World Suicide Prevention Day is held on 10 September each year to raise awareness of the terrible reality of suicide and to encourage people to think of practical and effective ways to help prevent it.
The law obliges everyone at least not to “encourage or assist” suicide. The Suicide Act 1961 was amended by the Coroners and Justice Act 2009, to make clear that it is illegal to set up a website encouraging suicide attempts, just as it is to seek to persuade someone to end his or her life, through social media, for example. Suicide itself is not a crime but it is always a tragedy and is never to be encouraged.
Perhaps the most controversial proposal for suicide prevention is to amend the Suicide Act 1961 to allow a doctor to provide a terminally-ill patient with a lethal dose. It is claimed that “assisted dying for the terminally ill” could actually prevent suicide. In the first place, assisted death would be a peaceful alternative to a lonely or violent unassisted suicide. In the second place, not everyone approved for assisted dying takes the lethal dose. Sometimes the security of having it is enough. So perhaps not only would unassisted suicide be prevented, but also the overall number of self-initiated deaths would fall.
This paradoxical argument was very prominent in the debate over voluntary assisted dying (VAD) in Australia. A Parliamentary Committee in Victoria was told that “nearly 50 people per year… took their own life in the context of an irreversible deterioration in physical health”. The Coroner shared harrowing stories which persuaded the Committee that the law needed to change. When a bill was introduced, Jill Hennessy, the Minister for Health, argued that it was needed because, ”one terminally ill Victorian was taking their life each week”. After the law was passed in 2017, the argument was repeated in Western Australia using their Coroner’s data and similarly in Queensland. This argument, more than any other, was instrumental in the legalisation of VAD across Australia.
In July 2020, Jill Hennessy spoke to the All-Party Parliamentary Group for Choice at the End of Life. She urged them to seek similar data from the UK government. The All-Party Group subsequently asked Matt Hancock, then Secretary of State for Health, to request data from the Office of National Statistics (ONS) on suicide among terminally ill people. In April 2022, the ONS showed that unassisted suicide rates among people in England with low survival cancers, and among people with chronic obstructive pulmonary disease (COPD) were 2.4 times higher than that of socio-demographic controls. The response from the ONS was widely reported at the time.
The ONS data shows that there is a serious problem, but is there any evidence that changing the law would be effective in alleviating this problem?
What happened, for example, in Victoria? Since the law was implemented in June 2019, over 900 people have died by VAD. At the same time, unassisted suicide has not decreased but increased. Among people of 65 or over, where you might hope to see a beneficial effect, comparing 2018 and 2022, there was an increase of 54 unassisted suicides a year. The UK is just over ten times the population of Victoria, so the equivalent figures would be roughly 9,000 assisted deaths over four years and more than 500 more unassisted suicides a year. The increase in unassisted suicide in Victoria is much higher than in the neighbouring State of New South Wales, which has not yet implemented VAD.
Evidence from other countries is similar. A study published last year in the European Economic Review showed that, in the States in America that legalised physician assisted suicide, this was associated with a statistically significant increase in unassisted suicide of 6% overall, and as much as 13% among women.
Again, a study this year from Switzerland found that the number of people with cancer dying by assisted suicide had doubled every five years over a twenty-year period. In contrast, among those dying by unassisted suicide, the proportion with cancer was unchanged. There was no evidence that, among cancer patients, increases in assisted suicide led to decreases in unassisted suicide.
The suicide-prevention argument has been put to the Joint Committee on Human Rights and to the House of Commons Health and Social Care Committee, which is currently looking at “Assisted dying/assisted suicide”. However, Parliamentarians should be aware that no study in the scholarly literature has found any statistically significant reduction in unassisted suicide after the introduction of assisted dying. Clearly some people who are terminally ill are dying by suicide under the current law. However, there is no evidence that weakening the law against encouraging or assisting suicide would help prevent this.
This argument is helpful, nevertheless, in drawing attention to the issue of suicide among older people and among people with physical disabilities or with chronic or terminal illness. Suicide occurs in every age group from adolescent and above, and it is important that we think how best to prevent suicide in each section of our community.
In Canada, which now has more assisted deaths than any other country, doctors and nurses are encouraged to raise the possibility of medical assistance in dying (MAiD), even if the patient has not mentioned it. It even happens that people who attempt suicide, and are recovering in hospital, are pro-actively offered MAiD as a treatment option. I find this chilling.
I had a colleague with a severe and progressive physical illness who took his own life. It was a terrible tragedy and one, I believe, that was avoidable. He was let down by mental health services at several key points. It appals me to think that in Canada, had he survived the suicide attempt, he might have been offered MAiD. The truth is that people can step back from the brink and can find a renewed hope in life even at the end of their lives. We need to find more creative ways to help people do so.
