Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com.

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Dear Dan,

I know that you’re turning 50 this year. How are you handling the big milestone?

—Abigail 

As you can imagine, I was rather apprehensive about my 50th birthday, but I decided to embrace it and designed my year with some extra time to reflect.

In fact, I am writing to you from the sixth day of a 30-day hike along the Israel National Trail, which spans the country of my birth from Eilat to the Lebanese border. I wanted to disconnect from technology and have more time to think about what I want from life and want to do next. Six days in, checking email only late at night, I’m already in a more relaxed and contemplative mode.

I also designed the hike to help me think about earlier stages in my life. So for each day along the trail, I have invited family and old friends to join me to walk and reflect on the road behind. I’ve just finished a day of hiking with six friends from first grade, and talking about our joint history and deep friendships made me calmer than I could have imagined.

Sure, I’m a bit worried about aging. But so far, taking myself out of the usual hurly-burly and opening up space to reconnect with loved ones is proving to be an amazing antidote to the 50th blues.

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Dear Dan,

How do people recover from horrible injuries, psychological traumas and other life-altering events? Is it character or circumstances that dictate whether people crumble or rebound?

—Lionel 

My sense, as someone who suffered very serious injuries as a teenager, is that the answer is both. Resilience is surely a function of one’s character and level of support, but it also has to do with the circumstances of the injury.

One of the most interesting lessons we have learned on this subject comes from Henry K. Beecher, the late physician and ethicist. In his 1956 study of pain in military veterans and civilians, Beecher showed how important it is to understand how people interpret the meaning of their injuries. These interpretations, he argued, can shape the way we experience trauma and pain.

Beecher found that veterans rated their pain less intensely than did civilians with comparable wounds. When 83% of civilians wanted to take a narcotic to manage their pain, he found, only 32% of veterans opted to do likewise.

These differences depended not on the severity of the wound but on how individuals experienced them. Veterans tended to wear injuries as a badge of honor and patriotism; civilians were more likely to see injuries just as unfortunate events that befell them. The more we interpret events as the outcome of something that we did, rather than something done to us, the better our attitude and recovery.

This lesson, while very important for traumatic injuries, also applies to the small bumps of daily life.

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Dear Dan,

My relationship with my husband is going downhill, and I can’t stop thinking about it—which is putting an added strain on our marriage. What can I do?

—Rachel 

Trying not to think about something is one of the best ways to ensure that you think about it constantly. If you try not to think about polar bears for the next 10 minutes, you will think more about them in those 10 minutes than you have in the past 10 years.

The same is true for your relationship with your husband. Instead of trying not to think about your marital woes, try reflecting on the good things in your relationship—then try to find activities together that will strengthen your bond. Good luck.

See the original article in the Wall Street Journal here.

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com.

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Dear Dan,

I always agonize this time of year over getting the right gift for my children’s teachers. I hate gift certificates, which feel so thoughtless and generic. So what should I give?

—Raquel 

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Dear Dan,

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Dear Dan,

As we enter December, I wonder whether I should make any New Year’s resolutions. I have been making them for years, and I inevitably fail to keep them, which is pretty frustrating. Should I give up or give it another go?

—Jamie 

Don’t give up. Even if you stick to your resolution for, say, three or six months, you will be better off than you would have been if you had done nothing. And you might do better if you make New Year’s resolutions that are more limited and achievable. For example, what if instead of promising yourself that you will exercise three times a week for the whole year, you pledged just to work out for six weeks? That goal would be far easier to grasp, and maybe by the time you reach it, you will want to keep going.

See the original article in the Wall Street Journal here.

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com.

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Dear Dan,

I live with several roommates, and our landlord ­recently refunded some of our rent to make up for construction-related hassles in the building. What should we do with the ­money? We could divide it among ourselves, use it for house supplies or get a bigger TV to watch movies together. How should we think about this?

—Kristen 

I vote for doing something fun with the windfall—ideally something that would let all the roommates have a new experience together. Your relationships with each other are, I suspect, the biggest contributing factor to your happiness (or misery) at home: When they are good, life smiles on you, and when they are bad, you probably tend to stay out as much as possible.

Doing some activity together—say, sailing, skydiving or learning a new skill—would bring all of you closer and encourage you to be nicer to each other. You would ordinarily have a hard time asking everyone to chip in for an expensive group activity; after all, you are roommates, not standard friends.

But a refund from your landlord should feel more like free money—cash that no one planned on having and that everyone can probably manage without. That should make it easier to persuade your roommates to partake in some group-bonding activity.

Looking for the ideal skill to learn together? I would suggest a cooking class. You’ll not only have fun learning something new, but you’ll also enjoy better food—and perhaps the joy of cooking for each other for a long time.

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Dear Dan,

It has increasingly struck me that humans feel pain much more intensely than pleasure. Is this true, and is there a reason why pain affects us more?

—Brian 

Yes, we do experience pain much more intensely, which makes sense from an evolutionary perspective. In general, nature wants to teach us to seek things that are good for us or the species (food, warmth, sex), so these give us pleasure. Nature also wants us to stay away from dangerous things (predators, toxins, fire), so these give us pain.

One might imagine that the things nature wants us to seek would give us pleasure, while the things that we should avoid would leave us feeling neutral. But the benefits and harms of life aren’t symmetrical. A good outcome (a delicious piece of fruit, for example) can give us some modest benefit, but a bad outcome (say, poison) can kill us—which is a very significant downside.

If the evolutionary priority for us is to seek good outcomes but especially to avoid bad ones, then our tendency to focus on pain (and potential pain) is a pretty effective way to shape our behavior. Even during painful times, I’ve found that a somewhat comforting thought.

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Dear Dan,

A friend of mine from work is turning 45. What should I get him?

—Janet 

If he doesn’t have reading glasses, get him a pair. People generally delay getting reading glasses, because it is hard to recognize the slow deterioration of our vision and because it means admitting that we are aging. If you give your friend a pair, you will spare him the procrastination, and he will immediately realize that he has been living in a blurry world. He might not immediately feel deep appreciation, but it would still be a very helpful present.

See the original article in the Wall Street Journal here.

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com.

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Dear Dan,

We recently invited two couples to spend the weekend with us at our cabin. We have two guest bedrooms, one larger and more comfortable than the other. When the first couple showed up, we suggested that they wait until the other couple arrived to discuss who would get which room or perhaps to toss a coin. But the first couple said that, since they had arrived first, they deserved the better room. I disagreed but didn’t want to argue, so they ended up taking the larger bedroom. Were they right to argue that taking the better room was fair?

—Shimon 

The first couple demonstrated what’s commonly known as “motivated reasoning.” There are many possible rules of fairness: first-come-first-served, weighing needs, flipping a coin and so on. For self-serving reasons, this couple adopted the first-come-first-served approach, and instead of simply admitting that they wanted the larger room, they justified their selfishness by advocating a fairness rule that happened to lead to their preferred outcome.

But you didn’t announce the first-come-first-served rule in advance, so it isn’t fair to use it: The other couple didn’t know that they were in a competition. Because both couples are your friends, I wouldn’t have used any fairness rule that depended on human judgment about who’s more deserving. Better just to toss a coin. Next time, it would be better to announce in advance the fairness rule that you want to use.

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Dear Dan,

I’ve been struggling recently to understand why childbirth is so painful. In principle, I suspect, nature could have made childbirth painless—so why did it “choose” to make it agonizing? Your research shows that the more labor we put into things, the more we love them. Could that explain why nature choose this approach—simply to make mothers value their children more?

—Tom 

I’ll leave the evolutionary biology to others, but my research group’s findings are indeed consistent with your interpretation: The more one is involved with creating something and the more difficult and complex the task, the more we end up loving it. We call this the IKEA effect, because of people’s increased pride in furniture they’ve put together from a kit. But Mother Nature seems not to have fully read our work: We found that just a bit of involvement would achieve the IKEA effect, so much less pain at childbirth would have sufficed.

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Dear Dan,

My son just turned 13, and he and his friends are starting to dare each other to do all kinds of stupid things. Some dares involve eating very spicy or disgusting foods; others involve jumping from high places; some involve asking girls out. I don’t get it. Why would someone suddenly be willing to do something just because the word “dare” is invoked?

—Manny 

Let’s consider two different types of dare. The first type is meant to help the person carrying it out. Imagine, for example, that your son has a crush on a girl but is too shy to tell her. If his friends dared him to ask her out, the social embarrassment would decline, and your son might be prodded into getting a fun date.

But there is a second type of dare—for instance, goading someone to eat jalapeño peppers or to jump off a wall. This category isn’t about the immediate well-being of the person doing the dare; it is about his or her place in a social hierarchy. The more impressive the dare, the higher their social status rises.

I hope that this helps you to see some of the beauty of dares—and maybe even to try out a double-dare yourself.

See the original article in the Wall Street Journal here.

In 1984, as a 17-year-old high-school student in Israel, I was a member of a youth movement that focused on study, civic work and preparation for military service. Our graduation ceremonies often featured big fires, intended to dramatize our patriotic fervor. That year, some of our leaders had brought back military supplies to help make the blaze especially intense.

One Friday afternoon, as we began putting away these materials, there was an accident. Nobody knows exactly what happened, but a spark must have been struck somewhere. A large magnesium flare—the kind that the Israeli military uses to light up a battlefield—exploded right next to me. In a moment, I was engulfed by flames.

The fire nearly killed me. About 70% of my body was covered in third-degree burns. In a matter of seconds, my life had changed irreversibly. Looking back now, more than three decades later, I realize that my awful new situation had one unexpected and positive effect: It began my career as a serious observer of the peculiarities of human behavior.

The explosion marked the start of a three-year period of hospitalization and surgeries—first in the emergency department of Beilinson Hospital, then in Tel Hashomer Hospital, both near Tel Aviv. I’ll never forget the day, perhaps four months after my injury, when I first saw myself in a full-length mirror. Before the accident, I had been a decent-looking teenager. But that day, I saw something completely different. My eyes were pulled severely to the side. The right side of my mouth and my nose were both charred and distorted. So was my right ear.

Was this really me? It was hard to see, believe or accept. Why was I still here? What would my future be, looking like this?

The burns and their treatment caused me extreme pain over a long period—a kind of pain that is more intense and lasting than almost any other medical condition. But since I had little else to do and badly needed distraction, I began to notice and record things.

For example, every day, I had to have a soaking bath that involved removing my bandages and scraping off my dead skin and flesh. The nurses would rip off the dressings all at once, without a break. It was excruciating, but the nurses insisted that tearing the bandages off was the best way.

One day, one of the nurses allowed me a bit of control over the process, and I found the treatment somewhat more tolerable. This made me wonder if having more control over the process would be better in general, but given my helpless position, I had little influence over the way I was treated.

After years of treatment, I left the hospital and went to Tel Aviv University. I decided to study psychology. My harrowing years had left me deeply interested in understanding how we experience pain and in the experimental method.

So I carried out laboratory experiments on myself, my friends and volunteers, using moderate (and safe) physical pain induced by heat, cold water, pressure and loud sounds—even the psychological pain of losing money in the stock market—to probe for answers. I learned that there are better and worse ways to deliver pain—and that my nurses’ methods hadn’t been the best ones. (One should remove the bandages slowly, not rip them off, and one should start from the most painful parts, then move toward the least.) If my nurses, despite all their experience with burn victims, had erred in treating the patients they cared so much about, other professionals might also be misunderstanding the consequences of their behaviors and make poor decisions.

Soon, I found, my personal and professional lives had become intertwined. For years, I felt the burden of my scars: the unending pain, the odd-looking medical braces, the pressure bandages that covered me from head to toe, the feeling of having gone through some kind of weird door and of living separately from the day-to-day experiences of my previous self and other “normal” people. I’d become an observer of my own life, as if I were watching an experiment on someone else—and I looked anew at other people as well.

This new approach became central to my work. Remembering the placebos given instead of medications during some treatments, I conducted experiments to explore the effects of expectations on painful treatments. (They can dramatically change our experiences—and even the intensity of the pain we feel.) Remembering how it felt to be given difficult information in the hospital, I tried to figure out how best to break bad news to patients. (Slowly, and in steps.) I kept finding topics that crossed the personal/professional boundary, and over time, I learned more about my own decisions and the behavior of those around me.

I saw people who managed their suffering and triumphed, and I saw others who caved in to fear and terror. I tried to take apart mundane daily activities—about why we shop, drive, volunteer, interact with co-workers, take risks, fight and behave thoughtlessly. And I couldn’t help noticing the intricate fibers that entwine our romantic life. (Fortunately, I never lost my sense of humor.)

All these questions began to weave their way into my research. I grew increasingly adept at observing how people went about their daily lives, prone to wonder about human habits, eager to explore the reasons for our behavior and motivated to find ways to make us behave slightly better.

My accident happened more than 30 years ago, and if any good came out of it, maybe it is this: I like to believe that the disaster and its aftereffects made me better able to understand myself and others. Maybe I’m rationalizing. We human beings do that exceptionally well: By trying to see something awful in a more positive light, we’re able to make sense of it, or at least make it more tolerable.

After years of writing scholarly papers on these topics, I started writing about my research and its implications in a more conversational, less academic way. And perhaps because I described how my research grew out of my own struggles, many people started sharing their personal challenges with me. With experience (warning: second rationalization coming), I got better at answering their questions. And I would like to believe that my advice was even helpful sometimes.

Don’t get me wrong: I don’t think that my injury was worth it. I have spent every day of my adult years in varying degrees of pain. I have endured, over and over, the dysfunction of the medical system. I have been exposed to an astonishing number of medical procedures and odd human interactions. I am more comfortable in public these days, but my scars still make me feel out of place in most social circumstances.

But—whether I’m rationalizing or not—I did learn important lessons from my injury, my time in the hospital, the years that followed, the research that emerged from my ordeal, and the questions and challenges that people have shared with me over the years. These have become my microscope on life.

My latest book, Irrationally Yours, which is based on my Wall Street Journal column “Ask Ariely,” was recently published by HarperCollins. See this article on the WSJ here.

As some of you might know, in addition to the general problem we all have with email overload, my specific issues are exacerbated by my disability (mostly limitations to moving my hands and some pain). I am not pointing my disability out to complain, but I do think that sometimes disabilities can act as a magnifying glass, letting us focus with more intensity on a problem we all have.  And I think that email overload is one of these problems

One of the main reasons for email overload is that email has become the one gateway for many different types of communications. We get email that are quick questions from co-workers, communications with family members and friends, mass communications, things we need to act on now, things that just keep us informed, invitations, discussions, and of course a lot of things we are not interested in.

With these various types of communications flooding one place—our inbox—and often interrupting us throughout our workday, is it any wonder that we feel frustrated and unproductive? That we are developing a collective ADHD, and that people look forward to sitting in an uncomfortable chair for a long time during flights just because there is no internet and no source for distraction (of course more and more flights are losing this advantage).

While complaining about email one day over breakfast with Dominik Grolimund—we came up with one partial solution to this problem: Why not ask the people who write email to be a bit more explicit about the type of email that they are sending and use this classification to redirect the email at the client side?  This way email will will behave differently based on its purpose and origin.

We used me as a case study, Dominik created the system, and I started asking people to email me using http://shortwhale.com/danariely by linking to it on my website and using it in my email signature.

Using this system I inform people how I prefer to get my email, I provide links to my online schedule, and I answer some questions I am most often asked. Most importantly, this simple contact form asks those who write me to choose their request type from a menu, the timeframe they want a response by, and if they need a response at all. With this classification system on the front end, my own email makes more sense and is less distracting. In my email client (Apple Mail) I have filters that redirect the email based on these tags and their requested timeframe.  For example, urgent emails appear in red in my inbox, while email that require a response by the end of the week find their way into a folder with that name. This sorting procedure allows me to stop my workday only to deal with important and urgent requests, and keep the rest of the email for the evening, weekend, downtime, and flight delays.

What has been incredibly satisfying about using Shortwhale for a few months is that it improves my use of time and it helps me respond more effectively to more people. After using Shortwhale for a while it was interesting to discover that the number of emails that are tagged “no response necessary” is rather large, and on top of this, I have also learned that a lot of people are happy to wait a week or even a month for an answer. Another feature of Shortwhale is that it allows people to easily create multiple choices within the email, and I find that providing people with this opportunity helps them get right to the point and saves me time.

Underlying all of this is the idea that while we we call a lot of things email, there are, in fact, different types of email and they each serve different purposes. The different types of email have different levels of importance, and we need to figure out how to differentially interact with them if we don’t want to continuously stop everything to check our inbox.

It is true that as it stands now, Shortwhale puts more demands on the sender. However, I think that the gains on the receiver’s side, coupled with the ability to respond quickly more than compensate for this extra initial hassle.

And, if you are under heavy email load, I’d love to hear what you think about this. You can contact me on Shortwhale 🙂

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com.

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Dear Dan,

I waste about two hours each day playing stupid games on my iPhone. It feels so innocent, but it actually makes me lose focus at work and takes up time I should be spending with my wife and kids. Do you have an idea for how I can ditch this bad habit?

—Arianna

One way to fight bad habits is to create rules. When you start a diet, for example, you can set yourself a rule such as “I won’t drink sugary beverages.” But to be effective, rules need to be clear and well defined. For example, a rule such as “I will drink only one glass of wine a day” is unlikely to work. With this type of rule, it is not clear what size of glass we are talking about, or if we can drink more today and reduce our drinking next week. In essence, if the rule is not clear-cut and unequivocal, we are likely to break it while deceiving ourselves that we are actually following it.

In your case, you could decide that, from now, on you won’t be playing the iPhone between 6 a.m. and 9 p.m. And to help you follow this rule, you should let your loved ones know. Or you could set up game bans for weekdays or working hours. Good luck.

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Dear Dan,

I am in middle school, and there is one topic in school I really love and one I really dislike. There is also one teacher I really love and one teacher I am not very excited with. Would I be better off if the teacher I love taught the topic I love, and the duller teacher taught the topic I dislike? Or would I be better off if the teacher I love taught the topic I dislike, and the duller teacher taught the topic I love?

—Tima

What you are really asking me about is the accumulation of pleasure and pain. On the one hand, you might argue that having one class with a great teacher and a great topic, and one class with nothing going for it, would give you at least one class to look forward to. You might also argue that, if a class isn’t going to be good, it doesn’t really matter how bad it is—adding a good teacher to a bad topic, for example, wouldn’t help much.

On the other hand, you might argue that a class with a bad teacher and a bad topic is going to be too much to bear. In this case, the combined pain might pass your tolerance threshold and color the entire semester.

I should say, first, that I am delighted you like some of your teachers and topics, and I don’t want you to stop thinking of school as joyful. But I do think that the mixing approach would be better for you.

I suspect that having a class with a bad teacher and a bad topic will be too much for you to handle. And I suspect that in the class with the teacher you love and the topic you don’t, you will learn to focus on the teacher and pay less attention to the topic, while in the class with the teacher you dislike and the topic you love, you will learn to focus on the material and pay less attention to the teacher.

I wish you many years of joyful (or at least not torturous) learning.

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Dear Dan,

What do you think is the best psychological approach to getting over a girlfriend? Should you cut off seeing her completely? Continue getting together for coffee, etc.?

—Jason

I suggest that you cut it off completely. Meeting an old girlfriend over and over, while wondering if you should have ended things or not, is just going to prolong the pain—and without any real value.

See the original article in the Wall Street Journal here.

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com.

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Dear Dan,

As you creep along in a traffic jam, someone inevitably tries to enter your lane from the side. Now here is the issue: If I let the car in, I feel good about it. But when I see others in front of me let someone in, I feel cheated, because I’ve been waiting longer than the car entering the lane, and I am upset with the driver who acted kindly at my expense. Any idea why I feel so different about these two situations?

—Walt

The issues here are control and credit. When you let someone into your lane, you’re the one making the decision—and you’re the one getting the nod or the hand-wave as an expression of gratitude. In contrast, if someone else is letting the needy car in, you have no control over the decision, and you’re not getting the credit—you only see the downside of the increased delay.

Consider a more moderate version of this case, one where you simply keep a large distance between you and the car in front of you. By doing this, you’re allowing the cars from the merging lane to come into your lane at will, but it doesn’t require a separate act of generosity on your part (you aren’t slowing down to let them in).

My guess is that this version of accommodating other drivers also would not feel very good for you, not to mention that you’re not going to get any credit for your kindness.

What‘s the conclusion? First, to feel good about the good fortune of someone else, we need to feel that the positive outcome is a result of our own actions. Second, we want other people to recognize how wonderful and helpful we are.

Still, given how many other people are stuck in traffic ahead of you and that they’ll keep on letting other cars merge, maybe you should start thinking that real altruism consists of allowing good things to happen both directly and indirectly—and even when other people are getting the credit for it. Taking this attitude won’t be easy, but if you manage it, good things will follow.

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Dear Dan,

I’m reading your book “The Upside of Irrationality.” As I read your description of the burn injuries you suffered as a teenager, I wondered the following: If you and I were ever to meet, and we shook hands, would it hurt you? My own hand was injured many years ago, and people can cause me pain by squeezing it when shaking. Basically, I worry when shaking hands with a new person. Do you have a similar worry? How would you like people to shake your hand? 

—Donni 

For me, the question of shaking hands is a mix of potential pain and the feeling that I am not part of normal society. If people shake my hand too strongly, it is painful, and if they shake too loosely, it reminds me of my injury and how I am still perceived by the outside world as someone who looks different. With this trade-off in mind, I prefer that people shake my hand, even if it causes me some pain. It may be irrational, but I like being able to share in this ritual of greeting. It lets me feel that I am part of the wider society.

Taking a different approach, I have started to switch from handshaking to hugs, which are not only less painful on my hands but more personal, more enjoyable and maybe even less likely than handshakes to transmit germs—so maybe this is a good direction for society as a whole.

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Dear Dan,

Are the stock markets manipulated or are they truly a mathematical outcome of buyers and sellers?

—Dave

Markets are a mathematical outcome of the interaction between buyers and sellers—some of whom successfully manipulate the prices.

See the original article in the Wall Street Journal here.

If you’ve been to the doctor’s office recently with any kind of complaint, it’s likely you were asked to rate the pain you were experiencing on a scale from 0 to 10 (being the worst pain possible). Well, a group of researchers from the Stanford University School of Medicine recently analyzed the self-reported pain measurements from 11,000 medical records from 2007-2010 and discovered something surprising: women report greater levels of pain than men for the same injuries and ailments.

In The Upside of Irrationality, I briefly discussed a disagreement I had with a professor about the difference in pain tolerance between men and women. My professor, Ina Weiner, maintained the view that women have a higher tolerance in order to cope with childbirth, and she was unimpressed by the story I told about a woman I’d met in the burn unit who confided in me that the pain of her burns was far worse than what she experienced in childbirth. As you might expect, I decided to run a small experiment, and asked the men and women who passed by my cubicle (where I worked as a research assistant) to submerge a hand in hot water and keep it there until the pain became unbearable. Meanwhile, I timed them and recorded their gender.

The next day in class I was excited to describe my experiment and to report that the men who participated kept their hand in the hot water for much longer than the women.  Professor Weiner replied that all I’d proven was that men were stupider—after all, who would subject themselves to such pain just for my silly study? Naturally this took the wind out of my sails, and I left the subject alone after that.

But as it turns out, the women analyzed in this study reported more intense pain—an average of about 20% more—for equal-opportunity afflictions ranging from neck and back pain to viral Hepatitis. While the experience of pain and the way people report it is inevitably subjective (for instance, the presence of a concerned family member might lead someone to downplay their pain), it’s likely that the large number of people included in the analysis counterbalances social and individual differences.

And while I would never say “I told you so” to a former teacher, I do hope that this research might make its way somehow to Professor Weiner.

For the original paper, click here.

By Arjun Khanna

As the American population ages, the debate about the ethics of physician-assisted suicide for terminal patients becomes more important.

Proponents of legalizing of physician-assisted suicide argue the practice is ethically justifiable because it can alleviate prolonged physical and emotional suffering associated with debilitating terminal illness.  Opponents claim that legally sanctioned lethal prescriptions might destroy any remaining desire to continue living – a sign of society having “given up” on the patient.

Ultimately, these arguments rest on differing opinions regarding the effect of this policy on the patient’s wellbeing.  The challenge, then, is to determine how legalization of physician-assisted suicide would affect the wellbeing of terminally ill patients and their medical decision-making.

Outside of philosophical arguments, examination of an interesting finding regarding physician-assisted suicide – know as “The Oregon Paradox” – can add an interesting dimension to the debate.  The paradox is the finding that when terminal patients in Oregon receive lethal medication (under Oregon’s Death with Dignity Act), they often feel a sense of greater wellbeing and a desire to live longer.  In 2010, of 96 patients requested lethal medication, only 61 actually took it. Even more interesting are the many anecdotal accounts of terminal patients, upon receiving lethal medication, that feel a surge of wellbeing and a desire to persevere through their illness.

Why is this this the case?  Looking at this question from an expected-utility perspective suggests that given the option to terminate their own life, terminal patients will decide how long they want to live by comparing the value they expect to gain from the rest of their lives to the expected intensity of their suffering.  At the point where future utility is expected to be negative – that is, when the patient’s condition becomes so intolerable that living any longer is not worth the cost – the patient would choose to end life if the option were available.

The critical point from this perspective is that patients choose the amount of time they are willing to continue living with their illness, which will depend how quickly they deteriorate.  If the rate of deterioration is slower than expected, then patients should delay terminating their lives; if the rate of deterioration is faster than expected, patients should desire to end their lives quicker.

But now let us say that patients have been prescribed lethal medication and have the option of ending their lives at any point of their choosing.  As before, patients don’t want to choose a time too soon or too distant, but with the power to control the end of their lives they no longer have a reason to err on the side of haste!  The patients can now wake up every day with the comfort of knowing that they do not have to suffer through pain or stress they might find intolerable.

Being given the option to determine the time of our own death can transform patients from powerless victims of their illness to willing survivors of it. Together, the importance of feeling in control and the ability to reduce (but not eliminate) uncertainty about rate of deterioration adds an interesting new dimension to the underlying ethical debate and seems to provide credence to the benefits of legalized physician-assisted suicide.

It is clear is that we need a greater understanding of the decision-making of patients at the end of their lives, and that with this improved understanding we can construct policy to better protect their wellbeing (for an interesting recent movie on this topic see “How to Die in Oregon”).

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References:

Lee, Li Way, 2010.  “The Oregon Paradox” Journal of Socio-Economics.  39(2):204-208.

Turman, S.A., 2007.  The Best Way to Say Goodbye:  A Legal Peaceful Choice at the End of       Life.  Life Transitions Publications.