Despair is Not Hopelessness: Autonomy and Behavioral Interventions for Deaths of Despair

The term 'deaths of despair' refers to suicide, drug overdoses, and alcohol-related mortality in the context of concern about rising mortality rates. This paper employs a philosophical distinction between despair and hopelessness, and their positive counterparts, hope and hopefulness, to examine how behavioral public policy can offer tools to reduce these deaths and what role autonomy plays in such contexts. The paper introduces a further distinction within hopelessness (desiderative and doxastic) each affecting autonomy in different ways, depending on whether desires, beliefs or both are compromised. The analysis considers autonomy from two perspectives: first, how it is diminished in the psychological and social contexts that give rise to deaths of despair; and second, how it may be further compromised by behavioral interventions that rely on paternalistic influence. By integrating these conceptual and ethical dimensions, the paper develops a framework for assessing when and how autonomy-sensitive behavioral interventions can be ethically justified in contexts marked by despair and hopelessness.