Matters of Life and Death

Sometimes a decision of life and death is not just a metaphor. What can we learn from people who genuinely face them?

In September 2007, Sampson Parker had to make a really difficult decision. Like really, really difficult. He was harvesting corn on his farm in North Carolina, when the corn picker he was pulling jammed. He jumped off his tractor and noticed the problem was a stuck corn stalk. Perhaps he could dislodge it by pulling it down? He reached in and grabbed the stalk, but it did not budge. So intuitively he pushed it up instead.

He had left the machine running so the rollers could grab the stalk and unblock the mechanism. Unfortunately, as he pushed the stalk up, they also grabbed his hand. They tore up his gloves, then the flesh of his hand, blood running down his arm. In indescribable pain he looked for ways to stop the rollers. He spotted the solid steel pin used to connect the picker to the trailer hitch and jammed it between the chain driving the rollers in the picker and the tyre. The rollers stopped, but his hand remained stuck. Unable to extricate it, he physically tried to pull his own hand off, something he discovered was physically impossible. Meanwhile, the machine was still running. Because the pin blocked the mechanism, however, the clutch was throwing sparks. It didn’t take long before the dry corn shucks in an around the picker caught fire.

There he was, losing blood rapidly, unable to free himself, and with flames engulfing his leg.

A life saver in a way we had rather not bring to mind (image: James Case CC BY)

He had to decide whether to burn to death there and then, or… well, what? So he made up his mind. With the wind blowing the heat from the burning tyre into his face, he reached for his pocket with his left arm, managed to grab his pocket knife, and jammed it into his arm. Eventually, experiencing excruciating pain, he managed to cut through the skin and the flesh. But the small knife was no match for the solid bone in his arm. Just seconds before they tyre blew up, he succeeded in breaking the bone using his weight, and he was free. And alive.

His decision was impulsive, a -like decision, driven by a profound, unquestioned desire to see tomorrow. Just one thought dominated his actions — get away from the burning machine to stay alive. His reasoning powers were used to figure out how to do it, not whether to do it. No options were out of bounds. (He is alive and well, albeit with a prosthetic right arm.)

Thankfully, most of us are unlikely ever to face an ordeal like Sampson Parker’s, having to make sacrifices that are beyond our comprehension. What he had to do is such a repulsive idea that it is literally unthinkable. But what we can imagine, and empathize with, is the deep desire to live, to do whatever is necessary to survive.

Yet life and death decisions are not limited to extreme situations. Some of us are confronted with decisions that involve very physical sacrifices in order to enhance our chances of survival. Someone very dear to me was recently diagnosed with cervical cancer. There were different treatment options possible, all involving a trade-off between survival rates and consequences, in particular on the ability to conceive and carry a baby, and to give birth. No split-second, intuitive decision-making here, but nevertheless the desire to maximize the chance of survival was prominent, even in the slow, reasoned, -like decision-making process. Our survival instinct may be latent, but when it is called upon it is strong. And it is something we almost all have in common.


Once you realize the incredible sacrifices people are prepared to make in order to see tomorrow, realizing some people choose death can be strange, disconcerting even.

It is now well over 20 years ago since my mother died. Eight years earlier, just after my family and I had moved to the UK, she had learned she had ovarian cancer. Treatment, though painful and debilitating, had been successful and she was in remission. Just as she was about to reach the magical milestone of 5-year survival, a routine test found elevated levels of tumour markers, and further analyses confirmed that the cancer was back, and that it had spread. The next two years she bravely battled the disease, undergoing intense chemotherapy treatment, fighting the increasing pain with a combination of morphine and will power, and trying to lead as normal a life as possible.

Ten days before she died, she said she did not want to go on living. At the time, I found it quite hard to take that message. Surely there was still hope, there were still new treatments about to become available? Surely the wish to see one’s granddaughters grow up should give anyone the strength to want to see tomorrow?

Can we understand when someone decides they have reached the end of the line? (image: Tee Cee CC BY)

I know better now. The choice between life and death is, like every other choice, really, a matter of costs and benefits, whether we realize it, or not — whether we want it or not. And just like the balance may tip towards life, as in Sampson Parker’s case, where we are willing to make unimaginable sacrifices and endure indescribable pain to secure our ability to go on living rather than to meet our end, so it may tip towards death, when the prospect of unbearable suffering outweighs any amount of joy.

We may live life mostly as if it is sacred. But it cannot be so sacred that we will unconditionally choose to live to see tomorrow, no matter the amount of suffering that is required to make that possible.

We sometimes fail to understand why people make choices and decisions that are different from our own, even the complete opposite of it. Yet, that is generally more a failure of imagination on our part: we are asking the wrong question. Instead of wondering why on earth someone makes a choice, we should try to imagine a situation in which we would make a similar decision. If we can imagine wanting to live so much that we choose to cut off our arm, if we can imagine being in so much pain that we conclude being dead is better than staying alive, we can understand why someone would make such extreme choices — even if they would not be our choices.

If we can do that for choices of life and death, it should not be too hard to understand other people’s much less extreme choices, whatever they are.

Originally published at on December 6, 2019.

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Accidental behavioural economist in search of wisdom. Uses insights from (behavioural) economics in organization development. On Twitter as @koenfucius