Nearly 65 years ago the Suicide Act (1961) changed a centuries-old law and taking one’s own life ceased to be a crime in the UK. Importantly the Act at the same time recognised that suicide – although no longer a crime – was still something we should try to prevent and introduced a new offence of encouraging or assisting another person to take their own life.
Decriminalisation was an important move towards reducing the stigma associated with suicide, leading to a slow but increasing acknowledgement that it was a cause of death that merited efforts at understanding and intervention rather than punishment. A further step in putting such efforts on a formal footing was the establishment of a National Confidential Inquiry into suicide in 1992, re-launched in 1996 and based since then at the University of Manchester. The Inquiry originally studied only those deaths of people who had recently been in contact with mental health services but the realisation that this remit left out the majority of suicides meant that it was later expanded to include all deaths. The Inquiry’s database now contains information on more than150,000 suicides and its reports act as an important stimulus to research and policy.
At the same time a government policy document, the Health of the Nation, backed by a number of support measures, placed suicide prevention as one of the key targets for mental health improvement. Since then England has published its first National Suicide Prevention Strategy in 2002 and suicide prevention has come to be seen as part of everybody’s business.
After impressive falls through the end of the 20th and beginning of the 21st-century, suicide rates have plateaued in recent years: although UK rates are about 50% lower than those in for example the USA, Australia or Switzerland there is still much to be done. However, the national consensus about the importance of suicide prevention and the slow but impressive progress that it has brought may be about to change, the vehicle being the Terminally Ill Adults (End of Life) Bill brought by private member Kim Leadbeater, which seeks to decriminalise medically-assisted suicide for people with life-limiting illness.
Of course Leadbeater does not describe her Bill like that, arguing that those who will be eligible in her Bill are not suicidal because they are “dying anyway”, a position that is legally and logically incoherent and not supported by the facts about prognosis or what we know about unassisted suicide associated with physical illness. Experience from other jurisdictions tells us that such legislation does not reduce unassisted suicides but merely adds assisted suicide to the total, leading to a doubling or more of a country’s overall suicides.
Apart from the evasive euphemism, campaigning for the Bill comes with a raft of marketing strategies – vacuous slogans, celebrity endorsement, garishly coloured merch, misleading opinion polls – designed to imply that what is being voted on in parliament is a general principle rather than a specific piece of legislation. Details matter, however. The Bill will rewrite the Suicide Act and the 1947 NHS Act to introduce ending some lives to the NHS’s current aims of preventing or treating ill health. Leadbeater says that she is changing our National Suicide Prevention Strategy in the name of “compassion, autonomy and dignity” but she is profoundly wrong. Driven by a libertarian preoccupation with personal choice regardless of other considerations, her Bill will upend societal and professional attitudes and change for the worse the nature of medical practice, end of life care and suicide prevention.
Today is World Suicide Prevention Day: It’s a good time to ask if we really want to undo our approach to these tragic deaths?
