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[These posts originally appeared on prawfsblawg.]

Saving Lives By Expanding Liberty

Precommitment Against Suicide (PAS)

People who fear suicide ought to be empowered to protect themselves. That is the core idea in my recently published article in the Boston College Law Review, Self-Defense Against Gun Suicide (pdf, no log-in required).

More specifically, my proposal is to allow individuals to confidentially put their own names into the federal background check system to prevent gun purchase during a suicidal crisis. There would be an option to change one’s mind and have one’s name removed after a delay period.

There are good reasons to think this proposal would save many lives:

● There were 21,175 firearm suicide deaths in the United States in 2013.

● Buying a gun is associated with an increased risk of suicide. One study found that the suicide rate among recent gun purchasers was 57 times the overall rate, which translates into hundreds of suicides each year.

● Most suicide attempts are impulsive. One study of survivors of firearm suicide attempts found that a majority had suicidal thoughts for less than a day.

● Some who had signed up for the proposal would probably attempt suicide without a firearm, but the other common means of attempting suicide are much less lethal.

● Surviving an attempt usually makes all the difference. The vast majority of suicide attempt survivors go on to die of something other than suicide.

Law professor Eugene Volokh doesn’t understand suicide

In his blog, Volokh wrote:

“[I]f you really want to commit suicide (and there’s good reason to think that people who use a gun to try to commit suicide — as opposed to, say, pills — really do want to commit suicide) but can’t get a gun, it’s not hard to find alternate reliable means of killing yourself.”

First, few people “really want to commit suicide” — -in the sense of having a strong, fixed desire to die. Most suicide attempters deliberate for mere minutes or hours. And the vast majority of survivors go on to die of something other than suicide. Presumably, Volokh would agree that people who jump from the Golden Gate Bridge also, in his terms, “really want to commit suicide” (given the lethality of this method), but one study of attempt survivors found that after a 26-year follow-up period 90% died of natural causes or were still alive. Suicide is generally impulsive. If someone has access to a gun, the impulse is almost always fatal. Even a short delay finding an “alternative reliable means” can make all the difference.

Volokh supports his quoted assertion with a 2004 report. Fair enough, but if he had updated his research, he might have discovered my co-authored article examining the impact of waiting periods and other purchase delays on suicide. Using state-level panel data for over two decades and controlling for a host of other variables, we find that purchase delays are associated with a significant reduction gun suicide with no evidence of substitution to non-gun suicide. And this is not just an isolated study. It has been well-established for many years that restricting access to lethal means is an effective way to reduce suicide (2006 JAMA review).

Does PAS violate the Second Amendment?

No. Law professors Ian Ayres at Yale (here) and Joseph Blocher at Duke (here) have both argued that the right to bear arms includes the right not to bear arms. Critically, my proposal is completely voluntary. The government is not taking away anyone’s right to buy a gun. Rather, the government is merely providing a new avenue for citizens to exercise their right not to buy a gun.

Here’s an excerpt from Ian’s endorsement of the proposal, titled “Libertarian Gun Control”: “Vars’s proposal is one that every card-carrying libertarian should endorse. It’s the kind of voluntary gun control that even the NRA can support — especially as it comes with self-chosen methods for subsequently removing yourself from the list.”

An explanation about the name removal options. There would be two, selected by the individual when signing up: (1) removal after a seven-day delay; or (2) removal after a judicial hearing finding no elevated suicide risk. These removal options negate Second Amendment challenges even for individuals whose waiver of the right to buy guns was not knowing and voluntary. If a person has an elevated risk of suicide, then a ban on firearm purchases is narrowly tailored to the compelling government interest in preventing suicide. A more complete explanation of the constitutional arguments appears in an article by me and Angela Selvaggio forthcoming in the Harvard Journal on Legislation (here).

Would anyone voluntarily give up their right to buy a gun?

Yes. Some of you may have known Cheryl Hanna, a professor at Vermont Law School. Cheryl bought a handgun and used it to kill herself the next day. Aged 48, she left behind a husband, two children, and a successful career. Hanna had been privately battling severe depression. She had twice voluntarily admitted herself to a hospital for psychiatric treatment. In doing so, she gave up much of her liberty in an effort to get better. One right she was not allowed to give up was her right to buy a gun.

“I think she would have signed up for this,” said her husband, Paul Henninge.

Cheryl is not alone. A suicide expert at UAB, psychiatrist Richard Shelton, has written: “Professor Fredrick Vars has proposed a simple and sensible alternative for people who have recurring periods of suicidal thinking: add their names to a gun ‘do not sell’ list. A natural first response might be ‘would anyone really do that?’ As a practicing psychiatrist I see suicidal people on a regular basis. Many of them readily agree to safety measures such as removing guns from their homes, committing themselves to a psychiatric hospital, and securing their medications to protect themselves. It seems likely that people will take the further step of blocking access to firearms in this way. A voluntary and confidential system of ‘opting out’ is a reasonable next step in reducing suicide deaths.”

For citations and further support, see www.StopGunSuicide.com.

Follow us at stopgunsuicide on Facebook and Twitter.

Please sign my petition at change.org.

 

[Originally published here]

STOP GUN SUICIDE

We should do more to help at-risk people prevent their own suicides.

Here is one way.

Jonathan Jacoves was described by his father as a “happy-go-lucky, pro tennis player.” That was before Jonathan’s mental health deteriorated. At age twenty, he attempted suicide by overdosing on nonprescription medication and was diagnosed with “major depressive disorder” “with suicidal potential and ideation.” Before being discharged from the hospital, Jonathan entered into a contract with his parents through which he agreed not to commit suicide for four months. Jonathan told a psychiatric aide about the agreement and that “he hoped he meant it, but doubted it.” Eleven days after his release from the hospital, Jonathan purchased a rifle from a sporting goods store and, that same day, used it to commit suicide. Jonathan is not alone.

Gun suicide in the United States is an epidemic: over 20,000 cases each year (58 people a day), which is about half of all suicides. Many suicides are completed with a recently purchased gun: one study found that the probability of suicide is 57 times higher among recent gun purchasers. There are, however, reasons for hope. Most suicide attempts are impulsive. The vast majority of people who attempt suicide and survive go on to die of something other than suicide. But those who attempt suicide with a firearm almost never survive. As many as 90% of suicide attempts using firearms are fatal. Given these statistics, it should not be surprising that reducing access to firearms, even temporarily, has been shown to reduce suicide.

Reducing access to firearms is admittedly controversial. Debates over gun control generally involve a trade-off between saving lives and preserving the right to bear arms. The two sides are entrenched and common ground is vanishingly slim. As long as the focus is on mandatory restrictions of gun rights, the trench warfare seems likely to continue for decades to come. But a new paradigm is possible — -one that bridges the gap by simultaneously promoting safety and liberty. Allow people who fear suicide to voluntarily restrict their own gun purchase rights.

I propose empowering individuals to prevent their own future gun purchases by confidentially submitting their names to the federal background check system. Once in the system participants would not be able to purchase firearms from licensed dealers. Participants could have their names removed after a seven-day delay or, if they choose greater protection up front, only after a judicial hearing. This proposal is termed “Precommitment Against Suicide,” or “PAS.” PAS is designed to stop individuals from purchasing a firearm in an impulsive suicide attempt.

PAS could well have saved Jonathan’s life. His elevated risk of suicide was apparent to everyone, including himself. Jonathan did not want to commit suicide, and even pledged not to, but he did not trust his own willpower. Had Jonathan been able to put his name into the federal background check system upon his discharge from the hospital, he would not have been able to purchase the deadly rifle less than two weeks later. He could have used an alternative method to attempt suicide, to be sure, but probably not one as lethal as a firearm. Under the proposed approach, Jonathan would have had to take additional steps to revoke his PAS before being allowed to purchase a gun, by which time the urge to commit suicide might have passed.

Given time, most people who attempt suicide change their minds. PAS would simply give more people this chance.

[Originally published here]

World Suicide Prevention Day

Today (9/10/15) is World Suicide Prevention Day. The theme this year is “Reaching Out and Saving Lives.” Human connections are indeed key to both prevention and healing. But empowering those at risk to protect themselves can fill gaps when friends and family can’t. That is the focus of the “Stop Gun Suicide” campaign I launched on this blog about a month ago: giving people the power to prevent their own impulsive gun suicides.

In the past month, I published a website, gathering information and references to support the idea. I have started a petition (click through to sign!), which has over 50 signatures so far. The idea was endorsed as “Libertarian Gun Control” by Yale law professor Ian Ayres at forbes.com. Some highlights:

“About 20,000 people kill themselves with handguns every year. Some of these people might, during moments of clarity, opt out of the ability to buy guns. There is every chance that Vars’s registry could save hundreds of lives each year — without causing a huge new bureaucracy, but merely by supplementing the national list that already exists.

“. . . The right to bear arms must certainly embrace the option not to bear them. And extending this right by giving citizens the right to pre-commit not to purchase firearms should be seen as enhancing our liberty. Vars’s proposal is one that every card-carrying libertarian should endorse. It’s the kind of voluntary gun control that even the NRA can support — especially as it comes with self-chosen methods for subsequently removing yourself from the list.”

OutdoorLife Magazine did not disagree in a blog post excerpting Ayres’s endorsement at length. Indeed, the website added this subtitle: “Law professor’s website addresses suicide by gun without imperiling rights.” Offering people another way to protect themselves could save lives without forcing anyone to give up their guns.

Banner art: John William Waterhouse, Ulysses and the Sirens (1891).  Ulysses ordered his men to tie him to the mast of his ship to resist the Sirens’ deadly song.