By Alex Schadenberg
International Chair, Euthanasia Prevention Coalition
For several years the Oregon suicide statistics seemed to indicate that legalizing assisted suicide had a suicide contagion effect.
The assisted suicide lobby argue that legalizing assisted suicide prevents desperate people from dying by suicide and they argue that legalizing assisted suicide enables people to live longer because they do not need to die earlier by suicide in order to be capable of causing their own death. The second argument was wrongly accepted by the Supreme Court of Canada in the Carter decision.
The data is clear. A study published by the Southern Medical Association (October 2015) concludes:
Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease 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 other individuals.
The study examined the suicide rates in Oregon, Washington State, Montana and Vermont, where assisted suicide is permitted. After taking into account factors that are known to effect suicide rates, the data indicates that:
PAS is associated with an 8.9% increase in total suicide rates (including assisted suicides), an effect that is strongly statistically significant (95% confidence interval 6.6%Y11.2%). Once we control for a range of demographic and socioeconomic factors, PAS is estimated to increase rates by 11.79% (95% CI 9.3%Y14.1%). When we include state-specific time trends, the estimated increase is 6.3% (95% CI 2.7%Y9.9%).
Therefore legalizing assisted suicide is associated with at least a 6.3% increase in the rate of suicide deaths.
The other assertion is that legalizing assisted suicide enables people to live longer since they do not need to die earlier based on being able to commit suicide. The study considered this argument as attributed to Richard Posner.
Richard Posner has conjectured that legalizing PAS may have the effect of reducing the total number of suicides and postponing those that do occur. The knowledge that PAS is available for people who are physically incapacitated could enable such patients to delay their decision to attempt suicide. Furthermore, some may be contemplating suicide because of an overly pessimistic belief about the progress of their disease and/or about their ability to cope with their declining condition. If people delayed their attempt at suicide they might then come to see that they had been mistaken. As a result, "if physician-assisted suicide in cases of physical incapacity is permitted, the number of suicides will be reduced. Moreover, in the fraction of cases in which suicide does occur, it will occur later than if physician-assisted suicide were prevented." An implication of Posner's conjecture about delays to suicide is that there would be an increase in the average age of suicide.
The Supreme Court of Canada agreed with Posner's assertion:
In 2014 "evidence of premature death" resulting from the lack of access to PAS was presented before the Supreme Court of Canada. In February 2015 the court concluded that "the prohibition deprives some individuals of life."
The study found no evidence that people delay death when assisted suicide is legal:
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.
Therefore the Supreme Court of Canada was wrong when it asserted that prohibiting assisted death was an infringement of Section 7 of the Charter, the right to life. The data does not uphold this dangerous and irresponsible conclusion.
Canada's parliament will need to respond by either using the Notwithstanding Clause (Section 33 of the Constitution) to put aside the Supreme Court decision or to protect Canadians with robust legislation that prohibits euthanasia and assisted suicide.