Menu
In the context of terminal and chronic illness, a wish to die is often temporary and transient due to depression caused by illness. In the general population, suicidal thoughts and urges are common symptoms of depression, and serious suicidal thoughts rarely arise apart from depression.
Correspondingly, and worryingly, in those jurisdictions where euthanasia and assisted suicide have been introduced into law and medical practice, significant proportions of those who have been euthanised or who have been enabled to commit suicide, have suffered from depression and suffered from other forms of mental ill health.
In the U.S. State of Oregon, a used by proponents EAS as a great example of what they are advocating, reports of individual assisted suicide cases show that patients are receiving assisted suicide who suffer from depression and dementia. A 2008 study published in the British Medical Journal examined 58 Oregonians who sought information on assisted suicide. Of them, 26% met the criteria for depressive disorder, and 22% for anxiety disorder. Three of the depressed individuals received and ingested the lethal drugs, dying within two months of being interviewed. The study’s authors concluded that Oregon’s law “may not adequately protect all mentally ill patients”.
The latest annual Death with Dignity Report issued by the State’s Public Health Division states that only 3.6% of patients dying by assisted suicide since 1998 have been referred for psychiatric evaluation. Based on the 26% figure above, 60 people should have been so referred in 2020 rather than the 3 (1.2%) who were, and only 1 (0.5%) in 2019.
We would expect such a low referral rate. In 2006, having compiled the available evidence, the UK’s Royal College of Psychiatrists advised that “many doctors do not recognise depression or know how to assess for its presence in terminally ill patients” (Statement from the Royal College of Psychiatrists on Physician-Assisted Suicide (2006), para. 2.4.). In the two doctor certification system proposed in the Oregon model, nothing establishes how the attending or consultant physicians would be able to overcome this, and even requiring one or both to possess mental health training, or the involvement of a mental health professional, would fail to address the insufficient time that would be had in only a few meetings with the patient to properly diagnose mental illness where it exists.
A 2015 study examined the association between the license of assisted suicide (AS) in individual American States, and suicide rates of those States, between 1990 and 2013. Introduction of that practice was associated with a 6.3% increase in total suicides (including assisted suicides), with a 14.5% effect in those over 65. The study concluded that States which had introduced AS saw an increased rate of total suicides relative to other States that had not done so, and that the same saw no decrease in non-assisted suicides. The implication of this was that licensing assisted suicide not only does not inhibit suicide more generally, but is associated with an increased inclination to suicide in some individuals. Such a reality would directly entail that EAS directly undermines society’s attempts at suicide prevention.
This is in fact an emerging area of discussion needing far more research, which attempts to license euthanasia and assisted suicide in Jersey would pre-empt.
Noa Pothoven (17), a 17-year old girl who suffered from PTSD after being raped, as well as consequent depression and anorexia, was allowed to starve herself to death in the Netherlands in 2019. One of her complaints before she died was that the Netherlands does not have specialised institutions or clinics where teenagers can go for psychological aid. Hers then, is a case where a medical and general culture allows a young person to experience a failure in care, and then allows her to take her own life in a context of normalised suicide.
Assisted suicide coarsens attitudes to suicide, normalising it in societies that have introduced it and drastically undermines suicide prevention campaigns. The rates of patients ending their own lives this way have increased exponentially wherever they have been introduced. The statistics gathered by the Oregon State Public Health Division show that the numbers of assisted suicides rose from 16 in 1998, to 191 in 2019. The latest 2020 figures show this has now increased to 245, an increase in one year of 28%.
If we were to abandon the law’s prohibition on EAS therefore, then the result would be to remove the cultural and public safety role of our law, potentially leading to ‘suicide contagion’. Evidence of each jurisdiction which has introduced euthanasia and assisted suicide shows that numbers of those being euthanised or committing suicide with assistance from their physician rises profoundly over time.
