Meta-Criteria

There are several resources for methods, both online and in print. But how can one compare different methods? According to which criteria can the various methods be assessed?

This article surveys several documents and research papers which suggest such criteria (called "choice structuring properties" in the scientific literature [1][2]). We also contemplate on the properties a set of criteria should have if they are to be of practical use. Future method compilations may use this information to determine a set of criteria by which methods may be rated.

Research

Durkheim[3] was the first to recognize that psychological and cultural factors influence choice of method. As an example for cultural factors, Durkheim noted that Englishmen rarely hang themselves, perhaps because in England at that time, hanging was the traditional punishment for traitors and murderers.

A later, more detailed analysis[4] distinguished three determining factors in choice of method:

1. Availability or accessibility
2. Suggestion or infectiousness (there are many examples that public suicides cause an increase in the number of suicide).
3. Personal and symbolic factors.

The Golden Gate Bridge is a good example for the effect of both suggestion and symbolic factors [5]. A comparison was conducted between suicides committed by jumping from two different bridges: the Golden Gate Bridge and the Bay Bridge. Both bridges connect to San Francisco, they are close to each other and of approximately the same height. The Bay Bridge is about eight times longer and carries twice as much traffic, however, in the 40 years of operation of the bridges (from 1937), suicides from the Golden Gate Bridge outnumbered those from the Bay Bridge by more than five to one (671:121).

One explanation is accessibility. The Golden Gate Bridge is accessible to pedestrians, whereas the Bay Bridge is only open to vehicles. However, most of the suicides from the Golden Gate Bridge arrived by car. If we consider only such cases, still the number of suicides from the Golden Gate Bridge outnumbers the Bay Bridge by a little less than three to one. This suggests that there are additional important factors, beyond accessibility.

Part of the explanation for this is the Golden Gate suicides receive more publicity. [5] claimed that suicides from the Golden Gate bridge are romanticized as esthetically pleasing and beautiful. People who survived jumping the Golden Gate Bridge described it as a "suicide shrine", associated with death, grace, and beauty [6].

As for personal factors, these include many different concerns. Some individuals are concerned about the pain involved. Others, particularly women [7], fear of damage to their faces and bodies. Some may wish to conceal their suicide as an accident, for religious causes, or to assure insurance payments to relatives. Some may wish to use their suicide to punish others, whereas others may wish to minimize the amount of distress. All these considerations may influence choice of method.

A different partition of factors identifies five variables which explain why an individual has chosen a specific method[8]:

1. Its physical availability
2. The actor's knowledge of the method
3. The actor's familiarity with the method
4. The actor's personal or social accessibility to the method
5. The actor's evaluation of the method

The most detailed breakdown is given in [1][2] and contains the following 20 factors:

1. Availability (e.g., own a car?)
2. Familiarity with the method (e.g., car exhaust gases)
3. Technical skills needed (hanging, gassing)
4. Planning necessary (buy a gun, save up drugs)
5. Likely pain (cutting wrists)
6. "Courage" needed (high building, train)
7. Consequences of failure (disability, publicity)
8. Disfigurement after death (hanging versus overdose)
9. Danger/Inconvenience to others (car crash, subway leap)
10. Messiness/bloodiness (wrist cutting)
11. Discovery of body (by loved ones or strangers)
12. "Contamination" of nest (i.e., avoid home)
13. Scope for concealing or publicizing death - shame, insurance (car crash, drowning, subway leap)
14. Certainty of death (perceived/actual)
15. Time taken to die while conscious (poisons, wrist cutting)
16. Scope for second thoughts (swim back to shore, switch off gas)
17. Chances of intervention ("fate", estranged lover)
18. Symbolism (cleansing by fire, seppuku)
19. Masculine/feminine (e.g., guns)
20. Dramatic impact (lover's leap versus overdose)

Some of these factors are related to each other in practice (for example, most bloody methods may need courage). It is possible to group these factors under more general dimension of "opportunities" (1-4 on list), "costs" (5-13) and characteristics of various methods (14-20).

Note that some factors may be considered positive or negative according to the intention. For example, how item 8 affects the choice of method depends much on whether the individual wants to maximize or minimize the shock experienced by those who find the body.

Criteria in Method Documents

In the previous section we presented scientific research about criteria which influence the choice of method. However, several existing method compilations already provide criteria. In the following, we focus on explicit criteria which are mentioned for all methods, since this allows comparison of different methods.

Geo Stone's book[9] provides the following criteria:

1. Lethal Intent ( how appropriate the method is for people who do not really want to die, but rather just want to carry out a suicidal gesture)
2. Fatality rate
3. Permanent Injuries

However, implicit criteria are typically hidden inside method descriptions. Geo Stone includes a brief summary of the pros and cons of each method. From these summaries it is possible to extract additional criteria: Pain, Equipment required(for carrying out method), Knowledge required, strength/dexterity/skill required, Availability and accessibility, Time till loss of consciousness, Time till death, Determination required, Risk for injuring others, Reversibility (once a method has been started, can it be stopped easily? For example, jumping is not reversible, but using gas is reversible until loss of consciousness) , Revivability (if one is found after carrying out a method, what are the chances of revival?), Mobility required (e.g, can be done without leaving bed), State of cadaver and Familiarity of method.

The old ash methods file[10] explicitly mentions only the following criteria: Time, Available, Certainty.

The CoE Draft[11] the following rating format:

1. Availability/access -- How easy it is to achieve.
2. Experience/symptoms -- What it will feel like. Ability to induce loss of consciousness and death without causing pain, distress, anxiety, or apprehension.
3. Duration (pain/death) -- how long it will take to die. Time required to induce unconsciousness.
4. Efficacy -- how sure we can be it'll work. Age and body limitations.
5. Collateral damage -- What other damage might be done.
6. Dosage/equipment -- What items are needed.
7. Skills/expertise -- What we need to know how to do.
8. Myths/inaccuracies -- False stories about it.

Another CoE document, specifically addressing criteria, suggests that a good method should satisfy the following criteria:

1. Quick
2. Painless
3. Certain
4. Discreet (low risk of other people detecting an attempt)
5. Safe (to other people...)
6. Accessible
7. Tidy (similar to messiness)

A Useful Set of Criteria

A set of criteria could be useful for individuals who wish to evaluate methods. The criteria mentioned above can raise awareness to factors which are not usually considered. However, in many cases it is up to the individual to actually evaluate the criteria for a specific method (for example, how available is a shotgun), since many criteria are either difficult to evaluate, or their evaluation is subjective.

The rest of this article considers a different application. Method compilations can use a predetermined set of criteria to evaluate and compare different methods. Furthermore, if different authors adopt the same set of criteria, which are graded according to a scale, this can help in comparing methods which have been researched by different authors.

Previously we have mentioned numerous possible criteria. However, the set of criteria should be as small as possible. A large set of criteria would burden method compilation authors, since accurately rating methods according to criteria is a daunting task. In addition, too many criteria can also confuse readers.

So, even though any of the previously mentioned criteria may have impact on choice of method, we will only include criteria which may reasonably have impact on choice of method for most people. The following sections eliminate criteria and explain exactly why.

Elimination: Subjective and Unconscious Criteria

When evaluating a method for a method compilation, according to a specific criteria, the author needs to able to evaluate the criteria in a way which would apply to all readers. To do this, the author has to know that something applies to all people, for example, that all people would find drowning painful.

"Subjective" criteria are problematic since they are evaluated differently for each individual. Each individual can only know about his own evaluation. In "unconscious" criteria, the individual may not even be able to evaluate the criteria for himself, since the individual is not aware of facets which effect such evaluation. In both cases, a method compilation author cannot evaluate such criteria.

Suggestion, infectiousness, and symbolic factors are either unconscious or subjective. Their evaluation varies considerably for different people, thus they cannot be used for a method compilation.

"Availability" is also subjective. For example, guns are available in the USA, but not in Europe. So it is left for the individual to determine which methods are available to him and limit consideration only to them.

Elimination: Independence

We should try to make the set of criteria independent, i.e., that , there is no correlation between the ratings of two different criteria (for the same method). The existence of correlation implies redundancy, i.e., that the two criteria are identical or overlap. In such cases one of the criteria should be eliminated or redefined.

For example, the criteria of "Masculine/feminine" is related (i.e., not independent) to several other criteria such as courage required, and state of body. These other criteria can define whether a method is masculine of feminine. For example, methods which require more courage are more messy and masculine (guns) whereas those requiring little courage and are not messy are feminine (drugs). So the criteria "Masculine/Feminine" can be eliminated.

Elimination: a Unique Audience

The audience of a method compilation is very different then the people who are considered in most research about suicide. Simply reading about methods implies that the reader is knowledgeable about them (at least after finishing to read) and that the reader is willing to make some effort in planning. For example, most people are not knowledgeable about methods. Also, researchers put more emphasis on opportunistic factors, whereas we are more likely to assume that people who read a method compilation are willing to plan in order to create opportunities rather than wait for them to occur.

For this reason, the criteria of "Knowledge of method" is not relevant to our audience. We can assume that readers are knowledgeable.

Also the criteria of "Planning" (including Equipment required, Familiarity with the method, Accessibility ) is not needed since we assume that readers are willing to invest in planning, and therefore, the criteria is of little importance.

Note that we distinguish between availability and accessibility. A method is available for a person if it is possible for that person to use the method. A method is more accessible if there are more opportunities to carry it out. For example, jumping from a high place is a method which is available almost to everybody. However, if one lives in a rural area with no high places then it may require some planning in order to travel to a place where such a method could be carried out. For a person living in such a place, jumping is available but not very accessible. Typically, the less accessible a method is, the more planning is required to carry it out.

Elimination: Pro-Choice

Some criteria are likely to be used in ways which go against our values. For example, some criteria can be used to exploit and increase society's disapproval of suicide.

The criteria of "Lethal intent" appears in Geo Stone's book. Geo Stone wanted to help people who are trying to make a suicidal gesture, i.e., they do not intend to commit suicide, rather they only want the attention which follows the attempt. However, such motives seems to counter the values of ASH. The intention of a suicidal gesture is to shock, using and re-enforcing society's rejection of suicide, whereas ASH wishes society to accept suicide. A suicidal gesture is a message to relatives saying: "look what a terrible thing you made me do!". This message emphasizes that suicide is terrible and wrong, which is exactly what ASH is working against. Assisting suicidal gestures would be hypocritical of us.

Another problem with the criteria of "Lethal intent" is that it is not obvious that it is conscious. I believe (perhaps wrongly) that people who wind up committing a suicidal gesture really intended to commit suicide, however ambivalence and other factors such as wanting attention, to which the actor is not consciously aware, come into play, affecting the choice of method to one which is not likely to result in death.

Similar problems occurs with the criteria such as "Scope for publicizing" or "Dramatic impact". It seems that these are more likely to be used to increase dramatic impact. Again, this goes against what ash stands for.

Elimination: Too Detailed Criteria

Some criteria have more effect on some aspect of how a specific method is carried out, and less impact on the actual choice of method.

For example, consider the criteria "Contamination of nest", most methods which can be carried out at home can also be done somewhere else, like a hotel room. It seems that this criteria is more about a specific detail of how the method is to be carried out rather than affecting the choice of method. The criteria "Discovery of body" (by loved ones or strangers) is eliminated for similar reasons.

Although "Danger/Inconvenience to others" is of great importance, in practice it is possible to carry out most methods without danger to others. Jumping could be done in a time of day or location so as no people are in danger. Even a car crash could be done against some obstacle on an empty road. Perhaps an exception to this is the method of leaping in front of a subway, which would cause inconvenience to the driver. However, since this is the only case where the method must inconvenience to others, we exclude this factor in order to obtain a small set of criteria.

Criteria of "Symbolism" and "infectiousness" effect the choice of location where others have committed suicide, but perhaps have no effect on the chosen method. Symbolism affected people to jump from the Golden Gate Bridge, however, it may have had no affect on their chosen method: jumping.

The Remaining Criteria

The remaining criteria are grouped and ordered according to when they come into play within the course of a suicide scenario.

Starting with criteria which are grouped in [2] as "opportunities", The Technical skills takes into account the strength, dexterity, expertise and mobility required to carry out a method. This is especially important for people who are ill or with disabilities.

A criteria which is in a group of its own is the Resolve ( Courage needed / determination) required to carry out the method: This takes into account the Reversibility (scope for second thoughts) and Messiness/bloodiness of the method.

The third group measures the effects of method execution during its progress: Time till loss of consciousness and Pain.

The fourth group of criteria attempt to quantify probabilities for success of the method:

• Reliability (i.e. Fatality rate)
• Chances of Intervention. Takes into account time till death and revivability ( degree to which revival is possible if found ).

The fifth group relates to consequences of the Outcome, whether success of failure.

Outcome Success:

• Disfigurement after death (includes messiness/bloodiness)
• Scope for concealing suicide

Outcome Failure:

• Consequences of failure (Permanent injury, publicity)

Conclusion

There is much room for additional consideration of the remaining criteria. It might be desirable to eliminate more of them. For example the criteria of Technical skill and those mentioned for the outcome of success, seems to be of marginal importance. Also, it is not obvious whether publicity of a method should be taken into account in the Outcome failure group of criteria.

Omitting these would leave the following criteria:

1. Resolve
2. Time
3. Pain
4. Reliability
5. Chance of Intervention
6. Consequences of failure (permanent injury)

Another issue of concern is that different criteria may require different measurements. For example, Reliability can be given in percentage of success. This is a number which has a wide range. However, the possibility of permanent injury might require a limited range. Perhaps even just a Yes/No value.

Finally, another problem not considered, is that in spite of the importance of some criteria, it may be impossible to measure them for some or most methods.

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REFERENCES

[1] Cornish D.B. and Clark R.V. "Crime specialization, crime displacement and rational choice theory", In H. Wegner, F. Losel and J. Haish (eds), Criminal behavior and the justice system: Psychological perspectives, New York: Springer-Verlag, 1989.

[2] Clark R.V. and D. Lester, "Suicide: closing the exits", New York: Springer-Verlag, 1989.

[3] Durkheim E. , "Le suicide", Paris: Alcan, 1987.

[4] Dublin L. , "Suicide: A sociological and statistical study", New York: Ronald Press, 1963.

[5] Seiden R. H. and Spence M. "A tale of two bridges", Omega, 1983-1984, pp 201-209.

[6] Rosen D. H. "Suicide survivors: A follow-up study of persons who survived jumping the Golden Gate and San Francisco-Oakland Bay Bridges", Western Journal of Medicine, 1975, 122 pp 289-294.

[7] Marks A. "Sex differences and their effect upon cultural evaluations of methods of self-destruction", Omega, 1977, 8, pp 65-70.

[8] Marks A. and Abernathy T. , "Towards a social-cultural perspective on means of self destruction", Life Threatening Behavior, 1974, 4, pp 3-17.

[9] Geo Stone, "Suicide and Attempted Suicide: Methods and Consequences", 1999.

[10] Ash methods file, 1993, http://ash.xanthia.com/methods.html

[11] Boboroshi, A Practical Guide to Suicide, http://www.satanservice.org/coe/suicide/guide/

[12] How to kill yourself a meta-guide, http://www.satanservice.org/coe/suicide/metaguide.html

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