Showing posts with label suicide. Show all posts
Showing posts with label suicide. Show all posts

Tuesday, November 14, 2017

Opioid Numbers

            A Chicago Tribune editorial reprinted in my local newspaper as "How to halt deadly toll of opioids" (Nov. 13) says that in 2016, "64,000 people died of drug overdoses," generally opioids. In 2014, there were 207,400 drug-related human deaths, so it's safe to assume there were more than that in 2016; 64,000 is for the US.
            It is a number that needs to be put in context and analyzed.
            In 2014, there were 2,624,418 total deaths of Americans, nearly 46% of them from heart disease and cancer. The 64,000 figure would put the US death rate from drug overdoses between those in 2014 for diabetes (76,488) and influenza plus pneumonia (55,227).
            What makes the 64,000 newsworthy — aside from money, politics, and the good old American obsession with drugs — is that such deaths are largely preventable.
            The Trib editorial suggests some ways of prevention, but we need more detailed numbers and analysis.
            To clarify a related discussion, I've suggested that the most direct way to decrease gun deaths in the USA would be to provide old men like me ways of killing ourselves more elegant than blowing out our brains. How many of those drug deaths are relatively nonmessy suicides? We might have less an opioid crisis than one of despair; and the responsible social answer to despair is psychological intervention and helping people achieve lives worth living.

            Are many of the deaths from accidental overdose? We keep down the rate of overdose deaths for legal drugs by regulation of purity and labeling. A direct way to reduce deaths by accidental overdose would be similar supply of FDA-approved illegal drugs, dispensed by responsible people. If we refuse to supply drugs of certified purity and dosage, then we need to make that decision consciously, and tone down laments about the horrors of overdose as such: we clearly have other priorities.

Thursday, March 9, 2017

Gun Deaths / Compassionate Death: Ventura County, California, 2000-2016




            Some points on gun deaths and their implications for — "self termination"? —  in my area, Ventura County, California, 2000-2016, relevant points, I think for elsewhere in the USA:
                        • One reason guns are used in suicides is that guns are an effective lethal device available with minimal risk of getting caught up in the apparatus of the State as would happen if one tried to obtain poisons or pain-killers in sufficient strength and quantity to be lethal.
                        • Our local paper, The Ventura County Star reports "Nearly 900 people died from gunfire in Ventura County over the past 16 years," the majority by suicide. That's fewer than 9 deaths per 100,000 per year, as opposed to the number one killer in the USA, heart disease, at 193 deaths per 100,000. Suicide is #10 on the list of the 15 leading causes of death in the US in 2013; homicide does not make that list.
            One reason homicides are rare among us — contrasted with earlier times and other places — is that most Americans depend upon law and government for resolving conflicts, rather than duels and vendettas. People attacking government legitimacy and its ability to protect us, people encouraging arming ourselves for self- and "tribal" defense, are moving in the wrong direction. And media coverage that makes mostly safe, middle-class Americans feel threatened by street violence pushes us further in that wrong direction.
            To reduce the rate of gun deaths, we need better options for people at risk of shooting themselves: including getting objective advice and practical help with problems — a decent job, for example, decent insurance — and access to more elegant ways for old guys like me to off ourselves than blowing out our brains. Preferably, though, more practical help living: When suicide seems like a rational solution for the problems of a fair number of Americans, American society has issues.


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Non-Linked Source: Ian Morris, War! What Is It Good For?: Conflict and the Progress of Civilization from Primates to Robots (2014).

            Richard D. Erlich, "Limiting Gun Deaths: A Direct and Humane Approach (23 Jan. 2013)" <http://rich.viewsfromajaggedorbit.com/2015/03/limiting-gun-deaths-direct-and-humane.html>.

Tuesday, March 24, 2015

Limiting Gun Deaths: A Direct and Humane Approach (23 Jan. 2013)

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            In a column in The Washington Post in January of 2013, Eugene Robinson cited an important statistic: "Roughly 30,000 Americans will die by gunshot this year. About two-thirds will be suicides […]." Of those gun-death suicides, 80% will be White males, and a high proportion will be people over 65. So if a crucial public goal is bringing down gun deaths — and if "Nothing is off the table" — a major strategy should be reducing suicide by gun among the elderly, especially among my people, White males over age 65.

            One obvious thing that can be done is to make life a bit less despair-inducing for old people. Many of us get ourselves isolated and not only feel useless, condescended to, and occasionally invisible but are, socially speaking, pretty useless, condescended to, and literally overlooked. (On one occasion I was, so to speak, walked through by a well-to-do family in an upscale mall; on another, I stood at the "Consultation" window at a pharmacy for a significant time being ignored. In each case I finally said, rather loudly, "Hey! I exist!")

            Society generally could do a better job finding some uses for us old farts, functions someplace short of Soylent Green. And better public transportation would help us, and probably others: US roads would be safer with fewer old folk driving.

            Still, there are horrors flesh is heir to that neither societies nor loved ones can do much to ameliorate; so we would do well to consider the custom of Thomas More's rational and moral, but nonChristian, Utopians. The Utopians take excellent care of their sick, but if any Utopian


is taken with a torturing and lingering pain, so that there is no hope, either of recovery or ease, the priests and magistrates come and exhort them, that since they are now unable to go on with the business of life, are become a burden to themselves and to all about them, and they have really outlived themselves, they should […] choose […] to die, since they cannot live but in much misery: being assured, that if they thus deliver themselves from torture, or are willing that others should do it, they shall be happy after death.

The Utopians believe that terminal patients who follow the advice of the Utopian religious and civil authorities and end their suffering "behave not only reasonably, but in a manner consistent with religion and piety."


            Moreover, some of us might reasonably choose skipping the drawn-out-torture phase of dying and off ourselves earlier; and most Americans would prefer to avoid the more totalitarian aspects of Saint Thomas's Utopia, including death panels of "priests and magistrates" delivering exhortations. Guns are efficient for moving on with finality, but messy and dangerous to have around: youngsters of 40 or 50 can get hold of them, for one thing, plus handguns are currently a bit too handy for oldsters who might be just in a funk.

             If reducing gun deaths is a priority and we're serious about considering all possibilities, then well short of spending billions to make schools totally like prisons we should consider offering old people suicide options more elegant than blowing out our brains: suicide options that may come with objective counseling, by counselors willing to give an honest opinion: "Yeah, given your options, the next week or so would be a good time for you to die. Here's contact information for a large-animal veterinarian who makes house calls and helps with funeral arrangements. Have your family over; have a farewell party." Additionally, and better, suicide counsellors should be able to recommend places where people can actually get aid: affordable health care, transportation, a decent job, which means an America that offers affordable health care, social support, and jobs.

             So you, dear reader, think about it: not killing yourself or encouraging grandpa to kill himself (already!), but about gun deaths generally.

             School shootings and mass murders make the headlines, but what drives up the bodycounts is suicide combined with banal homicides. We cannot eliminate murder, but we can reduce the scale of murders. And we can make suicide less traumatic for survivors and for those near death anyway, for old people who rationally and with compassion for their loved ones, choose to die. 

Doctor-Assisted Suicide: Some Useful Clarifications (6 March 2013)

            On her National Public Radio show on 5 March 2013, Diane Rehm got into an exchange that helps clarify the issues with doctor-assisted suicide.

            Early in the show, Ms. Rehm talked with Krayton Kerns, who, uses his doctorate with his name and stresses it on his website, and thereby made himself fair game for a line of questioning that started with his being a practicing veterinarian, and a vet definitely willing to euthanize animals: "Oh yeah, without a doubt. We do it all the time."

            Krayton Kerns, DVM, is relevant to discussing doctor-assisted suicide with humans because he is also the Honorable Krayton Kerns, Representative in the Montana Legislature for House District 58, and Rep. Kerns recently pushed through the Montana House of Representatives a bill that could — if approved by the Montana Senate and signed by the Governor — impose on any Montana physician assisting in a suicide (1) a fine of up to fifty thousand dollars and/or (2) ten years in jail.

            In response to Dr. Kerns's robust reply on his professional willingness to put down animals, Rehm asked, "And how do you see the treatment, the care and treatment of those animals as being different from the treatment of humans who wish to die?" Kerns responded that the situation with animals is "entirely different." He explained, "Number one, they can't give their consent […]." Since the non-human animals' lack of choice here seemed to work against Kerns's position, Rehm pushed the point, and Kerns replied that "The animal has no choice. That would be correct. And the human being does have the choice. Yeah, I think that would be a correct assessment."

            Rehm pushed on: humans have choice and what "if the human being says, I choose to die" and adds, "I really am asking you, my doctor, to assist me in dying" — how would Kerns "regard that as different"?

            Kerns's immediate answer was rambling but instructive: "Well, you're also asking the doctor to go against their oath above all, do no harm, and […] they're no longer an agent of healing. You know, it's a different circumstance then. And this also gets discombobulated as this nation degrades into a single-party payer health care system where everything is controlled by the government. And then we have a very frightening situation where the government controls the diagnostic end of your disorder, the treatment end of your disorder. And due to the power of the inheritance tax, it is to their advantage for you to select suicide as early as possible before you exhaust your resources."

            To help clarity — clarification is my goal here — Kerns raises the important points of (1) the possibility of harming someone by failing to act, (2) money, and, crucially, (3) of control: who gets to decide what.

            Like a good teacher or most excellent interviewer, Rehm prompts Kerns with "But suppose I am really suffering from something as debilitating as, say, Parkinson's disease or ALS or an invasive cancer that is bringing me so much pain and suffering that I no longer wish to live and wish to die in as humane a fashion as I would treat my dog." And then we get to the heart of the matter.

            "Well, of course, Kerns responds, "I view it as you're interfering with a decision that is not yours to make, it's God's. He'll take your life when it is time. And until that time, it's your obligation to press on and make the best that you can with what you have available."

            Rehm moves from a prompt to a bit of a goad, though pronounced without sarcasm: "So as a veterinarian, you bring in the religious element." Kerns says, "Well, I don't because I don't think it plays in in the veterinarian end because we're dealing with the animal and not a human life."

            On his website (www.KraytonKerns.org), Kerns handles the abortion issue succinctly: "*Abortion:  I am a Christian.  I am Pro-Life." And we can use this assertion to make clear that Kerns has a coherent position, an important position, and a position pretty radically opposed to those held by people likely to read anything by a commie-liberal-pinko-pretty-secular-humanist-registered-Democrat like me.

            I've got $50 to bet that by "Christian" Kerns means something like the student of mine meant when he said, "I used to be Catholic, but now I'm Christian" — but I'll just put it that what Kerns says makes sense in terms of a "Bible Christian" for whom Adam — Man — became a living being when he received the breath of life from God (Genesis 2.7), someone who believes that when we say "choose life" it means choose a life following God. Or, as God puts it, "[…] I have set before you life and death, blessing and curse; therefore choose life, that you and your descendants may live, loving the Lord your God, obeying his voice, and cleaving to him; for that means life to you and length of days […]" (Deuteronomy 30.19-20).

            Human beings live and have choice and free will because we have within us a special life-breath, one different from non-human animals: a direct-from-God kind of ruach, anima, spiritus: words that (roughly speaking) evolved from "wind, breath" to more or less "spirit," and then to soul.

         Kerns can kill dogs and cats and all without qualm if not literally "all the time" but objects to even suicide by humans because with a dog "we're dealing with the animal and not a human life," not a real life, not the life of a creature ensouled.

            One of the reasons he can so readily kill non-human animals is precisely because they have no choice in the matter and are innocent in their deaths and in all else. Humans should be prohibited from killing ourselves precisely because we have free will as a gift from God and have souls from God and damn well better be willing to put up with any shit God sends us. Or else.

            And that's "or else" you will be damned to eternal Hell, you and, in this case, the physician you rode in on: indeed all those risk damnation who aided you in succumbing to the unforgiveable sin of despair.
            God has set before us life and death, but we don't — in the traditional Christian view — we don't get to choose death in the sense of suicide because that is "a decision that is not yours to make, it's God's. He'll take your life when it is time. And until that time, it's your obligation to press on […]," even if doing so subjects you to misery we would not inflict on a gerbil.

            Indeed, you're to "press on" even if it bankrupts your family, and definitely without getting advice that you'd do better to shuffle off this mortal coil before you and the other codgers bankrupt a single-payer health system.

            I'm serious about the family bit, and about money. However much Christianity — definitely here including Catholics and Orthodox and all the traditional Church — however much the churches have long been big on the family, you do have the musical injunction from Martin Luther, "Let goods and kindred go"; and Jesus was emphatic that "[…] he who loves son or daughter more than me is not worthy of me" and enjoined his followers, "Do not lay up for yourselves treasures on earth" (Matthew 10.37, 7.19). Nor for the kids.

            God gave you the breath of life and freedom and the promise of eternal life. Immortal God put on flesh and became human — Yuck! — and was tortured to death willingly for your sins, so you, you ingrate, can bloody well die miserably and bankrupt your kids and help bring down the economy rather than disobey a jot or a tittle of God's word which, traditionally (uh, actually, without a whole lot of scriptural warrant) says man up, press on, and die a lingering death if that's what God wants for you and from you.

            That may not be what mere mortal reason and compassion says — see Saint Thomas More's rational but non-Christian Utopians on the matter — but that's why we have Revelation to supplement, and sometimes over-rule, mere mortal reason (and occasionally compassion).

            Personally, when "It's time," as the vets say, I want to be put down like a dog. Or, since my dog was killed by a train and that would be hard to arrange — more exactly, I'd like to be put down like my cat Lilith, who died in my arms Christmas Eve a while back, from lethal injection.

            Still, there are reasons to carefully hedge assisted suicide. We do want to ensure that the family doesn't send grandpa off to the needle the first time he breaks a hip or that a fascist State doesn't start a program in racial hygiene by slaughtering the infirm. More immediately relevant here, secular sorts must understand that Representative Krayton Kerns has a coherent code behind him and one agreed to more quietly by a lot of people.

            The question is control. Mr. Kerns doesn't want the US Federal Government to be the single-payer for health care; a lot of us don't want Mr. Kerns and Church or State in any of their forms getting too coercively involved with what we do with our bodies.

Reprise: "Freedom isn't free" — Gun Deaths (19 Sept. 2013)

            For forty years of my life I taught just about every year at least two classes in Rhetoric and Composition. To a great extent, I taught argument, and with that sort of background even sampling most current debates in US politics can be very frustrating, rarely more frustrating than the fights over guns.


            The biggest group for gun deaths in the USA is my people: old fart White guys killing ourselves. If you want a direct and effective way to reduce gun deaths in America, make it easier for old folks to off ourselves in ways more elegant than blowing out our brains. Providing alternatives to getting intimate with a Smith & Wesson .38 Special could also provide compassionate and objective counseling along with cyanide (or whatever) and help limit suicide to cases where it's a rational (secular) choice.

            There are also gun deaths through sheer accidents and carelessness, and gun deaths where it's just as well that the person shot dead was shot dead (e.g., someone shooting children who can only be stopped with a bullet, or a number of bullets); but for analysis let's throw together for the moment (figuratively) all the bodies and say that widespread gun ownership results in 30,000 avoidable deaths in America each year.

            Even in such a biased context, gun advocates could still argue that "Freedom isn't free" and that the right to keep and bear arms is the ultimate guarantor of all the other rights Americans possess. Humankind may have been endowed at the Creation, individual humans may be endowed at birth, with "certain unalienable rights," but those rights are made real against tyranny by the ultimate Right of Revolution; and the Right of Revolution is made a real threat to potential tyrants by an armed citizenry.

            And in a country the size of the USA, thirty thousand deaths a year would be a steep price to pay for freedom, but, obviously, affordable.

            Now Crosby, Stills, Nash, and Young reformulated "Freedom isn't free" for themselves and for my generation and sang "Find the cost of freedom," and one can take that injunction more literally than Neil Young and Stephen Stills intended — and come up with one's own calculations and dicker over freedom's sensible price. One should do that calculating, but the immediate counter-argument to a pro-gun argument in terms of the Bill of Rights must first be about rights.

            So on the subject of rights and making rights real and not just theoretical — on the subject of rights, the claimed right of gun owners to all the armaments they might want has contributed to a culture with a whole lot of guns and ammo and armor and an arms race among the somewhat overlapping groups of cops, criminals, "civilians," and (to a lesser extent) the National Guard and Federal forces who'd take on as necessary the task of putting down insurrections. All of these citizens — and noncitizens among us benefiting from the Second Amendment in arming themselves — all of these folk have ramped up their fire-power, and we now have police militarized beyond anything I grew up with in the violent big city of Chicago, and kids subjected to privacy invasions rare when I was growing up and a young adult in the youth-fearing eras of the 1950s and 1960s.

            As a practical matter, the over-insistence on Second Amendment rights has led to a diminution of other rights as citizens have come to be viewed by cops as those "civilians" and treated as potential threats. So we get "Stop and Frisk" laws and metal detectors and locker searches in schools and increases of State power epitomized by SWAT teams with automatic weapons.

            The Right of Revolution and the Right to Keep and Bear Arms are indeed rights, but they must be recognized as rights in the real world in competition with other rights, starting with such things as ordinary citizens' arrested for crimes having the right to expect to be asked to "Come along quietly" and not routinely handcuffed. I do blame the cops for not being as courageous and courteous as they ought to be, but it makes perverse sense to treat just about everyone as potentially armed and dangerous when just about everyone a cop arrests is potentially armed and dangerous.

            Etc.

            "[T]he right of the people" as individuals "to keep and bear arms" is an important right — but if the subject is rights, there needs to be balance, and it can and should be argued the right to buy a 30-cartridge magazine if one takes a mind to is trumped by the right of kids not to go to schools increasingly managed like prisons, complete with "lock downs."

            That necessity for balancing of rights having been established, we can get down to facts, details, and dickering. For one thing, there are historical issues to be resolved over just what sort of citizen armaments are useful for resisting tyranny — hint: the State always starts out with overwhelming fire power; the turning point in revolutions is when ordinary soldiers refuse to fire on the people and join them. Perhaps "The People, united, / Will never be defeated"; but even with assault rifles they won't be taking out a tank platoon.

            After arguing out the history, we can dicker over hunting weapons and what is reasonable for home defense (where I've lived, home defense meant a serious knife or two and a baseball bat).

            Or we could dicker if the politics allowed it. But they don't, so for now about the best we can do is improve the statistics by getting old folks to kill ourselves without firearms — and we unarmed or lightly-armed Americans can embark on a long-term project of making our over-armed fellow Americans a little less fearful. Long term, we need to give all Americans a little more confidence in the "collective security" of government and a whole lot less confidence in the effectiveness of self-help justice.


            It also would help to go back to the idea that guns are "equalizers"; the conviction that real men, and real women, can get by with words or, when things get violent, fists or knives or a baseball bat. Conflict is inevitable and violence may be; but you don't have drive-by knifings or a dozen people killed in a few minutes by a guy with a ball bat.

Monday, March 23, 2015

Journalistic "5 W's" and More Important "C's" (3 March 2015)

           By the time they get to where they have an audience, most American journalists have pretty well gotten down "the five W's": Who, What, When, Where, Why, and for more technical stuff, How? (which isn't a "W," but, then, I didn't count it). Now, guys and gals, let's move on to the more advanced "Whole bunch of 'C's": considerations of characters in conflict and crisis vs. concern, plus context and maybe contemplation.
            If you're writing an exciting story, as in story story, if you're writing a story, for entertainment, it's good to have conflict that moves to a crisis and then a resolution. And violent conflict and some sex can be effective.
            About 2100 B.C.E., King Gilgamesh (the story goes) can't live a quiet life and oppresses the people of his city of Uruk, so the gods send a wild man, Enkidu, to oppose Gilgamesh, and Gilgamesh gets Enkidu drunk and laid and (therefore) civilized, and they fight and travel and have adventures and — SPOILER ALERT — Enkidu gets killed, and that story-line wowed 'em four thousand years ago and has worked well ever since. 
            That's a story story, or one form of fictional narrative, and not the only form; a news story, however, is different, and writing it as a story story can be a temptation, and a problem.
            Look, journalists; you don't have First Amendment protections because anyone has ever liked you. Often enough, the larval form of reporters is gossipy little teen-weasels ferretting out rumors to spread about other kids justifiably more popular than they are. Reporters have special protection because journalism performs a public service, and entertainment isn't particularly it.
            For entertainment we go to the Class Clowns, not the ferrets and weasels, and it's one of the ironies of our time that for the last couple decades the class clowns like George Carlin and Jon Stewart and Stephen Colbert have done a better job than most journalists not only entertaining but in doing what we privilege journalists to do: provide information and analysis needed by citizens of a republic.
            And sometimes the "Who" in news stories are particularly interesting characters, and/or don't have to be developed as characters at all. And we don't always have characters in conflict and crisis.
            Sometimes there are just matters for concern, but often matters for a whole lot more concern and action than they're getting.
            E.g., we don't have a crisis of rapes occurring on college campuses as such, nor is there a crisis epidemic of suicides among current military personnel, recent military veterans, and/or teenagers: these are not conflicts with heroic whistleblowers fighting the forces of indifference and reaction. We have matters here of concern, and we would know to be concerned and concerned enough to act — but not panicked — if we had more news stories that give context.
            For a "W" of context: What is the rate of rape and other sexual assault among American women 18-22 generally? Last time I checked, "the National Crime Victimization Survey revealed that college-age women who are not in school […] are actually more likely to be victims of rape and sexual assault" than American women in college. Or, what is the rate of rape and other forms of sexual assault in US prisons? Apparently, it is highHuman Rights Watchreports that "In December 2000, the Prison Journal published a study based on a survey of inmates in seven men's prison facilities in four states. The results showed that 21 percent of the inmates had experienced at least one episode of pressured or forced sexual contact since being incarcerated, and at least 7 percent had been raped in their facility. A 1996 study of the Nebraska prison system produced similar findings, with 22 percent of male inmates reporting that they had been pressured or forced to have sexual contact against their will while incarcerated. Of these, over 50 percent had submitted to forced anal sex at least once. Extrapolating these findings to the national level gives a total of at least 140,000 inmates who have been raped."
            If there isn't a crisis in prison rape or rape of non-collegiate women, there is not a crisis with on-campus rapes. 
            Obviously.
            More obviously, these are matters for concern and for considered action, and for reporters supplying more context, including history.
            Ill-considered crisis reactions on campus sexual assaults are an invitation to return to parietal rules, "women's hours" — probably expanded to males and the transgendered — and the doctrine of "in loco parentis," where the school is in the place of the parents of students assumed to be children.

 (Or, if crisis mode gets both extreme and truly serious, there could be enforcement of the prohibition of underage boozing.)
            Such consequences would not be progress for undergraduate Americans, including women undergrads even if the "in loco parentis" authoritarianism is equal opportunity.
            Similarly for suicides among teens and the US military: suicide rates are low for teens as Americans go, but still too high, and the rate for suicides among the military is about the same as in the relevant civilian populations. Concern here would be good: getting more aid to vets and young people. If there's no crisis of suicides among Americans 45 to 64 years of age — the Americans with the highest rate of suicides — there isn't a crisis among teens. It's proper to value the lives of teens above those of their elders (insofar as they should have longer to live), and military personnel above civilians (we owe them, and they've been trained at some expense to defend the State), but talking about an "epidemic" of suicides in these groups adds to the teen-bashing idea of pathological kids and the harmful stereotype of the battle-crazed veteran.
            So come on, reporter-folk, you're not creative authors selling tales of action and adventure.
            I realize that we Americans need to be hit over the head to get our attention, but American journalism is in a vicious cycle of hype and more literal hyperbole, and you're messing up your function in the Republic.
            So, newsies, do tell us who, what, when, when, and why — and sometime how — but hold off on the crisis's until we really have them, and give some bloody context, already (including honest numbers). Then you might get us to show some significant concern and maybe, just maybe, now and then to contemplate solutions to problems.