July 7, 2022

Fears of suicide contagion after victory in California

A study shows that physician-assisted suicide may not reduce the suicide rate.

The Werther Effect   

Will California’s new assisted suicide law actually result in fewer people committing suicide as its supporters have promised?

Dramatic new findings about the Oregon experience with physician-assisted suicide (PAS) were published this week in the Southern Medical Journal which suggest that this is not true.  In a fine-grained statistical analysis of the experience in the four American states where PAS is currently legal British academics David Albert Jones and David Paton show that “the introduction of PAS seemingly induces more self-inflicted deaths than it inhibits”.

The suggestion that legalisation reduces the total number of suicides and postpones those that do occur is a popular argument on the right-to-die side. It was first mooted by libertarian economist and jurist Richard Posner and has subsequently been adopted by assisted suicide advocates around the world. It allows advocates of assisted suicide to claim, paradoxically, that they are against suicide. But there is very little data to support it.

The study by Jones and Paton suggests that Posner’s argument is plainly wrong. In fact, PAS could actually increase an inclination to suicide in others.

The evidence from suicide rates in states that have legalized PAS is not consistent with Posner’s conjecture that such legal changes would lead to delays and net reductions in suicide. Rather, the introduction of PAS seemingly induces more self-inflicted deaths than it inhibits.

Furthermore, although a significant proportion of nonassisted suicides involve chronic or terminal illness, especially in those older than age 65, the available evidence does not support the conjecture that legalizing assisted suicide would lead to a reduction in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide or that it acts in this way in some individuals but is associated with an increased inclination to suicide in others.

As psychiatrist Aaron Kheriarty points out in an commentary in the same journal: “Several well-studied phenomena in the social sciences and suicide literature suggest that Posner’s hypothesis was dubious, even before empirical testing. You do not discourage suicide by assisting suicide.” He goes on to write:

“Many PAS advocates claim that this decision is a purely private exercise of personal autonomy, but … research suggests that behaviors like suicide, whether assisted or non-assisted, influence the behaviors of not only one’s friends but also of one’s friends’ friends’ friends. No man is an island.”

One of the best-studied phenomena of suicide is the Werther effect, named after a disappointed lover who takes his own life in Goethe’s 18th century novel, The Sorrows of Young Werther. The book was phenomenally popular and sparked a rash of copycat suicides throughout Prussia. The dangers of romanticising suicide are so obvious that the Centers for Disease Control and Prevention in partnership with the National Institute for Mental Health, the World Health Organization, and the Surgeon General recommend the utmost discretion in reporting suicides, lest vulnerable people succumb to the siren call of suicide. “Suicide is already a public health crisis; do we want to legalize a practice that will worsen this crisis?” asks Dr Kheriarty.

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