement to Commit Suicide

An interesting story in the press some time ago:

A former nurse from Faribault, Minn., was convicted of two felonies Tuesday when a judge ruled he had used “repeated and relentless” tactics during Internet chats that coaxed two people to kill themselves.

Rice County District Judge Thomas Neuville found that William Melchert-Dinkel, 48, “imminently incited” the suicides of Mark Drybrough of Coventry, England, and Nadia Kajouji of Ottawa, Ontario. Drybrough, 32, hanged himself in 2005, and Kajouji, 18, jumped into a frozen river in 2008.

In a 42-page ruling that found Melchert-Dinkel guilty of two counts of felony advising and encouraging suicide, Neuville wrote that it was particularly disturbing that Melchert-Dinkel, posing as a young, suicidal, female nurse, tried to persuade the victims to hang themselves while he watched via webcam….

Neuville, in rejecting the free-speech defense, noted that inciting people to commit suicide is considered “Lethal Advocacy,” which isn’t protected by the First Amendment because it goes against the government’s compelling interest in protecting the lives of vulnerable citizens. (source, source)

I guess that’s correct, even though the case doesn’t really fit with any of the commonly accepted exceptions to free speech rights. We’re not dealing here with incitement to murder or a death threat – standard exceptions to free speech, even in the U.S. And neither is it speech that incites illegal activity – another accepted exception. Suicide isn’t murder and isn’t illegal (anymore). Abstract and general advocacy of crime and violence is – or should be – protected speech, but not the advocacy or incitement of specific and imminent crime or violence if this advocacy or incitement helps to produce the crime or violence. If speech intends to produce specific illegal or violent actions, and if, as a result of this speech, these actions are imminent and likely, then we have a good reason to limit freedom of speech. Examples of such speech:

None of these forms of speech should be protected, and laws making them illegal are perfectly OK. On the other hand, claiming that all politicians deserve to die or that people shouldn’t pay their taxes are, in most cases, forms of protected speech because they probably do not incite or help to bring about imminent lawless activity.

The problem is that none of this is applicable here. Suicide isn’t illegal, and neither is it violence as we normally understand the word. So, the commonly accepted exception to free speech rights that I just cited can’t possibly justify the conviction of Melchert-Dinkel. He did of course advocate, incite and cheer on his victims, and his advocacy, incitement and cheering probably helped to produce their suicides. But a suicide is not a crime or an act of violence. At least not as such. One could argue that the encouragement of a suicidal person should be viewed as a form of murder. And if that statement goes too far for you, you may want to consider the fact that causing someone else’s death is in general a crime, whichever way you do it. Moreover, if the victims in this case were suffering from depression or a mental illness, the state has a duty to provide healthcare, and allowing someone else to worsen their depression or illness to the point that they kill themselves is not consistent with this duty.

So, while the encouragement of suicide in general, the teaching the methods of suicide or the claim that non-suicidal people should go and kill themselves (“you don’t deserve to live”, “why don’t you just go and kill yourself”) are all forms of protected speech, the same is not the case for speech that encourages specific suicidal people to kill themselves.

Measuring Human Rights (16): The Right to Healthcare

(There’s a more theoretical post here about the reasons why we should call health care a human right. But even if you think those are bad reasons, you may find the following useful).

The right to health care is one of the most difficult rights to measure. You can either try to measure people’s health directly and assume that good health means good health care, or you can measure the provision of health care and assume that there will be good health with a good health care system. Doing the latter means, for example:

  • measuring the number of health workers per capita for countries
  • measuring the quality of hospitals
  • measuring health care spending by governments
  • measuring the availability and affordability of health care
  • measuring the availability and affordability of health insurance
  • etc.

Doing the former means:

  • measuring life expectancy
  • measuring infant mortality
  • measuring maternal mortality
  • measuring calorie intake
  • measuring the incidence of certain diseases
  • measuring the survival rates for certain diseases
  • etc.

Needless to say that every single one of these measurements is fraught with problems, although some more so than others. Even if you’re able to have a pretty good measurement for a single indicator for a single country, it may be difficult to compare the measurement across countries. For example, health insurance is organized in so many different ways that it may be impossible to compare the level of insurance across different countries.

But let’s focus on another measure. Life expectancy is often used as a proxy for health. And indeed, when people live longer, on average, we can reasonably assume that they are healthier and that their health care system is better. It’s also something that is relatively easy to measure, compared to other indicators, since even developing countries usually have reasonably good data based on birth and death certificates. And yet, I say “relatively” because there are some conceptual and definitional problems:

  • Exceptional events such as a natural disasters or a war can drag down life expectancy numbers, but those events need not influence health in general or the quality of health care.
  • Wealthy countries may have more deaths from car accidents than poorer countries, simply because they have more cars. This will pull their relative life expectancy down somewhat, given that younger people are more likely to die in car accidents. And if you use life expectancy to measure health you’ll get a smaller health gap compared to poorer countries than is the case in reality (at least if life expectancy is not corrected for this and if it’s not supplemented with other health indicators).
  • How are miscarriages counted? If they are counted as child mortality, they drag down life expectancy rates compared to countries where they are not counted.
  • What about countries that have more homicides? Or suicides? Although the latter should arguably count since suicides are often caused by bad mental health. If a country’s life expectancy rate is pulled down by high suicide rates, life expectancy rates are still a good indicator of health and of the quality of health care, assuming that health care can reduce suicide rates and remove, to some extent, the underlying health causes of suicide. However, homicides are different: a country with a very good health care system, a very high level of health and a high murder rate can have its health rating pulled down artificially when only life expectancy is used to measure health.
  • Differences in diet and other types of risky behavior should also be excluded when comparing health and life expectancy across countries. It’s wellknown, for instance, that obesity is more of a problem in the U.S. than in many countries that are otherwise comparable to it. Obesity drags down life expectancy and reduces the average level of health, so life expectancy rates which are not corrected for obesity rates are still a good measure for health, but they are not a good measure for the quality of the U.S. health care system. If you want to use life expectancy rates to compare the quality of health care systems you’ll have to correct for obesity rates and perhaps for other types of risky behavior such as smoking or the absence of exercise. Maybe the U.S. health care system, even though it “produces” somewhat lower life expectancy rates than in comparable countries, is actually better than in other countries, yet still not good enough to offset the detrimental effects of high average obesity.

Hence, uncorrected life expectancy rates may not be such a good indicator of national health and of the quality of a national health care system. If we return to the case of the U.S., some of this may explain the strange fact that this country spends a lot more on health and yet has somewhat lower life expectancy rates than comparable countries.

Or maybe this discrepancy is caused by a combination of some misuse and waste at the spending side – more spending on health doesn’t necessarily result in better health – and some problems or peculiarities with the measurement of life expectancy. Let’s focus on the latter. As stated above, some cultural elements of American society, such as obesity, pull down life expectancy and worsen health outcomes. But there are other peculiarities that also pull down life expectancy, and that have nothing to do with health. I’m thinking of course of the relatively high levels of violence in the U.S. Death by assault is 5 to 10 times higher in the U.S. than in comparable countries (although those numbers tend to go down with the passing of time). This affects younger people more than older people, and when more young people die, life expectancy rates drop sharper than when more old people die.

However, even if you correct U.S. life expectancy rates for this, the rates don’t move up a lot (see here). The reason is that the numbers of deaths caused by homicide pale in comparison to other causes. Obesity levels, for instance, are a more important cause. But correcting life expectancy rates for obesity levels doesn’t seem appropriate, because we want to measure health. If you leave out all reasons for bad health from life expectancy statistics, your life expectancy rates go up, but your average health doesn’t. Obesity isn’t the same as homicide. Correcting life expectancy statistics for non-health related deaths such as homicide makes them a better indicator of health. Removing deaths from obesity doesn’t. If you have life expectancy rates without obesity, they may be a fairer judgment of the health care system but not a fairer judgment of health: a health care system in a country with a lot of obesity may be equally good as the one in another country and yet result in lower life expectancy. The former country does not necessarily have lower life expectancy because of its underperforming health care system – we assumed it’s of the same quality as elsewhere – but because of its culture of obesity.

However, if you really want to judge health care systems, you could argue that countries plagued by obesity should have a better quality system than other countries. They need a better quality system to fight the consequences of obesity and achieve similar life expectancy rates as other countries that don’t need to spend so much to fight obesity. So, life expectancy is then reinstituted as a good measure of health.

Why Do We Need Human Rights? (16): You Always Hurt The Ones You Love

Inflicting suffering on people is wrong. This simple and basic moral rule is a large part of the justification of human rights (although there are many other justifications). And yet, the parents among us – the large majority of human beings – simply by bringing children into existence, guarantee that those children will suffer. No life is without suffering. And they do so wittingly and willingly. So ignorance or impotence do not excuse this imposition of suffering. These children don’t get born because they have a right to be born. Non-existent people don’t have a right to come into existence. The opposite sentence would have some really scary and dizzying consequences. They are born because of parents’ choices. And those are informed choices. We all know that no life, not even the best one, is without suffering. Hence, the parents are, to some extent, responsible for this suffering (read more about the chain of causation here).

The fact that people keep reproducing without so much as an ounce of remorse, indicates that the willful infliction of suffering is an acceptable part of life, even if it is an infliction upon those closest to you. Perhaps we can explain this strange fact by the generally rational belief that the good that comes out of life compensates for the suffering we inflict on our children. Life’s suffering is just the price to pay for a greater good. Overall, most people do indeed find life worth living, notwithstanding the occasional suffering. Otherwise suicide would be much more common, I guess. But that kind of cost-benefit analysis is something we usually find repugnant. Many of us shudder at the decision to incinerate thousands of Japanese in order to end WWII.

But perhaps this cost-benefit analysis is much more acceptable when the cost for one persons isn’t intended to benefit another person. In our topic, the costs and benefits that are weighed against each other are for one and the same person. And yet, it’s not this person that does the weighing; it’s her parents. This is a case of literal paternalism: we decide for another person that some harm we do to her is necessary for a greater good. Like we decide that people can’t smoke cannabis (doing so is imposing a harm) because we believe that it’s in their interest and for their benefit. And paternalism is generally only acceptable when dealing with children, and with children as long as they are children. When reproducing we of course also inflict suffering on our children when they are grown up.

Lies, Damned Lies, and Statistics (29): How (Not) to Frame Survey Questions, Ctd.

Here’s a nice example of the way in which small modifications in survey questions can radically change survey results:

Our survey asked the following familiar question concerning the “right to die”: “When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?”

57 percent said “doctors should be allowed,” and 42 percent said “doctors should not be allowed.” As Joshua Green and Matthew Jarvis explore in their chapter in our book, the response patterns to euthanasia questions will often differ based on framing. Framing that refers to “severe pain” and “physicians” will often lead to higher support for ending the patient’s life, while including the word “suicide” will dramatically lower support. (source)

Similarly, seniors are willing to pay considerably more for “medications” than for “drugs” or “medicine” (source). Yet another example involves the use of “Wall Street”: there’s greater public support for banking reform when the issue is more specifically framed as regulating “Wall Street banks”.

What’s the cause of this sensitivity? Difficult to tell. Cognitive bias probably has some effect, and the psychology of associations (“suicide” brings up images of blood and pain, whereas “physicians” brings up images of control; similarly “homosexual” evokes sleazy bars, “gay” evokes art and design types). Maybe the willingness not to offend the person asking the question. Anyway, the conclusion is that pollsters should be very careful when framing questions. One tactic could be to use as many different words and synonyms as possible in order to avoid a bias created by one particular word.

Lies, Damned Lies, and Statistics (22): Objects in Statistics May Appear Bigger Than They Are

From a news report some weeks ago:

French Finance Minister Christine Lagarde Thursday voiced her support for France Telecom’s chief executive, who is coming under increased pressure from French unions and opposition politicians over a recent spate of suicides at the company.

Ms. Lagarde summoned France Telecom CEO Didier Lombard to a meeting after the telecommunications company confirmed earlier this week that one of its employees had committed suicide. It was the 24th suicide at the company in 18 months.

In a statement released after the meeting, Ms. Lagarde said she had “full confidence” that Mr. Lombard could get the company through “this difficult and painful moment.”

The French state, which owns a 27% stake in France Telecom, has been keeping a close eye on the company, following complaints by unions that a continuing restructuring plan at the company is putting workers under undue stress.

The suicide rate among the company’s 100,000 employees is in line with France’s national average. Still, unions say that the relocation of staff to different branches of the company around France has added pressure onto employees and their families.

On Tuesday, a spokesman for France’s opposition Socialist Party called for France Telecom’s top management to take responsibility for the suicides and step down. Several hundred France Telecom workers also took to the streets to protest against working conditions.

In the statement released after Thursday’s meeting, France’s Finance Ministry said Mr. Lombard had set up an emergency hotline aimed at providing help to depressed workers. The company has also increased the number of psychologists available to staffers, according to the statement. (source)

More on the problems caused by averages is here.

The Ethics of Human Rights (18): A Right to End Your Life

There’s currently some controversy over the Swiss Dignitas clinic where people can receive help in their attempt to end their own lives.  This is reminiscent of the controversy surrounding “Doctor Death”, Jack Kevorkian, in the U.S. some time ago, and the Oregon Death With Dignity Act.

The issue of assisted suicide or euthanasia usually arises in discussions on terminal illnes and suffering, but it is part of the wider problem of self-determination: do human beings have the right to determine and chose the time and the method of their own death, irrespective of health issues? And do other people have a right to assist them if they can’t execute their will themselves?

I’ll focus on the first question here, and I’ll avoid the legal issues for the time being, apart from this: in international human rights law, there is no right to end your life, hence no right to suicide, assisted or not, and hence no right to euthanasia (the differences between assisted suicide and euthanasia are negligable according to me).

Should there be such a right? I don’t know. I certainly support the moral right, based on some arguments which I’ll mention below. A legal right would remove some of the prohibitions on assisted suicide and euthanasia in some countries. In such countries, people have to travel abroad – to Switzerland for example – to end their lives, at least if they want to do it in a painless and guaranteed way. This means that there is discrimination: rich people have a painless way out (the Swiss ask a lot of money), whereas other people have to use painful or riskier methods or – worse – have to continue their lives involuntarily if their (medical) circumstances don’t make it possible for them to take matters into their own hands.

Why should there be a moral right to end your life? We own our own body. Our body is part of our private property. It is something that is ours; it is the thing par excellence that is our own. It is not common to several people and it cannot be given away. It cannot even be shared or communicated. It is the most private thing there is. Owning our body means that we are the master of it. Other people have no say in the use of our body; they should not use it, hurt it or force us to use it in a certain way. This underpins the security rights such as the right to life, the right to bodily integrity, and the prohibition of torture and slavery. But it also implies the right to self-determination, and therefore, the right to die. We should therefore be able to cimmit suicide without interference, at least as long as we are able to determine our will independently, and as long as our suicide doesn’t harm other people’s rights (e.g. if we throw ourselves in front of a moving car, or if we believe that our suicide leads us to heaven on the condition that we take a few infidels along with us in the grave).