Monday, February 6, 2012

Things that are painless (and bring on many changes)

Flare-ups over the contraception coverage portion of the Affordable Care Act and its intersection with the beliefs, doctrines and practices of the Catholic Church are back in the news. Gripes on all fronts of late have gotten me to think more about a rather grim subject close to my research interests: suicide. Specifically, physician-assisted suicide. 
Going back as far as Hamermesh and Soss in 1974, economists have a peculiar habit of modeling suicide as a rational act. Nobel Laureate Gary Becker claimed to have identified a relevant margin between murder and suicide and much of the recent literature draws on the same sort of analysis that lets folks price call options. In my own work, I like to use a Bayesian equilibrium with a touch of systematically biased beliefs, but then again, I don't deal with end-of-life cases, and if memory serves, much of the economics of suicide literature assumes that there's not all that much interesting to say about assisted suicide except to say that the market for this particular transaction is thin and often incomplete. It would not be much of a stretch to note the inefficiency of bans on assisted suicide: otherwise clear-headed and rational people (outside of Washington, Oregon and Montana) are being denied a medical option that people find, for lack of a better term, gruesome.

And to be sure, there is a gruesome aspect to it. The decision to end one's own life is... well, I hope it's one my readers never have to endure. The only thing I would consider worse is the alternative driving the decision.

Mrs verpetas worked briefly at a nursing home upon our return to the United States following my year of exile and she made me promise her that if she ever ended up in a situation like the residents of C Wing (the psych ward) that I would take every effort to obtain the euthanasia option. I didn't want to agree at first until I learned some of the details of terminal care. I now have a living will of my own specifying no extreme measures. My resolve has only been bolstered by yet more horrifying tales of pale existence at the mercy of machines and uncaring hospital staff. Despite this, in the Commonwealth of Virginia, I cannot freely contract with a physician to help me take my own life*. Why not?

Well, once again, I look to EE for answers. I have sort of a suspicion that there is some sort of compromised ability to contract for impaired individuals (whether this is actually true or not is debatable, of course). One might also forward an externality argument, perhaps, but that would be an externality largely imposed on the family, hardly cause for concern of a legislative body, right? Right?

The absence of regret criterion is one that occurs to me might hold a little water, at least under the assumption that there are homogeneous components to suicide including severe depression (which has a notable impact on time preferences [aw yeah, cited Heller, baby]). This implies that under normal discounting rates, the value of staying alive rises. The counterfactual is one where the patient survives and is glad she didn't kill herself. Well, I would argue that the people seeking assisted suicide are terminal patients, and the regret criterion is pretty much covered. I also tend to think that the heuristic of the down-in-the-dumps, hard-on-his-luck sad sack taking his life at home is emphatically the wrong template for euthanasia. The decision calculus for terminal patients is wholly different.

I am willing to consider self-interest on the part of families: grandpa can't be dissuaded and it just makes it easier to petition for a ban and so on and so forth, but the question I put to my readers is something like this: is physician-assisted suicide euvoluntary? If not, why not, and if so, why the rather widespread ban? Also, if you really feel like casting a pall over whatever cocktail party you happen to be at, ask the other guests if there is a difference between one the one hand a physician simply providing the materials and machinery to commit suicide and on the other hand actually activating the machinery. The courts sure thought so. Kevorkian did 8 years of a 10-25 stint before he died in 2011.

Anyway, this subject is kind of well-trodden, but the EE aspect of it might be a good way to give it a little spit-shine. Try it out and let me know. Be sure to really stress the unpleasant aspects of the BATNA.

*Note here that this would occur in the event of unexpected accident or disease. I otherwise plan to freeze my brain to be transplanted into a robot body when technology has advanced sufficiently.

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Do you have suggestions on where we could find more examples of this phenomenon?