Don’t just stand there, do something! (Provided there’s something useful to do.)

Of course my brilliant old friend and longtime UCLA colleague Eugene Volokh is right (and Jeb Bush was also right, though tin-eared and hard-hearted).  The impulse do “do something” in the face of a bad situation, and especially after a disaster, can lead to policies that make things worse instead of better (for example, invading Iraq), and it is wiser to resist that impulse than to do something foolish. The “Yes, Minister” syllogism – “We must do something; this is something; therefore we must do this” – is not a form of reasoning that leads to good results.

That’s especially true for gun policy, because the debate heats up after a mass shooting, and mass shootings are completely atypical of gun deaths overall. The question “What would have prevented this particular disaster?” is inevitably the wrong question.

And Eugene is also right – being right in the service of really bad policy choices is one of his annoying habits – to compare guns to alcohol as two commodities whose consumption in the United States leads to the deaths of tens of thousands of people other than consumers, in addition to deaths among the consumers themselves.

But that’s where Eugene stops being right and becomes ridiculously and disastrously wrong. He assumes, falsely, that just because we’re not currently doing much to stop the violence involving guns and alcohol it must be the case that nothing useful can be done.  In the case of guns, the cross-national statistics offer a strong hint that there’s something very wrong with policy in the United States, since no other developed country has anything like our rate of gun deaths. Our rate is three times that of Finland or Switzerland – our closest competitors among developed nations – four times that of Canada, and ten times that of Australia. That suggests we might have something to learn from their policies.

John Donohue’s recent work showing that adopting a “shall-issue” concealed-carry law correlates with future increases in homicide rates  suggests that state-level gun policies matter, though it’s hard to tell whether the results are due specifically “shall-issue” as opposed to “stand-your-ground” and other elements of the NRA policy agenda; states that loosen their gun laws are likely to do so along more than one dimension.  But even if there’s nothing positive to do, reining in the desire of Eugene’s gun-crazed allies to increase the prevalence of gun ownership and gun-carrying would be a good place to start.

One obvious positive thing to do about guns would be to tighten the rules about background checks. Right now, registered gun dealers (Federal Firearms Licensees, or FFLs) must verify that gun buyers are eligible to purchase; that’s the Brady Law background check. But about a third of all gun transfers don’t involve an FFL: they’re private sales, including sales at gun shows, or they’re gifts.

There’s no good reason not to require a check for every transfer; no doubt the gun stores would be happy to provide the service at a competitive price.  That simple change, supported by the vast majority of voters and proposed by the Obama Administration, fits perfectly the NRA slogan that what we need is better enforcement of the laws already on the books. But in fact the NRA opposes it, and if Eugene supports it he’s keeping that support a secret.  No one can estimate how many lives it would save, but surely that number isn’t zero.

If Eugene wants to say – as apparently Jeb wants to say – that protecting the convenience of gun owners and gun merchants is more important than saving lives, that’s his right. But to say that there are no lives to be saved,  at reasonable cost to other goals, is simply false.

That’s even more obviously true with respect to Eugene’s comparison case, alcohol. He writes as if the only alternative to our current insanely loose alcohol policies would be a return to Prohibition, and that what we can do  about controlling alcohol-related deaths is “not much, other than trying to catch and punish alcohol abuse.”

Nonsense. There are at least two options out there that would substantially reduce the number of people who die as a result of other people’s drinking (while also reducing the number who die, suddenly or slowly, as a result of their own drinking).

The first and most obvious (except to a libertarian) is raising alcohol taxes. When something costs more, people use less of it, especially people who use enough of it so its price matters in their personal budgets. Most of the damage from alcohol-related violence comes from heavy drinkers, not casual ones.  So higher alcohol prices will lead to less drinking by heavy drinkers and therefore fewer drunk-driving deaths and fewer drunken homicides.

Philip J. Cook’s Paying the Tab estimates that a 10% increase in the price of drink (which could be achieved by doubling the current federal alcohol tax) would reduce all violent crime – not just alcohol-related crime, but of course including a lot of gun crime – by about 3%.  The effects on traffic fatalities are of about the same magnitude. The effects seem to be roughly linear.

So tripling the alcohol tax – which would cost the median drinker less than 20 cents a day, and which wouldn’t be nearly high enough to create a black market – would eliminate about 6% of the 13,000 murders we suffer each year, saving about 800 lives. It would also eliminate about the same proportion of 32,000 traffic fatalities, saving something more than 2000 additional lives.  In other words, a simple change in the tax code could eliminate about one 9/11′s worth of sudden death per year.

The other straightforward approach to shrinking alcohol-related damage, including homicide, is to deter drinking by people who commit crimes under the influence. That’s the approach of South Dakota’s Sobriety 24/7, which requires people with prior DUI convictions arrested for a fresh DUI to come in twice a day for an alcohol-breath test, under the threat of a night in jail if the result isn’t 0.0.

The results are spectacular: being on the program (for an average of 90 days) reduces DUI recidivism by 50% over the next two years. Applying the program at a county level reduces auto fatalities by 12% and domestic-violence complaints by 9%. (Beau Kilmer and his colleagues at RAND are about to publish an estimate of the effect on all-cause mortality that will blow the top off everybody’s head, but that work is still under review so I can’t more than hint at the results.)

Here’s a more speculative idea, but one I’d like to see tried. A third activity that leads to lots of sudden deaths on the part of bystanders is driving. One thing we do to reduce the carnage is to forbid people to drive if they’re under the influence. Alcohol effects coordination, but it also influences anger management, impulse control, and judgment. So why do we let someome walk around armed when he’s drunk out of his gourd? The old-fashioned Western saloon had a “hang ‘em here” policy; customers were expected to disarm before getting loaded. Why not enact that as law, requiring that anyone possessing a gun in public either (1) remain sober or (2) lock it and unload it? You could think of that as either a modification of gun policy or a modification of alcohol policy.

So Eugene’s comparison case is almost uniquely poorly chosen. There are some things we could do today to reduce gun violence by changing gun policy, but those effects would mostly happen slowly and can’t be estimated with much confidence.  But there are things we could do about alcohol policy today that would reduce violent death, including violent death by firearm, predictably and measurably six months from now.

Yes, the activist impulse to “do something” can and does lead us astray. But so does the libertarian impulse to just sit there and watch people die, all in the name of limited government.











First rule of GOP politics: Never, never, EVER tell the truth

Incoming House Speaker Kevin McCarthy just committed a “gaffe” in Michael Kinsley’s sense of the term: in an unguarded moment, he allowed himself to tell the truth. The truth is, as most of has have always known, that Benghazi!, like its predecessor Whitewater!, was an entirely bad-faith exercise in partisan character assassination from the get-go. But don’t listen to me, listen to what the Speaker-to-Be told Sean Hannity:

Everybody thought Hillary Clinton was unbeatable, right? But we put together a Benghazi special committee, a select committee. What are her numbers today? Her numbers are dropping. Why? Because she’s untrustable. But no one would’ve known any of that had happened had we not fought and made that happen.

Naturally, the rest of the House Republicans are outraged: not, of course, at Trey Gowdy for ghoulishly making a political meal out of the bodies of four dead Americans, but at McCarthy for blabbing.

The political press corps is caught in the middle. Lots of those reporters and editors, especially at the New York Times, have been more than willing to peddle Gowdy’s “partial-transcript” leaks as if they had news value, and to let Gowdy and his staff hide behind anonymity to defame a political rival. In other words, they’ve been playing according to the Clinton Rules, which hold that anything a Clinton does is guilty even after it’s been proven innocent.

So far, most of that crowd has reacted to McCarthy’s stunning admission, which makes them look like fools or scoundrels or both, by ignoring it. But I’m hoping that the second round of stories, with other Republicans commenting on McCarthy’s blunder, will start to crack that Wall of Silence. And I’m starting to look forward to Clinton’s appearance before Trey Gowdy’s inquisition. He might well come out of that experience as no more than a Deuce.




The marijuana movement and the marijuana lobby

Reactions to the “Responsible Ohio” cannabis-legalization initiative have a lot to tell us about the changing politics of the marijuana question. No much of what they have to tell us is encouraging.

Cannabis policy change in the United States has been driven, until now, by people whose interest in the matter was primarily non-commercial: pot smokers yearning to toke free, culture warriors of the (cultural) left, libertarians, criminal justice reformers concerned about arrest and incarceration, and people who think that it’s bad policy to criminalize the behavior of tens of millions of people unless there’s a stronger reason to do so than the risks of cannabis create.

Not that economic interests have been entirely absent; Dennis Peron was in the business of selling “medical marijuana” when he spearheaded Proposition 215. But Peron was also a righteous stoner; there’s no reason to doubt the sincerity of his expressed opinion that “all marijuana use is medical.” But the main funders of the recent initiatives, and of the big marijuana-legalization groups, have been ideologically-driven billionaires such as George Soros and the late Peter Lewis.  (How old am I? Why, I’m s-o-o-o-o-o-o old that I remember when billionaires weren’t a branch of government.) And the people doing the work have been, for the most part, true believers rather than hired hacks.

That has begun to change. Americans for Safe Access has morphed from an advocacy group for medical-marijuana patients to, in effect, a trade association of medical-marijuana growers and sellers. The National Cannabis Industries Association has taken things even further, hiring a Washington lobbyist who might have been provided by Central Casting: about as far, culturally, from a typical NORML or MPP activist as it’s possible to imagine.

Inevitably, then, the marijuana movement has begun to give way to the marijuana lobby. To be sure, I’ve had my share of clashes with movement folks, and I haven’t always been impressed with their policy acumen or their standards of argument, but I’ve never seen any reason to doubt that they’re advocating the public interest as they perceive it. The people now being hired by the guys in suits doing cannabis-business stock promotions play by different rules. I expect them to have about the same ethical standards as lobbyists for the alcohol, tobacco, pharmaceutical, food, and fossil-fuels industries: that is, I expect them to be utterly willing to sacrifice human health and welfare on the altar of the operating statement, just like those folks at VW who decided it would be a cute idea to poison the air just a little bit to goose the performance of their diesel-driven cars. Continue Reading…

Gaming out the VW affair from the Oval Office

Imagine you were the President of the United States. (Sure, that’s daunting, but remember you’re more qualified for the job than about 90% of the people now running for it.)

You just found out that all the Volkswagen diesels sold in the U.S. over the past six years are in massive violation of pollution-control standards, and that the resulting excess emissions have caused, and will continued to cause, deaths and injuries. Apparently, in order to get those models past emissions certification without sacrificing mileage or performance, VW installed an elaborate software patch on the computer that runs the engine.

The program cleverly detects whether the car is being emissions-tested (apparently a testing machine isn’t much like an actual driver) and, if it is, turns on the emission controls. Once the test is done, the program notices that, too, and turns them back off. So the car-on-the-test-treadmill looks legal, but the car-on-the-road is grossly illegal.

GM, Ford, and Honda have all been caught before playing similar tricks; so had VW. There’s even a term of art for them: “defeat devices,” because they’re designed to defeat emissions tests. And Bosch - which supplied the code to VW, supposedly to be used only in testing rather than actual operations – also supplies several other automakers, so there may be other recent-model cars with the same problem.

Even after the cheating had been detected by some very clever engineers at West Virginia University, VW officials kept denying that there was anything amiss until the EPA threatened not to certify its 2016 models. Then the company changed its tune. (Note that if the people making those denials knew them to be false, they may have serious personal criminal liability; 18 U.S.C. 1001 (a) provides, in relevant part:

[W]hoever, in any matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States, knowingly and willfully (1) falsifies, conceals, or covers up by any trick, scheme, or device a material fact; (2) makes any materially false, fictitious, or fraudulent statement or representation; or (3) makes or uses any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry shall be fined under this title, imprisoned not more than 5 years …or both.

In that situation, Mr. (or Madam) President,what should you be trying to accomplish, and how should you go about it?

I submit that your goals should be:

1. Getting the cars off the road – or fixed, if that turns out to be possible – sooner rather than later. The death rate is unknown, but a month’s delay will, more likely than not, kill at least one person.
2. Identifying whether there are similarly gimmicked non-VW cars on the road, and deal with them as well. Again, time is of the essence.
3. Ensure that justice is done with respect to VW as an enterprise and the VW officials who engaged in this conspiracy. Of course legal guilt or innocence remains to be determined in each case, but there’s no doubt there was a conspiracy to cheat the testing process; VW has now admitted what was done, though of course the company is trying to blame a “small group” of engineers. Doing justice is not merely a matter of revenge; this is your best opportunity in years to establish the principle that deliberately planned regulatory violations that cost lives can have drastic consequences for firms and individuals.
4. The decision whether VW stays in business is now up to you and people who work for you. There’s a case for corporate capital punishment. But there’s also a case for using the leverage this case gives the government to force VW to spend company money on environmental improvement. That needn’t involve VW’s own operations. To choose an example not quite at random: pollution from new cars – even faux clean diesels – is trivial compared to pollution from old cars. The problem with a systematic “cash for clunkers” program is that it encourages people to keep their clunkers rolling until a buyback comes alone. It’s also hard to get Congress to come up with the money. But a buyback paid for by VW as part of a settlement of the criminal and civil cases against it would – precisely because it was unpredictable and unlikely to be repeated – pose no such problem. Buying and scrapping a million old cars at $1000 a copy might be an excellent way of spending $1 billion that the Congress never has to appropriate, and it would almost certainly turn the whole event into a net plus from the perspective of morbidity and mortality, even given the inevitable fact that some of those cars would have been headed for the scrapheap anyway.

All of those purposes are served by promptly gathering information about who did what at VW and elsewhere. No doubt folks at EPA and at various universities are feverishly inventing tests to detect defeat devices, so it’s likely we’ll eventually learn about most of the schemes that have been put into practice recently at any substantial scale. That still leaves the problem of detecting older or smaller schemes, and the further problem of determining which individuals at the offending firms were responsible.

You could speed that process enormously by instructing the Justice Department to open a criminal investigation into conspiracies to install defeat devices.  Again, you’d need to be careful to make it clear that you weren’t imputing criminal liability to any specific individual or firm, but it would be well within your legitimate function to say, or have your Attorney General say, something like this:

On the facts as reported, it seems more than likely that criminal laws have been violated, and at least possible that they have been violated by more than one manufacturer, with regard to “defeat devices” designed to evade pollution controls. People have gotten sick and died, and others are getting sick and dying right now, because of the excess pollution that was deliberately and illegally emitted. These are not “regulatory violations” in the sense that someone forgot to file the right paperwork; this was a deliberate scheme to put toxins into the air we breathe and to conceal that fact.

Starting this week, Federal agents will be asking automobile manufacturers and their employees for information about defeat devices and other attempts to cheat the emissions-testing process. For now, those requests for information will be voluntary; no one is obliged to answer. But everyone involved should also know that making a false statement to a federal official in such a situation is a felony.

It also seems very likely that eventually one or more grand juries will be empaneled and subpoenas issued. Again of course, everyone involved has the right to assert the Constitutional privilege against self-incrimination and refuse to answer questions that might lead to his own prosecution. As in any such investigation, those who come forward early and make a clean breast of things are likely to wind up facing less serious consequences than those who wait to be called.

To facilitate the process, we have established a hotline, 1-800-DEFEAT-D. People who call that number have the option of giving their own names or remaining anonymous. Of course, those who think they may be facing personal criminal liability should consult an attorney first.

We need to find any other cars that have similar gimmicks and get them fixed, or off the road, as soon as possible. Every mile driven by any of those cars makes this country just that much less healthy to live in.

The truth is going to come out eventually. I appeal to anyone who can help it come out faster to call that hotline.


So far as I can tell, of the eleventeen people currently running for President, only Hillary Clinton has made a statement on the issue; hers was forceful but brief. There’s no sign of any legislative action.  The contrast with the phony Planned Parenthood scandal couldn’t be stronger.


Cities of Refuge

When I first met Paul Roemer a few years ago a few years ago he was promoting an idea he called “Charter cities.”

The basic idea is that, under contemporary economic conditions – in particular the astonishingly low cost of transporting freight by water – economic activity doesn’t require much in the way of natural or even human resources: just a piece of land with access to ocean transportation, a little basic urban planning, the rule of law, and the absence of intrusive and kleptocratic government.

Alas, those last two are sufficiently rare in the worst-off countries that hundreds of millions of people, deprived of industrial opportunity where they are, want to leave and go somewhere else. The problem is that “somewhere else” mostly doesn’t want to take them in.

Romer’s proposed solution flows directly from this analysis: find an empty space with the requisite transportation access, get the national government out of the way, and build a new city, attracting economic migrants from around the world. At first the charter city would be governed by an international board, with housing and industrial plant built by private actors and infrastructure and public-services financed by ground leases: in effect a Henry George single tax.

Continue Reading…

The moral universe of the corporate killers

Daniel Fisher – not otherwise known to me – writes for Forbes, covering “finance, the law, and how the two interact.” Naturally, given where he works, he hates plaintiffs’ lawyers, which is his right and privilege in this great and free country of ours. So his first reaction to the VW emissions-cheating scandal was to criticize - not VW – but a class-action law firm threatening to sue VW on behalf of consumers.

His point is that the buyers of the supposedly-clean-but-actually-filthy-dirty VW diesels weren’t in any direct sense harmed by VW’s fraud. By disabling pollution controls except when the car was being tested, VW managed to pack more performance and fuel economy into a car than it could have done while also actually meeting the emissions targets. So when VW issues a recall notice it will in effect be asking consumers to trade their existing car for one that performs worse and gets lower miles-per-gallon. So, he says, except for a few Marin County cranks, they’re mostly going to ignore the recall.

Therefore, the plaintiffs’ lawyers are being silly again.

Tort reform, tort reform, sis, boom, bah!

Now, I don’t know what it is you need to know to be a Certified Financial Analyst - that’s the credential Fisher claims – but apparently it isn’t logic or economics.

Continue Reading…

Pure evil, VW edition

I don’t suppose we’ll never know how many people died – asthmatics, for example – because Volkswagen designed its “clean diesel” vehicles – all 482,000 of them sold in the U.S. since 2009 – to burn dirty except when they were being tested. The story reads like the most paranoid anti-corporate fantasy, until you get to the line where the firm admits what it did, and then discover that Honda and Ford got caught years ago doing the same thing in a less sophisticated way. There’s even a  term of art for such tricks: they’re called “defeat devices” because they’re designed to defeat emissions testing.

In the VW case, code was written into the engine-control software to detect the pattern of pedal and steering operations characteristic of an emissions test. Then, and only then, the car’s emissions-control machinery would kick in. Once the test was over, the software noticed that, too, and returned to normal – that is to say, illegally and dangerously dirty – operations. That meant emitting about 40x the permitted -and advertised – level of nitrous oxide, which makes smog.

Now just think about the depth of corporate depravity involved. This wasn’t one rogue engineer or engineering group at work. People up and down the chain had to be party to the crime.  And note that the conspiracy held together for six years, and was finally broken not by an internal leak but by the work of outside scientists at West Virginia University. Wasn’t there a single decent human being around when this was being planned and carried out?

Some quick comments:

1. The news stories discuss fines that might be levied against VW.  When people conspire to commit a crime that harms the health of untold numbers of people,  criminal charges are appropriate. And not only against the company, but against every official in it who can be shown to have known about the conspiracy.

2. At minimum, the civil penalties and civil-lawsuit damages should be sufficient to put VW out of business. That might make managers, and boards of directors, in other firms a little bit less casual about lawbreaking.

3. Keep this case in mind when evaluating the claim oft heard from Koch-funded “criminal justice reform” advocates that it’s wrong to “criminalize” regulatory violations. Of course no one should go to jail for paperwork errors. But deceiving the regulators is a fraud on the government, even when it isn’t – as it is in this case – a physical assault on the public.

4. Can we hear some more from the Republican Presidential candidates how business is Good and government is Evil? And is there any hope that a reporter will ask them whether they think the perpetrators of this appalling crime should face prison time for it? (Again, note that VW isn’t denying what was done, and can’t possibly deny that it was done deliberately.)

Footnote  I’ve quoted C.S. Lewis on this before, but his words bear repeating:

The greatest evil is not now done in those sordid “dens of crime” that Dickens loved to paint. It is not done even in concentration camps and labor camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices.

The most horrible thing about this case is that very few if any of the people involved will have lost any sleep over their guilt in making sick people sicker (and killing some of them) and none will lose face among their friends and neighbors. Even if some are found guilty of felonies, life won’t be nearly as bad for them as it is for someone who gets caught committing burglary. And yet no burglar’s contribution to human suffering can hold a candle to what the VW conspirators managed to inflict.




Gay marriage, divorce, and the Gospels

Ted Cruz’s statement on Kim Davis, the Kentucky county clerk now in jail for defying a court order to do her job by issuing marriage licenses to same-sex couples, demonstrates once again that a high IQ and excellent meritocratic credentials are consistent with functional idiocy, and that functional idiocy is no bar to being treated as a “mainstream” Presidential candidate. (Walker, Jindal, Rand Paul, and of course Huckabee, all came out the same way.)

Of course Davis wasn’t arrested “for living according to her faith.” She was arrested for refusing to do what a judge, after a hearing, ordered her to do. She could have avoided jail by (1) doing the job she gets paid for; (2) allowing her clerks to issue the licenses she doesn’t want to sign; or (3) resigning. She chose to do none of these, and she’s in the clink. That’s life in the big city. When she gets out, she will no doubt spend several years collecting some kind of wingnut welfare.  To liken her to victims of genuine religious persecution is an insult to those victims.

On some level Cruz is plenty smart enough to understand all this, but he’s decided to make a career out of not understanding it.

There’s been some rather indecent glee among supporters of same-sex marriage about Davis’s own rather colorful marital history. There ought to be a strong presumption that a public official’s private life is off-limits in political debate, and Davis has on the face of it a reasonable case that behavior predating her religious conversion is irrelevant to her current beliefs.

But, as Lt. Colombo used to say, there’s just one more thing. Davis claims to be acting as a Bible Christian. Adultery violates one of the Ten Commandments. (Male/male sex violates a rule that’s on a list with eating shellfish, and female/female sex is never mentioned.) And Jesus of Nazareth – breaking with existing tradition in the interest of protecting women against being cast off by their husbands – says quite explicitly (Matt 5:32 and Luke 16:18) that marriage with a divorced woman (or marriage by a divorced man) constitutes adultery.

Therefore, by Biblical standards Ms. Davis’s sin is not in the past. Every time she has sex with her current husband, both of them are – according to the one they acknowledge as the Son of God – violating one of the Ten Commandments. The only way she could stop sinning would be to live as a celibate from now on (just like all those gay folks are supposed to do).

So, whatever religion Kim Davis is suffering for, it’s not the one preached in the Gospels.

This analysis suggests a question for Cruz and the other Republicans coming out in support of Davis:

If an elected county clerk who was an actual Bible Christian refused to issue licenses for the remarriage of divorced people with living spouses, on the grounds that his religion forbade him to connive at adultery, would that be legitimate exercise of individual conscience? And should divorcees in that county remain unable to marry?

Footnote There’s a general point here: Lots of the stuff that’s done in the name of “Christianity” has as little to do with the Bible as some of the stuff done in the name of “Islam” has to do with the Koran. In each case, local customs have been engrafted onto a larger religious tradition. As Don Marquis said, an idea isn’t responsible for the people who believe it. Especially, as he might have added, when they really don’t.








Suicide, assisted suicide, and physician-assisted suicide

Something like one million people each year in the United States try to kill themselves (with various levels of determination) and about four percent of them succeed. That makes suicide the 10th-leading cause of death: way ahead of homicide, and about on a par with auto accidents. About half of those attempts involve people with alcohol, tranquilizers, or opiates on board, raising the question of whether the person involved would make the same choice sober. (The answer might be “yes”: someone could decide in cold blood to kill himself and have a drink or three to steel himself to do it, or someone in chronic pain and taking opiates for it could decide that the pain is more than she wants to handle for years to come.)

In many cases, the impulse is transient; of those who survive suicide attempts, fewer than 10% eventually finish the job. Even people who, seemingly by chance, survive suicide attempts using methods that kill 95% or more of the people who try them (e.g. jumping from tall buildings or bridges, gunshots to the head) mostly don’t try it again. That suggests that most of those who succeed in taking themselves off were not acting on a steady, settled decision that life wasn’t worth living.

That being the case, preventing someone from committing suicide seems as straightforward a public-health objective and medical responsibility as preventing any other sort of sudden death.

Suicidal thoughts are even more widespread than suicide attempts. Physicians and other service providers know something – not as much as they would like, but something – about how to keep those thoughts from turning into attempts, and how to reduce the lethality of the attempts that are made. (Keeping guns out of the hands of those who might use them on themselves ranks high, since guns are especially effective means of ending one’s own life.)

Much of the burden of this work falls on psychiatrists. Those I know are proud of their many successes and intensely distressed by their occasional failures. So it doesn’t surprise me to find my friend Keith Humphreys, who teaches psychiatry, strongly opposed to having physicians – and psychiatrists above all – involved in helping people kill themselves. And published descriptions of Belgium’s legal Kevorkians are not encouraging in terms of how much care they use to avoid helping to end the lives of people who would, if they survived, be happy about it.

With all that said, I still think that people who have formed and held the view that their lives would be better shorter ought to be allowed to act on that view. The fact that much suicide is impulsive doesn’t mean that all suicide is impulsive. The fact that some people might change their minds later, either spontaneously or as the result of a medical breakthrough, doesn’t – in my view – justify the state in requiring someone who doesn’t want to go on living to do so anyway.

And the right to die ought logically to include the right to seek help in dying from a willing helper. There’s not much that can be done to prevent suicide by someone sufficiently determined and capable (physically and psychologically) of acting without help; but when someone asks for help that creates the opportunity, by surrounding the act of helping with appropriate rules, to try to screen out the cases where the intention is impulsive.

Where I agree with Keith is in thinking that the helper should not be a physician (with some exceptions I’ll get to). Physicians have the social role of protecting life and health; getting them involved in killing those who aren’t dying creates too much role tension, given that in the vast majority of cases the goal ought to be prevention.

But the real reason not to get docs involved in assisted suicide is that their professional knowledge and skill are almost completely irrelevant to the task. A physician can provide (probabilistic) information about the subject’s current and likely future health status, including mental health. “Is my depression going to get any better?” is a question a psychiatrist can try to answer. But “Would I be better off dead?” isn’t a medical question, and therefore a medical professional has no qualification for offering an opinion.

Nor is a physician needed to provide technical help, except where the laws get in the way. A breathing mask or plastic bag plus a tank of nitrogen will kill someone reliably and painlessly, and a plumber is more likely than a physician to be able to provide the requisite equipment and aid in its use. “Physician-assisted suicide” is an artifact of a world in which suicide is illegal, and some of its more reliable means (opiates and barbiturates, for example) available only with medical approval. In the special case of death by intravenous injection, skilled help is necessary simply because most of us don’t know how to mainline, even if we had the equipment and the nerve. That makes the physician the natural helper for someone who is already dying and in intense physical pain; a lethal dose of morphine or its equivalent can be given without anyone explicitly asking for a lethal dose when nothing less than a lethal dose will stop the pain.

But in the cases Keith addresses – physically healthy people who want to die because they can’t see any end to the suffering from their life situations or their somatic or mental illnesses – I’d want to keep the doctors far away. Someone in that situation ought to be allowed to register his or her decision to stop living, and – after some waiting period and approval by an actual “death panel” based on the panel’s conclusion (perhaps having taken psychiatric or other medical advice) that the subject’s intention is serious and not merely impulsive, is not made under pressure from others, and that the reasons the subject offers for the decision are not likely to materially change in the near future – be allowed access to carry out his or her intention without interference, and with help from willing helpers.

Of course this is personal. I’m now at an age where I’m going through the deaths of older relatives and friends, and every year my age gets closer to theirs. Some live well to the very end, but by no means all. I can think, without pausing, of five people close to me whose lives would have been improved by a fatal stoke months or years before the Man with the Sickle eventually showed up. I’ve spent enough endless hours in nursing homes to be absolutely certain I want to die before I land in one.

Yes, I’m worried that permission to die could evolve into social pressure to die. (See Tom Schelling’s “Strategic Relationships in Dying.”) And of course your mileage may vary. If your moral or religious principles forbid suicide, no one should try to change your mind, and you shouldn’t have to be involved in helping anyone else. But none of that seems to me an adequate reason to force continued life on those who are tired of it.

Footnote I note that Arthur Caplan, whose exquisite ethical sensibility requires that people who want to live die instead unless they can get replacement kidneys in ways that Caplan finds acceptable, also holds that people who want to die should be required to live until Caplan is satisfied there’s no “slippery slope” nearby. Seventeen people will die today in the United States waiting for kidneys, but Caplan and friends have made sure that potential living donors (you can get along just fine on one kidney) can’t be compensated for donating, so the waiting lists just keep getting longer.

In the good old days, the people who told you that innovations to alleviate human suffering (vaccination, anaesthetic-assisted childbirth, contraception, IVF) were e-e-e-e-villll and must be forbidden by law were called “bishops.” Now they’re called “bioethicists.” This represents dis-improvement in two important ways: (1) Bishops had more impressive costumes; (2) The separation of church and state doesn’t work to keep the bioethicists from imposing their professionally hyperactive consciences on the rest of us, whether we agree with them or not.