Does legalising assisted suicide affect the suicide rate?
- Legalising assisted suicide for some Australians undermines the commitment to suicide prevention for all Australians
- Legalising assisted suicide has been shown to lead to an increase in the overall rate of suicides of 6.3% and of the elderly (65 years and older) by 14.5%
- This is outcome is predictable because of the well-known Werther effect of suicide contagion whenever suicide is presented in a positive light as a romantic or rational act
- The families of those who commit suicide under an assisted suicide law suffer high rates of post traumatic stress disorder
Should suicide prevention strategies include all Australians?
Proposals to legalise assisted suicide or euthanasia for a select group of people, such as the terminally ill, necessarily imply that society agrees such people may be better off dead and supports their suicide as a legitimate, rational choice to be facilitated rather than prevented.
The question arises as to how publicly and openly offering assistance to commit suicide to one group of Australians fits with the public policy goal, widely shared across the whole community, to reduce the incidence of suicide?
DOES LEGALISING ASSISTED SUICIDE REDUCE THE SUICIDE RATE AS CLAIMED?
Proponents of assisted suicide have claimed that providing the elderly, terminally ill with a legal lethal dose of drugs to facilitate assisted suicide will reduce the incidence of other forms of suicide among this group and, because, it is claimed, many of those for whom the lethal dose is prescribed may never take it, actually decrease the overall suicide rate.
This hypothesis has been subjected to careful scrutiny in an important study by David Albert Jones and David Paton comparing trends in suicide rates in those states of the United States which have legalised assisted suicide compared to those which have not.
The study, which controlled for various socio-economic factors, unobservable state- and year effects, and state-specific linear trends, found that legalizing assisted suicide was associated with a 6.3% increase in total suicides (i.e. including assisted suicides).
This effect was significantly larger in the over 65 year old age group with a massive 14.5% increase in total suicides.
The introduction of legalised assisted suicide was not associated with a reduction in non-assisted suicide rates, nor with an increase in the mean age of non-assisted suicide.
The conclusion is that assisted suicide either does not inhibit (nor acts as an alternative to) non-assisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.
The latter suggestion would be consistent with the well known Werther effect of suicide contagion.
This conclusion is supported by evidence from Victoria.
When arguing for the legalisation of State-approved and funded assistance to suicide, then Minister for Health and Human Services, the Hon Jill Hennessy, claimed that:
Evidence from the coroner indicated that one terminally ill Victorian was taking their life each week.
The Voluntary Assisted Dying Act 2017, which she introduced on behalf of the Victorian Government, excluded deaths by self-administration of a "voluntary assisted dying substance" for the purpose of causing a person's death from being considered as caused by suicide.
By this legal fiction, which is replicated in Section 8 of the Bill, such deaths are recorded as caused by the disease, illness or medical condition cited by a doctor in the application for a self-administration permit under the Victorian Act.
If Ms Hennessy’s claim was correct there ought to have been a decrease of around 50 deaths by suicide each year once the Act came into operation, as it did on 19 June 2019, as these terminally ill Victorians would now have access to a State-approved and State-funded way to intentionally cause their own deaths by ingesting a lethal poison.
However, according to the Coroners Court of Victoria there were 694 deaths by suicide in Victoria in 2017.
There were slightly more - 698 - in 2020, which was the first full calendar year in which State issued suicide permits and the State-funded poison delivery service were in operation.
So there is no evidence that the anticipated decrease of 50 deaths by (non-authorised) suicide each year has been achieved.
Moreover, if we put aside the legal fiction declaring suicides pursuant to a permit issued by the Victorian Secretary of the Department of Health and Human Services there were an additional 144 suicides in 2020 which were officially recorded by the Voluntary Assisted Dying Review Board as "Confirmed deaths - Medication [sic] was self-administered".
Adding these 144 State-approved, State-funded suicides by the ingestion of State-supplied lethal poison to the 698 suicides without such State approval and facilitation gives a total of 842 suicides in 2020 - an increase of 21.2% on 2017.
The 144 suicides with State approval in 2020 are nearly three times the 50 suicides of terminally ill persons each year claimed by Minister Hennessy during the 2017 parliamentary debate.
Additionally, 31 Victorians were killed by injection of State-funded and supplied lethal poisons by a doctor who had been issued, a voluntary assisted dying physician administered permit, by the Secretary of the Department for Health and Human Services, specifically authorising the doctor to administer the poisons in order to cause the death of the person.
If these are added to the count of suicides - insofar as they are at least purported to be performed at the request of the person with the intention of causing that person's death - then the total for 2020 would be 873 - a 25.8% rise since 2017.
EFFECT ON FAMILIES
Suicide is a distressing event that disrupts the lives of families, friends and communities who are bereaved.
Like any other suicide, assisted suicide can profoundly affect surviving family members and friends.
A recent study found that about 20% of family members or friends who witnessed an assisted suicide in Switzerland, where assisted suicide is legal, subsequently suffered from full (13%) post-traumatic stress disorder or subthreshold (6.5%) post-traumatic stress disorder.
Proposals to promote assisted suicide for some people run an unacceptable risk of undermining efforts to prevent suicide for all other members of the community and of increasing the trauma suffered by families, friends and communities due to the suicide of loved ones.
9. Social Contagion of Suicide