Talk:Suicide bag/Archive 3

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Removed swaths of original research and primary sourced

The statements in this article fall under WP:MEDRS, WP:RS and WP:OVERLINKING. Please use secondary MEDRS-compliant sources if you wish to include any medical or health-related statements. Carl Fredik 💌 📧 20:25, 9 May 2016 (UTC)

This article has been looked at by numerous members of wikiproject medicine and found compliant; this you ignore. It seems you object to the content more than the MEDRS aspects, given the sweeping deletions you have made. And regarding MEDRS, one needs to be very careful about applying MEDRS to this article. MEDRS applies to Wikipedia:Biomedical_information only, NOT information about ethics, history, beliefs, legal issues or society and culture issues (inter alia) — much of which comprises the content of this article.

Illustration

That said, I will endeavor to raise each deletion here for discussion. Let's start with the diagram deletion. Your reason : "The image is controversial enough to merit a source — preferably secondary" first of all ignores the previous discussion had about this image both here and at the medicine wikiproject, where there was no consensus for removal, but also fails to account for the exact description of the bag in the most famous book on rational suicide, Final Exit. This is a secondary source, I believe (because Humphry did not invent the bag, merely documents its existence). The diagram is a schematic based on this secondary source description, as well as the video "Doing it with Betty" [1] as well as other sources. Unless you raise other more cogent objections, I'll re-insert. Ratel (talk) 20:47, 9 May 2016 (UTC)
The image itself should have a secondary source, both for the drawing itself, and for the caption. It is controversial, it needs a compliant source. Carl Fredik 💌 📧 21:20, 9 May 2016 (UTC)
The image was created by me, a wikipedia editor, to give the article an illustration. If I had simply taken a photo, that would be equivalent. If I had taken the illustration from a book such as Final Exit, it would be deleted as copyvio. The diagram is based on the content of Final Exit, that is the source, but it was not copied from Final Exit. Ratel (talk) 21:59, 9 May 2016 (UTC)
I would suggest using something better, such as a secondary source — at the very least a reference has to be inserted into the caption and the commons description with page-numbers. Carl Fredik 💌 📧 22:06, 9 May 2016 (UTC)

That can be arranged. Ratel (talk) 22:22, 9 May 2016 (UTC)

You don't even need to arrange it, because you've already done it. Final Exit is a secondary source. Secondary is not some fancy word for "good source". It's a word that means the source is based upon prior work ("primary"). I suspect that CFCF meant to say "recent, high-quality, academic secondary source, ideally a peer-reviewed review article in a highly reputable journal" rather than any old "secondary source".
Also, a WP:CHALLENGE (=the only situation that can be completely fixed by citing a reliable source, so presumably what CFCF is trying to do here) is supposed to involve someone believing that the material is wrong. "Contentious" only applies to BLPs, not to plastic bags. Since the complaints about this image have centered upon it being far too accurate and detailed for some people's comfort, playing the "give me a source" game might not be a useful approach. WhatamIdoing (talk) 06:35, 10 May 2016 (UTC)

Beliefs not claims

  • You made this deletion based on the MEDRS aspects of the term "painless", but this is nonsensical. The source states that right to die advocates believe ( a "belief", not covered by MEDRS) this form of death to be painless ("This form of suicide is recommended by right-to-die groups and in the internet as a certain, fast, and painless suicide method") which is self-evidently true, as numerous links can prove. Again, unless better justification for removal can be given, it will go back in. Ratel (talk) 20:55, 9 May 2016 (UTC)
They are making a medical claim. Carl Fredik 💌 📧 21:20, 9 May 2016 (UTC)
But it is not a medical claim, it is a statement about what a societal group believes to be true. You seem to have difficulty with comprehension here. Ratel (talk) 21:59, 9 May 2016 (UTC)
You are giving their claim WP:UNDUE merit, and it is a medical claim, even if it is made by such a group. I would suggest you reread WP:MEDRS. Carl Fredik 💌 📧 22:07, 9 May 2016 (UTC)

Sorry, but how does one give a the right to die movement's beliefs undue merit or weight on a page about a relatively painless method of dying, merely by mentioning it? The right to die movement is very large, and up to 80% of voters in many countries subscribe to the right to end life when appropriate. What you are suggesting is that it is undue weight to mention the beliefs of a prominent movement on a page about an issue which is their vital concern. On the face of it, this is a ridiculous viewpoint you have adopted. Ratel (talk) 22:28, 9 May 2016 (UTC)

it ( such a movement mention) seems WP:UNDUE...IMO--Ozzie10aaaa (talk) 22:33, 9 May 2016 (UTC)
When opinion is allowed to override fact it is undue. The problem is that you are giving a fringe organization's voice more volume than the medical literature — which as far as I can see does not make any conclusive statements. Carl Fredik 💌 📧 22:44, 9 May 2016 (UTC) 
I contest your statement that right to die movements are "fringe"; they exist all over the world and have broad support in the population. That's provable and quantifiable based on surveys. Secondly, how is one able to balance their views with medical views, when there are no secondary medical sources, only primary, which tend to concur with the views of the right to die people? Ratel (talk) 22:52, 9 May 2016 (UTC)
what sources (references) back up your statement? links?--Ozzie10aaaa (talk) 22:55, 9 May 2016 (UTC)
You want proof that surveys find that most people support the right to die when one chooses? Ratel (talk) 23:00, 9 May 2016 (UTC)
That the general populace supports a certain agenda doesn't make its most radical proponents less fringe. Animal rights is generally lauded, but the organizations that support throwing rocks at research labs are no less fringe.Carl Fredik 💌 📧 23:08, 9 May 2016 (UTC)
Um, inappropriate comparison there, CFCF! There is nothing extreme about the right to die movement. If you maintain they are an extreme fringe group, please provide some proof, otherwise I will ignore that claim. Ratel (talk) 00:25, 10 May 2016 (UTC)
I'm with Ratel here: "Joe believes X" isn't WP:Biomedical information, and even if it were, this isn't the belief of some random tiny-minority group. PMID 20211999 says that it "appears painless", and PMID 18043029 reports this as the belief of multiple right-to-die organizations, including Dignitas. I have found exactly zero sources that contradict this idea. This isn't "opinion [being] allowed to override fact"; this is an opinion about a widely accepted fact.
This sounds more like basic POV pushing here: Let's not tell people that this method is painless, because then they might use this method, instead of, say, dying in horrible pain and uncontrollable nausea over several days after killing their livers by overdosing on acetaminophen. WhatamIdoing (talk) 06:52, 10 May 2016 (UTC)
WhatamIdoing your first source, Ogden, as well as Dignitas very much have a vested interest in this topic. They are the view of the tiny-minority, not the wider medical community, yet they are the only ones sourced in this article this far. Ogden is also a master's level sociologist, so his opinion on what he believes is "painless" is irrelevant to wikipedia. The second source you mentioned says "right-to-die groups" recommend this method as fast and painless, which it sources to Ogden. The authors aren't making that argument themselves. They're mentioning it to explain why it's becoming more common, not whether it's true. If you actually read the paper, they are just looking to find better ways to detect when people have died from this method as its use is increasing. They aren't asserting if it's it's a good why to die or not. If you haven't seen any articles that contradict Ogden's findings, it's because you've only looked at the sources already cited in this article. Ogden himself has published papers talking about being uncomfortable watching people twitching and contorting while dying from this method. I don't remember which paper off the topic of my head, but I'll link it when I find it. (If you look at the archives of this talkpage, there are editors discussing leaving that part out.) Frost et al. (2013) specifically refute the idea that it's painless, "In our case 2 autopsy revealed bilateral eyelid petechiae and large amounts of gastric content in the airways. These findings challenge the assumption that death by this method is painless and without air hunger, as asserted in Final Exit." A couple of sources talk about the length of time it takes not being as quick as suggested and a few talk about unsuccessful attempts with this method. Frost et al. is the only the one I have at the tip of my fingers since I've previously mentioned it on this page. Ratel and I have been adding sources at Talk:Suicide bag/Source dump. Take your pick of the independent, reliable sources and you will see that no one outside of advocacy groups is calling it quick and painless. PermStrump(talk) 14:58, 10 May 2016 (UTC)
The suffocation findings were only present in one of Frost's two case studies, and it's the one about which Frost says, "The medical examiner's conclusion as to the cause of death was suffocation due to a plastic bag over the head and aspiration of gastric contents", i.e., not due to a properly functioning suicide bag. The phrase "In our case 2 autopsy" means "in the autopsy we called 'case 2' but not in the autopsy we called 'case 1' on the previous page". There's also no way to know that these effects began while the person was still conscious. (Pain requires consciousness, by definition. While you are permitted to personally disagree with the definition – and I do, in part – that is the generally accepted definition, so I assume that this is what these sources intend when they say something is 'painless'.) And there's some other evidence that it is painless, because if it were painful or even unpleasant, then don't you think that this accidental death would have been prevented? Or even that the person in case #2 would have thought, "Hey, this doesn't seem to be working as predicted, so maybe I should stop and check the setup again?" That's probably why none of the sources are willing to directly say something like, "this is probably a painful way to die", rather than what Frost says, which is that, sometimes, especially if it's not functioning correctly, then you might die from plain old suffocation, which you might consider painful and which is generally reckoned unpleasant, if you are conscious at that point, which you might not be.
The Ogden paper I noted is the one that said that the Dignitas volunteers were disconcerted by involuntary twitching. Those motions don't mean that there is any pain being experienced. Killing neurons (e.g., through oxygen deprivation) commonly results in involuntary myoclonus. If the volunteers were surprised, this might indicate inadequate training for the volunteers, but it does not indicate pain. The same behavior is also commonly seen with some anesthetics used for surgery, and it doesn't indicate pain then, either.
Frost cites the Dignitas-based study (without disapproval) on the second page, and says that the time to unconsciousness with a mask (not a suicide bag) was never more than 55 seconds and that time to death was usually 5 to 10 minutes (except 40 minutes once, due to poor mask fit), which I think also counts as "quick" by most people's standards. It is, for example, about the same amount of time to death as seen with execution by lethal injection (which are usually 10 minutes but have sometimes taken nearly two hours), and half the time for death by hanging. With an actual suicide bag, rather than a mask, Frost says that time to unconsciousness was 10 to 12 seconds – still "quick" by most people's standards.
Also, the subject is not solely Helium-based suicide bags, and if you seriously want to argue that Nitrogen narcosis is painful, then you've got an uphill battle to fight. PMID 23457887 (from your source dump) is about Helium inhalation as a recreational activity, and it says that a third of "helium users reported they actually did get high when they inhaled helium". Euphoria ≠ pain.
Finally, I think you need to explain Ogden's "vested interest" in the subject. "Vested interest" usually means "gets more money if people use this more". For example, sellers of plastic bags could be said to have a vested interest in this method. What exactly is Ogden's alleged vested interest? NB that merely being WP:BIASED is not the same thing as having a vested interest. The Catholic Church is probably BIASED against suicide, but we'd never say that the pope has a vested interest in the subject. WhatamIdoing (talk) 18:11, 10 May 2016 (UTC)
Commercial saturation divers are routinely breathing helium (with about 0.4bar ppO2) at partial pressures of more than 10 bar for periods of weeks at a time specifically because the narcotic effects are the lowest of any known respirable gas mixture. I can provide sources if anyone needs them and can make a reasonable case why they can't just look them up for themselves. Nitrogen at 1 bar partial pressure is not significantly narcotic. Most people wouldn't notice the difference compared with air right up until the point they lost consciousness if it was pure nitrogen. This is one of the most significant hazards in rebreather diving. There is no warning. Those divers who have been rescued from hypoxic incidents generally do not report any awareness of a problem, far less pain or distress. Recreational divers with a bare minimum of training routinely breathe gas mixtures with a nitrogen partial pressure of 1.5 bar with minimal narcotic effect. This is in marked contrast with hypercapnic incidents, where the victims report intense panic and desperate need to breathe. • • • Peter (Southwood) (talk): 18:30, 12 May 2016 (UTC)

Repeated data

History = trivia

  • You have labelled the History section as "trivia", tagging it and showing a message denigrating it as miscellaneous data and we should "please relocate any relevant information into other sections or articles." This seems to betray a destructive agenda on your part, because the section is clearly and unarguably about the history of this item. The trivia label should be removed.
The history section is full of minor references to books, which amount to promotion — apart from that it is a haphazard jumble of petty facts, with no internal coherence. Carl Fredik 💌 📧 21:20, 9 May 2016 (UTC)
That is a style criticism. The suicide or exit bag, as a recent cultural phenomenon, does not have a long list of glittering sources, so we deal with what we have, even if they are "petty" and "minor references". Your spurious and vague charge of "promotion" once again betrays the fact that this entire topic is something you'd rather see disappear. Ratel (talk) 21:59, 9 May 2016 (UTC)
We deal with what we have according to policy — a lack of sources is not rationale for including everything, especially not when the statements are akin to:

This book from 2006 mentions/is about suicide bags.

Carl Fredik 💌 📧 22:09, 9 May 2016 (UTC)

The section could do with some rewriting, some of the statements are vague. I'll see what can be done over the next few weeks. Ratel (talk) 22:53, 9 May 2016 (UTC)

History (case reports) removed

  • You have removed numerous case reports from the article. While case reports are not acceptable in medical articles about treatment efficacy, this is an article about a societal phenomenon, a so-called suicide bag or exit bag or hood, so the case reports serve here to document the existence of a behaviour, not make "medical [MEDRS] claims" (as stated in your edit summary). MEDRS does not apply. Ratel (talk) 21:07, 9 May 2016 (UTC)
MEDRS applies to medical and health information as defined by among other things that essay — as far as I'm aware there were editors in WPMED who strongly questioned the content in the article — they just knew better than to engage because of the assumed backlash. Carl Fredik 💌 📧 21:10, 9 May 2016 (UTC)
That is what you claim. But in the mean time you are killing off articles by pushing ridiculous claims for just a certain type of sources and rejecting sources that might by better informed. The Banner talk 21:23, 9 May 2016 (UTC)
As far as I can see there is quite a lot left in this article — and rejecting sources is a major part of building an encyclopaedia. Carl Fredik 💌 📧 21:25, 9 May 2016 (UTC) 
Let's just work with the biomed essay as it stands. I don't want to re-argue the content of that. Ratel (talk) 21:59, 9 May 2016 (UTC)

Ethics again

  • In this edit, under a section explicitly labelled "ethics" (to which we know that MEDRS does not apply, as shown above), you have used MEDRS as justification to remove content.
That uou chose to label a certain section as ethics doesn't automatically make it free from the criteria that medical claims (yes they are in there) abide by MEDRS. Carl Fredik 💌 📧
The concept of "medical claims" must be fleshed out. In MEDRS it clearly relates to claims of treatment or drug efficacy, not to peoples' beliefs about efficacy, or to ethical issues, or to cultural phenomena like suicide methods, or to histories. Ratel (talk) 21:59, 9 May 2016 (UTC)
Not really, it is fleshed out very well in MEDRS. I suggest you go read it. No, but what was removed was not ethical issues or cultural methods/history. All that content remained. What was removed was when those intersected health claims, and it is not correct to suggest that a procedure is painless and to reference a non-MEDRS compliant source. Carl Fredik 💌 📧 22:04, 9 May 2016 (UTC)
You grossly misunderstand the meaning and purpose of MEDRS. Carl Fredik 💌 📧 21:24, 9 May 2016 (UTC)
Absolutely not. My experience is that when left unchecked "you guys" claim more and more territory. I have seen it already happen that a chemical analyses of fruit, done by an agricultural university, was rejected as not conform MEDRS. I will allow that to happen hear. The Banner talk 21:56, 9 May 2016 (UTC)
MEDRS-compliance depends of the statements made — if a health statement is sourced to chemical analysis of fruit then it most certainly should abide by MEDRS in the same way that content here must. Carl Fredik 💌 📧 22:02, 9 May 2016 (UTC)

I suggest that WikiProject Medicine and her MEDRS completely withdraw from this article instead of killing it off deliberately. The Banner talk 21:18, 9 May 2016 (UTC)

Could you clarify what that odd statement is supposed to mean — and how it would abide by sourcing policy? Does the argument have any more merit than shouting WP:I DON'T LIKE IT when policy is against you? Carl Fredik 💌 📧 21:22, 9 May 2016 (UTC)
It means: go away with your whole WikiProject and let us write an encyclopaedia. And you are shouting straight away about WP:I DON'T LIKE IT while you are in fact POV-pushing and claiming articles. The Banner talk 21:44, 9 May 2016 (UTC)
Which POV would that be? The one that promotes science? Carl Fredik 💌 📧 22:02, 9 May 2016 (UTC)
CFCF, I think if this article were completely afoul of MEDRS, we would have heard about it years ago. Maybe you are wrong? Ratel (talk) 21:59, 9 May 2016 (UTC)
Absolutely wrong, yes. It isn't possible to stay on top of all articles on Wikipedia, and there are many horrible articles that need trimming. Carl Fredik 💌 📧 22:02, 9 May 2016 (UTC)
I concur 100% w/ Carl Fredik...this is within the parameters of wikiproject Medicine and Wikipedia:Identifying_reliable_sources_(medicine),--Ozzie10aaaa (talk) 22:08, 9 May 2016 (UTC)
In reference to Ratel's statement: "In MEDRS it clearly relates to claims of treatment or drug efficacy, not to peoples' beliefs about efficacy, or to ethical issues, or to cultural phenomena like suicide methods, or to histories." (1) WP:MEDRS applies to anything in an article relating to biomedical information, not just claims of treatment or drug efficacy. (2) MEDRS doesn't disappear simply by saying certain beliefs about biomedical information belong to a specific person or group. That also becomes a WP:WEIGHT issue. Most of the issues I see in this article are related to lack of MEDRS, and overabundance of WP:PROFRINGE and WP:ADMASQs WP:BOOKSPAM. I believe that other editors have previously stayed away from calling this article out on lack of MEDRS because they don't want to read the source to find out if the statements are supported. It's hard for me to read them and I avoided it for a while until I realized that pretty much none of the independent, reliable sources support the statements in this article. PermStrump(talk) 22:17, 9 May 2016 (UTC)

I cannot see the advertising here, Permstrump. What's the product, and who profits? Ratel (talk) 22:57, 9 May 2016 (UTC)

You are talking here about "a WP:WEIGHT issue". But who says that MEDRS-sources are the right sources for this article? Are they not top-heavy sources weighing like lead on mnost articles? Are they not grossly overweight? The Banner talk 23:48, 9 May 2016 (UTC)
The Banner: In response to: "Are [MEDRS-sources] not top-heavy sources weighing like lead on mnost articles? Are they not grossly overweight?" I can't tell if you meant that in a tongue-in-cheek sort of way or if you really aren't familiar with that policy, so I'm going err on the side of assuming you were being genuine... The policy on due and undue weight isn't referring to weight in an abstract sense. The policy says,

"Neutrality requires that each article or other page in the mainspace fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources.[3] Giving due weight and avoiding giving undue weight mean that articles should not give minority views or aspects as much of or as detailed a description as more widely held views or widely supported aspects."

You also asked, "who says that MEDRS-sources are the right sources for this article?" Wikipedia's policy on WP:MEDRS says,

"all biomedical information must be based on reliable, third-party published secondary sources, and must accurately reflect current knowledge."

The wikilink on biomedical information leads to an essay that says,

"Biomedical information is information that relates to (or could reasonably be perceived as relating to) human health."

The essay gives further explanation and examples of what constitutes biomedical information requiring MEDRS. PermStrump(talk) 00:05, 10 May 2016 (UTC)
Ratel, in response to: "What's the product, and who profits?" To give you an example from earlier today, I left an edit summary that said, "rm WP:ADMASQ -- doesn't provide new information to article" in reference to these lines:
The "Customized Exit Bag" was described and briefly marketed in 1995 by the Right-to-Die Society of Canada in its privately distributed book, Beyond Final Exit.[12]Bruce Dunn wrote about the use of inert gases and a hood in the same volume,[13] and the idea was developed by ERGO.
The description of ADMASQ isn't quite on point. I should have gone with WP:BOOKSPAM:

"the insertion of text mentioning books to call attention to the books, rather than to contribute to the article."

A couple sections of the spam policy are applicable, (e.g., see WP:CITESPAM). PermStrump(talk) 00:31, 10 May 2016 (UTC)
I just see that response as wikilawyering. Fact is this very arcane topic has few book sources, so any mention of books like Final Exit can be deemed by disruptive editors as bookspam. Really, this is atrocious. Ratel (talk) 00:34, 10 May 2016 (UTC)
I didn't try to remove every reference to Final Exit and I'm not suggesting that every reference is bookspam. I was only referring to the 2 sentences that I copied above. Those 2 sentences specifically are spam because they don't contribute new information to the article. It doesn't necessarily mean that someone deliberately placed them there for marketing reasons, but it doesn't contribute knowledge to the article, so it gives the impression of being an ad masquerading as content, Regardless if it was on purpose, it's still clutter. PermStrump(talk) 00:40, 10 May 2016 (UTC)
Read what you have just have written and count the number of policies quoted. That is why I call MEDRS a death knell for all articles hammered with it. It does not matter what kind of sources you have, if the MEDRS-guys don't like it, it will be removed. How on earth can you write a neutral article when you have to use biased, selective or just a few selected sources? The Banner talk 00:49, 10 May 2016 (UTC)
Ok. I re-read what I wrote. And I stand by it. "count the number of policies quoted" (1)MedRS (2)fringe (3)weight (4)spam. That doesn't make me think, "Wow. What a death knell all of those policies are." It makes me think, "Wow. This article has been violating a lot of major policies for a long time, because people who aren't interested in promoting this topic are averse to reading the sources required to give the article a neutral voice." PermStrump(talk) 01:30, 10 May 2016 (UTC)
Slow down there PermStrump. There is no consensus that (1) MedRS (2)fringe (3)weight (4)spam are being violated. You're engaging in wikilawyering slight of hand. You and Carl should maybe try discussing the matter more instead of acting as the sole arbitrators. --Lo te xendo (talk) 01:53, 10 May 2016 (UTC)
Lo te xendo, how have I acted as an arbitrator? I don't have any special user permissions that would allow me to do so. I haven't made any reverts and I'm here discussing the policies that I think apply to this article and giving specific examples from the text. Wikilawyering is some editor's opinion essay, not a policy or guideline, so (a)It's not helpful to continue invoking it as if I'm breaking some rule by trying to talk about policies and (b)It doesn't apply anyway. No one here is arguing over technicalities since the only counter arguments I'm hearing is that wikipedia's main policies and guidelines are too confining. PermStrump(talk) 02:32, 10 May 2016 (UTC)
PermStrump, you're acting as if your perspective is the only perspective. That's the problem. You're also not contextualizing the guidelines you cite. You seem to be reflexively citing them. I don't foresee any randomized double blind crossover studies on whether use of a "suicide bag" is quick and painless. And I very much doubt that there are going to be any meta-analysises for these non-existent studies... You get my point? If not take a look at this: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. That doesn't mean that we can't explain the issues. You can do so by qualifying the quality of the evidence cited. WP:MEDRS says, "Primary sources should generally not be used for medical content." That's not a hard universal law.
My other problem is that you're bringing up fringe and weight without actually stating the counter nonfringe majoritarian position. If the groups and issues in this article are freaky fringe then you actually have to show evidence of this! It isn't as simple as you stating it to be the case. --Lo te xendo (talk) 03:09, 10 May 2016 (UTC)
That parachute article is a thing of beauty. It so well illustrates the point. +1 Cheers • • • Peter (Southwood) (talk): 13:12, 10 May 2016 (UTC)
While MEDRS is not policy wp:PSTS is. It is quite clear on the subject of the limitations to the use of primary sources. LeadSongDog come howl! 18:04, 10 May 2016 (UTC)
@LeadSongDog, Ignoratio elenchi

Ignoratio elenchi, also known as irrelevant conclusion,[1] is the informal fallacy of presenting an argument that may or may not be logically valid, but fails nonetheless to address the issue in question. More colloquially, it is also known as missing the point.

--Lo te xendo (talk) 18:55, 10 May 2016 (UTC)
Yes, I recognize that they missed the point, which is why I felt it necessary to make it more directly.LeadSongDog come howl! 19:08, 10 May 2016 (UTC)
I'm going to pretend/assume that comment was sarcasm because otherwise we may as well nuke this talk page from orbit. --Lo te xendo (talk) 19:40, 10 May 2016 (UTC)
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