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Are most (if not all) deaths to some extent “suicides”? One more time

I recently blogged on the following ridiculous (to me) quote from economist Gary Becker:

According to the economic approach, therefore, most (if not all!) deaths are to some extent “suicides” in the sense that they could have been postponed if more resources had been invested in prolonging life.

In my first entry I dealt with Becker’s idea pretty quickly and with a bit of mockery (“Sure, ‘counterintuitive’ is fine, but this seems to be going off the deep end . . .”), and my commenters had no problem with it. But then I updated with a more elaborate argument and discussion of how Becker could’ve ended up making such a silly-seeming (to me) statement, and the commenters here just blasted me. I haven’t had such a negative reaction from my blog readers since I made the mistake of saying that PC’s are better than Macs.

This got me thinking that sometimes a quick reaction is better than a more carefully thought-out analysis. But I also thought I’d take one more shot at explaining my reasoning and, more importantly, understanding where I might have gone astray. After all, if I can barely convince half the commenters at the sympathetic venue of my own blog, I must be doing something wrong!

OK, so, very quickly:

1. By referring to “most (if not all!) deaths,” I assume that Becker considers it a reasonable possibility that perhaps all deaths are “to some extent ‘suicides'” in his definition. But I don’t see how he can refer to a 4-year-old dying of cancer—or, for that matter, my grandmother dying of cancer at age 82—as a suicide. For the 4-year-old, it should be pretty clear that this kid didn’t have a lot of options. For my grandmother, who tried her best to live a healthy life and to get the best care when she was sick, I don’t see what Becker is saying. Not all aspects of life are fungible, and it’s not clear at all how the investment of “resources” (in Becker’s words) would’ve prolonged her life.

2. There’s a riddle that goes something like this:

A family has two dogs and three cats. If you call a dog a camel, how many camels does the family have?

The answer is zero. If you call a dog a camel, it’s still a dog.

That’s how I feel about Becker’s definition of “suicide” (from the dictionary, “the intentional taking of one’s own life”), I just don’t see what’s gained by calling Grandma’s death a suicide, and I can’t see what she was supposed to have done differently to have prolonged her life.

3. In my blog entry, I made a longer point that I think was misunderstood. I accept that in many cases, life could be prolonged by a shift in resources, for example taking fewer car drives, smoking less, and eating a healthier diet (whatever that means! There’s lots of debate on that one). Now take the thought experiment of a person who does everything that it takes to prolong life. Such a person will still die. More generally, people die from unexpected, unanticipatable causes all the time. Nonsmokers get cancer, health eaters get heart attacks, people die in (statistically unlikely) plane crashes. Commenters argued about how often such events occurred, but, again, my point is that they do occur, and, even if they occur less than 50% of the time, they’re not extremely rare either (recall my two grandmothers).

4. I think the best argument against all the stuff I’m saying is the meta-argument that Becker is so smart that he couldn’t be saying anything that stupid. Well, sure. I don’t think Becker thinks my grandmothers committed suicide. In fact, I’ll go one better and say that Becker doesn’t actually think that it’s possible that a reallocation of resources might prolong everyone’s life, or even almost everyone’s life. Becker was saying something provocative in order to get people to think. And I applaud him for that.

I was probably unfairly devaluing Becker’s statement because, as someone who works in decision analysis, I was already extremely familiar with his point. (Again, take a look at my papers with Phil on measurement and remediation for home radon, or section 6 of my article from 1998 on teaching the principles of decision analysis, where I painstakingly lead students to the inexorable conclusion that, yes, they do trade off dollars and lives, whether or not they want to admit it.) I was reading Becker as going beyond the conventional (and, in my opinion, correct) statement that many lives could be prolonged by a reallocation of resources (and thus people implicitly value other things along with lifespan) to a stronger statement about most if not all deaths being avoidable. This was unfair to Becker. I was being like the spoilsport who heckles a comedian because he’s heard his jokes before, not realizing that many people in the audience are new to the act.

Becker’s statement about suicide is true in the same way that I would say that much of Chris Rock’s routines are so, so true. You wouldn’t take Chris Rock literally, but he says things in a striking way that can cause you to rethink the familiar, and that was what Becker was doing for Stephen Dubner as well as many others.

And maybe that gives an insight into why my first, more lighthearted comment on Becker’s remarks were better received than my later, more serious exploration. To criticize a joke because it’s not literally true is to miss the point, and I further confused matters by not fully explaining that I agreed with the true parts of Becker’s statement. I do think that Becker’s over-the-top reasoning may have let him to miss some of the subtleties in his own argument (in particular, the idea that lifestyle changes that might save lives could have economic consequences that ultimately could cost lives), but, really, it’s hard to say, just given the quotes I’ve seen.

Beyond this, some commenters felt I was being insulting to Becker (and maybe to Dubner) by ascribing their mistakes to logical fallacies. Here, all I can say is that the nature of cognitive illusions and biases is that they affect us all (or, I suppose I should say, almost all of us) until they’re pointed out to us. I am subject to fallacies also, and I think it makes a lot of sense, if we disagree with someone, to try to understand where the disagreement is coming from.

P.S. Just kidding about the PC’s and Macs thing in the third paragraph above. I’m a blogger, not a troll!

18 Comments

  1. q says:

    interesting (or maybe not) how so many words can be shed before the eyes of so many intelligent people about definitions of words and about how rigidly to interpret the boundaries of categories. is this sort of thing fundamental and useful, or is it noise? can we tell?

  2. LemmusLemmus says:

    "the nature of cognitive illusions and biases is that they affect us all (or, I suppose I should say, almost all of us) until they're pointed out to us"

    I know that's not your main point, but I'm afraid biases often keep affecting us after they've been pointed out and we've accepted their being biases. Robin Hanson had a post on that a while ago, quoting research. If anyone's seriously interested, I could dig it out.

  3. I suspect it's epistemologically stupid to call these deaths "suicides", for the reasons you've articulated well in all three posts.

    "I do think that Becker's over-the-top reasoning may have let him to miss some of the subtleties in his own argument (in particular, the idea that lifestyle changes that might save lives could have economic consequences that ultimately could cost lives"

    That's not a subtelty, that's the meat of this discussion.

    I think it can be tough to disentangle hedonistic and altruistic activity (which arguably move the probability meter in the direction from lifespan maximization to suicide) from managing one's own mental health, social relationships, macrosocial coordinations, and capacity for self-control in order to maximize one's healthy lifespan.

    "Becker was saying something provocative in order to get people to think. And I applaud him for that."

    My intuition says we'd have done just fine without it. Although it would be provocative if in a follow up post Professor Becker claimed his previous remarks were an attempt to extinct humanity.

  4. Andrew Gelman says:

    Lemmus: Good point. What I should have said is that it's the nature of cognitive illusions and biases that, when they're pointed out to us, we recognize our mistake, but we are generally still prone to repeating the errors in the future when they appear in other guises.

  5. Andy says:

    Jeff Smith (economist at Michigan) has a nice response that neatly expands on the point Becker is making: here.

    I have to agree with Jeff that Becker's point, and its subtleties, seem completely obvious to me, but that's because I'm an economist!

  6. Andrew Gelman says:

    Andy: I don't think Jeff got the point that I understood Becker's point (and its subtleties) too! But I guess that's because I didn't make this clear myself…

  7. I just read (Professor?) Smith's response linked to by Andy and I wasn't impressed. There's something a bit obscurantist, a bit reaching for the creation of axiomatic ideologies in the way "All people are committing suicide" is being chosen as the sentence to communicate "Many people value other goals over maximization of their own lifespan". Not every thinker has this problem, at least not at this level of consistency -but a good number of economists seem to. Fundamentally, I think the problem is one or two levels of reduction more than is useful. I don't really care as much about the word suicide except for the degree to which it's obscurantist (but maybe it's because my Granny is still alive?)

    After reading some (weak) defenses, I'm glad Professor Gelman called out Professor Becker on this.

  8. Eric Rasmusen says:

    I missed the earlier discussion, but I think the fundamental difference between dying of alcoholism and suicide by gunshot is that the alcoholism death has negative price while the gunshot death has positive price. To die of alcoholism you drink lots of whisky, which you want to do anyway if you like drinking that much, so the death is just a bonus. To die of gunshot, you need to buy a gun, endure the thought of making a mess and the fear of pain: you have to exert effort to die.

    If you took away the dying, you'd still drink the whisky, but you wouldn't buy the gun and shoot yourself.

  9. William Ockham says:

    I think you give Becker way too much credit. Using his logic, most (if not all!) deaths are murder to the extent that someone else could have done something to prolong that life. No, wait! They are also executions since the government could have done something to prolong those lives. I've found Sarah Palin's death panels!

    To paraphrase Dickens' Mr. Bumble, if the economics approach supposes that, then the economics approach is an ass – an idiot.

  10. Thorfinn says:

    These points are all well taken, but even the extreme cases of elderly grandmas have an element of choice:

    http://online.wsj.com/article/SB12621358833930965

    People are trying to delay death for even a few days to avoid estate taxes. There are also huge efforts deployed to extend life close to death, as have been well-publicized lately as a cause of rising medical costs.

    Child cancer is trickier; but even here you see large variations in the effectiveness of different treatment teams. We could save more children's lives, or extend them further, if we really wanted.

  11. jonathan says:

    I skipped the blog posts between the first and this one, but at this end it's clear that you're now engaging Becker much more directly on the terms that he's defined. Using his semantics, I agree that his characterization is off unless one expands the concept of choice to such a degree that any action is made with full volition – so for example a person who dies in a car accident while drunk made a series of choices to get there but is it fair to say these were made with full volition when drinking (and maybe alcoholism, which has a number of complex causes) was involved?

    You highlight another area – when a person's choices end in death no matter what – so when a person with terminal lung cancer declines the utmost possible care because the pain / cost is not worth an extra day or week it isn't fair to say that's suicide without devaluing completely the notion of choice inherent in the semantics of the word suicide.

    Another area you could disagree with Becker while keeping his semantics is by focusing more on the "fullness" of choice. That you do something can mean you choose to do that but is that a meaningful definition when life and death is involved? If I get hit by a car while crossing in a crosswalk, does that mean I chose to walk, took the risks knowingly and thus committed suicide? That would turn the idea on its head. In blunt terms, a choice is most often only a choice in a narrow context. If I choose to run across a major freeway, we can say that degree of recklessness could amount to a suicidal choice but that wouldn't apply to the average accident. This concept, btw, has been well worked over by generations of legal scholars because the difference between choices defines liability for negligence versus gross negligence versus willful, as well as other issues of intent. In law, we assume a reasonable person and stick that person into the story to view the action under consideration in a reasonable context. If we stretch Becker's semantics, that would be equivalent to throwing out all the meaningful distinctions that determine liability and that's plain contrary both to human reason and to our cultural history.

  12. JF says:

    The quote is like the argument that there's no such thing as an unselfish act, because the actor receives something, a feeling of satisfaction, for instance. This redefines "selfish" so broadly that to say "there is no unselfish act" is equivalent to saying "people don't do things without a reason". It makes statements about selfishness vacuous, and it makes true selfishness amoral rather than immoral: if everything is selfish, nothing is.

    Of course, this is all in line with what you, Andrew, said in an earlier post, that saying "most (if not all!) deaths are to some extent 'suicides'" seems "like a way of getting oneself off the hook, morally speaking". The word "suicide" is so widely redefined as to become useless, or perhaps be used to classify immoral behavior as amoral.

    The definition of suicide includes intent. If a person shoots himself without intending to, that's an accident. If a person shoots himself intentionally, that's suicide. This key part is, of course, lost in the redefinition. Also for this reason, I think talking about tradeoffs is not directly to the point. We take actions for an intended goal and what are being called tradeoffs here are in fact side effects of taken action. To call the side effects tradeoffs under-differentiates them from the intended consequences.

    Most (if not all!) of this has been said in the original posts or in other comments, but I think this point is important. For determining suicide, the relevant consideration is not tradeoffs, statistically correct decisions, or life expectancy; it's intended consequences vs. side effects.

    Now, all of this is pertinent only if Becker really means suicide when he says "suicide". However, if he does not mean suicide, why use that word? Why use a word whose usual meaning is contrary to your intended meaning?

    (If you disagree with anything I've written here, it's because I don't mean these words in exactly the way you think I do.)

  13. Eva Bonin says:

    I think that you suffer from a particularly inability to understand the concept of marginality.

    What Becker means is very much along the example usually used to illustrate that the value of life is apparently not infinitely high. If it were, we would be willing to take zero risk of death, i.e. invest all our resources into the prevention of death.

    Traffic lights reduce the probability of having an accident. So why do we not have traffic lights everywhere? Because the impracticality of it (= a type of cost) outweighs the perceived benefit.

    We accept a non-zero risk of death because we prefer not to shift all resources to the prevention of death. I think his argument boils down to this, rather than to the question whether one should fly or drive to a family gathering.

  14. Andrew Gelman says:

    Eva: No, I understand the concept of marginality. But all the traffic lights in the world wouldn't have prevented my grandmother from dying of cancer.

  15. bxg says:

    To Eva (and others): I would recommend you use as working assumption that: the fact that we do not optimize resource allocation to extract every possible extra second of human life is obvious and trite to most people and doubly so to Gelman's readers. Becker himself state his claim comes "at a moment's thought"!

    I see the issue as the rhetoric: mostly "if not all!" and "suicide", and equally bad if not so much discssed "According to the economic approach, therefore". Dubner's article goes out of the way to praise Becker's writing and so it's a fair target to criticize Becker's language. And this is deeply AWFUL writing. E.g. It's not suicide in any sense at all unless the term is utterly redefined beyond all recognition (e.g. to remove: the fact that the person dying is making the relevant decisions, the fact that the person dying intends and wants to die, and more). So why "suicide" then: a pointless, misleading, rhetorical trick. And "if not all!"? Grant this as "almost all" and it's still absurd – and certainly so if you think about all the second order risks and implications of a given resource allocation (as Gelman states) but (contra Gelman) to even raise this valid point is to take the assertion more seriously than it deserves.

    There is another possibility. Arguably Becker is saying something actually interesting and deep. Something beyond me, seemingly beyond Gelman, to see. When commentators say things such as "the world is very much better off" to have Becker comment these things, I have to wonder if they are seeing something I don't. Someone cited Jeff Smith's counter-blog. Well, it seems Mr Smith doesn't seem anything interesting in Becker's quote either unless he's keeping it secret from us. (Mr Smith: I'm sure your rephrase of what you see as Becker's points are "completely obvious to [you]", as you say, but you should also take it as a strong default belief that your restatement are blindingly obvious to the rest of humanity as well.)
    Perhaps someone who understands how empty the surface restatement of Becker's quote is, but sees the deeper meaning that justifies the off-the-wall rhetoric, could explain?

  16. Dean Eckles says:

    The folk use of "intentionally" generally is seen as involving two conditions: knowledge and desire. Philosophers have puzzled over the difference between doing X and doing some Y such that X is a known side-effect of Y (see the doctrine of double effect).

    People's judgments of intentionality seem to be influenced by various factors that may have a moral component: Joshua Knobe argues (via some experiments) that people judge "bad" side-effects to be intentional more often.

  17. indrek says:

    Well, I think what Becker had in mind was that there are probably methods to extend even a cancer patients life for e.g. one day. In a sense we "choose" not to use these methods (and I am of course broadening the meaning of "choosing" here, as Becker was with "suicide"). So the argument in its broadest sense also applies to your grandmother.

  18. Andrew Gelman says:

    Indrek:

    1. I don't know that there was any way to extend my grandparents' lives. They died in their eighties, of various diseases.

    2. Many people die suddenly–run over by a bus, or whatever. As discussed above, I can't see how Becker's "most (if not all)" claim can make sense in this context. He might say that you could avoid being run over by a bus if you stayed at home, but then someone would still have to come and bring you your food, and they might get run over by a bus, etc.