The Ethicist: Her Brother Most Likely Died From Autoerotic Asphyxiation. Do I Tell Her?

[ermingarden]

Warning for discussion of suicide:

When I was a young child, my friend’s 14-year-old brother died after hanging himself. Nearly everyone, including my friend, believes it was suicide. My cousin happened to be one of the paramedics who arrived at the scene and administered CPR to him unsuccessfully. Many years later my cousin (now deceased) shared some information with me about the incident that makes it appear that it was not suicide but an accidental hanging from autoerotic asphyxiation.

My friend has always struggled with not understanding why her seemingly happy brother wanted to end his life at just 14 years old. I’m fairly certain her father, who found him, knows it may have been accidental but has never shared that information with his daughter. Her father is now in his 90s. I think my friend would be comforted by learning that it may not have been an intentional suicide. But it could also cause her more anguish knowing it might have been accidental. Putting aside the ethics of how I acquired the information, what are my obligations to my friend? Name Withheld

You asked me to put aside the ethics of how you came by the information, but I don’t think we can. Whether we should pass on information depends, in part, on how we acquired it. Your cousin had an ethical duty to not disclose what he learned outside the context of medical care. You have a weaker but real reason to keep the information to yourself: We should all contribute to maintaining the conventions of medical confidentiality.

Even after people are dead, it’s wrong to reveal information they would justly have wanted kept confidential. (This consideration fades with time, in part because the potential knowers we care most about are people with whom we have a substantial connection, and their numbers diminish as time passes.) You may have another reason to bite your tongue. When your cousin told you these things, he may have explicitly asked you to keep them to yourself. And promises do not lapse simply because the promisee has died.

It would certainly have been wrong, in any case, for you to share the information you gathered as mere gossip. But you’re considering sharing the information in order to give solace to the dead boy’s sister. And there are two parts of what you have to say. One is that he was evidently engaging in autoerotic asphyxia, something he probably would have preferred to keep private; another is that he evidently hadn’t meant to kill himself, something he probably would have wanted his loved ones to know.

You think that the father has known all along. If that is the case, it would have been best had he told his daughter what he knew, rather than let her believe for years that her brother was driven to kill himself by distress that the family had failed to recognize. Would learning the truth from you much later have the same positive effect? Bear in mind that this revelation would trail another one: that you and her father have both hidden something important from her for all these years. That might harm her relationships with each of you. (Indeed, because her father would be implicated by any disclosure, you should consider discussing your quandary with him first, although this decision will depend on the nature of your relationship with him, and on whether you judge that conversation would be productive.) Bear in mind too that your friend would come to realize that her grief over the years was entwined in a misunderstanding. She may need to mourn again.

Assessing these pros and cons of speaking up now, you should ask this question: If you were in your friend’s situation, would you want to know the full story? That may help you answer a second question: Will your friend be better off, once she has time to reflect, if you belatedly tell her now? You know her well. You can only be guided by your intuitions here. If your answer to these two questions is yes, then the reasons I’ve identified for keeping quiet would be outweighed by the potential benefit: deepening her understanding of what must remain a harrowing event in her life.

Comments

[ermingarden]

My instinct is to say that if – and it's a big if! – LW is certain the information is reliable, and that LW's friend doesn't already know, then LW ought to disclose it. Even thinking about the possibility of my loved ones believing I'd died by suicide when it was really an accident horrifies me!

I can definitely see an argument that LW shouldn't, that it's been so long that this information would just cause fresh grief. But LW says the friend is still actively struggling with trying to understand her brother's death, so it wouldn't be dredging up something she's not already thinking about.

[ioplokon]

the level of guilt and responsibility you feel when someone you know kills themselves is something that never really goes away. if i was in the sister's position, i'd want to know.

(and if I was in the brother's position, I'd want my family to know it wasn't suicide)

[jadelennox]

Her father is now in his 90s.

Did this happen in, like, 1950?

(Arguably I'd say if it happened that long ago in a different cultural context I would be suspicious of a paramedic saying 'oh yeah it looked like it was a kinky accident' having even a reasonable conception of what a kinky accident looks like.)

(Also I distrust the judgement of medical workers who violate privacy even before you get to 'kink or suicide'.)

[laurajv]

"(Also I distrust the judgement of medical workers who violate privacy even before you get to 'kink or suicide'.)"

...yeah. This sounds to me more like the LW's cousin likes scandal-tinged gossip than any real information.

[ethelmay]

I don't know if it affects your point, but it wouldn't be quite that long ago. Someone old enough to have a 14-year-old son in 1950 would be well over a hundred now. Say the father was 25 when the son was born, 39 when he died, and now 91-99, it would be 51-60 years ago, so 1962-1971. Or if the father was 45 when the son was born, 1982-1991. Also it doesn't say the paramedic cousin realized then (or ever - it may have been the friend's interpretation of the details in question) that it was likely autoerotic asphyxiation. The interpretation may have occurred to them later.

Incidentally, there will be a death certificate on file, and possibly an autopsy report.

[pauraque]

This was my thought as well. The only "information" LW actually has is the cousin's opinion. LW didn't see any evidence for themselves and doesn't know for sure what really happened that day. I don't think this is the kind of thing they should be repeating to anyone else without being really, really, REALLY sure.

[azurelunatic]

The circles of suicidality information that I am aware of tend to prefer "completed suicide" to remove that criminal connotation.

[conuly]

I've heard "died by suicide" a lot more recently.

[topaz_eyes]

Paramedics weren't a thing until 1970, and even then it took several years for paramedics to become established across the country. The earliest this could have happened would be the early 1970s, given the father's current age.

[ermingarden]

That's what I generally use. I tend to think of the construction "died by suicide" as deliberately aligned with the common way of discussing deaths from disease, e.g., "died of tuberculosis" – emphasizing that suicide is, in almost every case, a death caused by an ultimately lethal illness.

[ermingarden]

Agreed. I think this letter becomes really interesting on an ethical level if we assume that the information is reliable...but it probably isn't.

[ioplokon]

though i think it needs to be emphasized, not inevitably lethal (at least not always). i am a bit uncomfortable with the medical framing as something that implies inevitability, though this more a general frustration with not considering/ameliorating social/economic factors in illnesses vs something unique to suicide.

i also have complicated feelings on agency in this situation irt not wanting to rob people of it posthumously while also recognizing the profundity of their suffering + impacts on decision-making. but this is kind of a triggering discussion for me, as much as I am interested in it, so I don't want to get too deep. I'm interested to hear others thoughts, if they want to share, but might not be able to reply. (and i recognize this is getting far off the topic of the original letter)

[ermingarden]

Oh 100%, I re-read my comment and what I meant was lethal in that particular case. And I really appreciate what you're saying about agency! It's also not something I'm inclined to dive into here, but I like what you're saying; I myself am not exactly sure how to navigate that balance in discussing suicide.

[green_grrl]

In either of those timeframes, a paramedic should be able to connect the dots in autoerotic asphyxiation. But a father of that age would NOT be comfortable talking to his daughter about her brother’s masturbatory kinks, despite what The Ethicist thinks.

I certainly don’t think there’s a reason to keep a dead person’s secrets when they are hurting a living person. If LW is worried about the friend being further hurt by LW or her father having kept the secret, the kindest thing to do is say, “I was reading an article about how commonly autoerotic asphyxiation is classified as suicide. I suddenly remembered my cousin saying [something leading but not overt] about your brother. Now that I think back, I believe he was trying to tell me your brother’s death was an accident.”