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Would the legalisation of Medically Assisted Dying encourage suicide in the NZ population?

Some opponents of Medically Assisted Dying are concerned that the introduction into NZ would increase suicide. End-of-Life Choice says that there is no evidence that this would happen or has happened. In fact, there is some evidence that the absence of Medically Assisted Dying leads some individuals with relentless disease to take their lives prematurely while they are still physically able to do that.

Suicide rates in legalised jurisdictions

If it were true that Medically Assisted Dying encouraged suicide, one might expect that in countries where legalisation has occurred, the suicide figures would confirm a link. However, from data available, there is no evidence of a causative link in countries where legalisation has occurred.

  1. Suicide rates in both Luxembourg (8.55 /100,000 in 2017) and Switzerland (11.3 /100,000 in 2016) are decreasing (the figures are significantly lower than in 2007).
  2. Oregon: the ‘Death with Dignity Act’ in Oregon was passed in late 1997. They have always had a high suicide rate compared with the average for the USA (although they are lower than many States – rank 13th in the USA). In 1986 there was a peak at 17/ 100,000, and while lower in the intervening years (14-15), they have returned to 17/100,000, with sharp upward spikes in 2009 and 2010. They were 17.8 in 2015 and 17.79 / 100,000 in 2018. This increase mirrors an increase in the average for the rest of the USA.
  3. Netherlands: the Netherlands legalised assisted dying in 2002. At 9.6 /100,000 of the population (after rises over the previous 6 years), the rate of suicide in 2016 is similar to the level which was present in the early 1990s. However, the suicide rate is still less than NZ figures, which have hovered between 10 and 15/100,000 between 1985 and 2018. It is noteworthy that the average European Country rate is 12/100,000, and out of 25 countries, 17 are higher than the Netherlands.
  4. Belgium has traditionally had high rates of suicide e.g. 15/100,000 (1965), 22.1 (1980), 23.1 (1985) and 19.4 (1995). In 2013 and 2016 the rates were 15.7/100,000 which is lower than all previous rates since 1970. Legalisation of assisted dying in Belgium occurred in 2002.

Summary of Suicide Statistics above:

The above figures show there is no correlation between the legalisation of Medically Assisted Dying and increased suicide rates. Luxembourg, Switzerland and Belgium have decreased rates. Oregon is the same as more than 10 years prior to legalisation. The Netherlands rate is the same as 10 years prior to legalisation and is lower than most of the other European countries and NZ.

Premature Death by Suicide because Medically Assisted Dying is not available

There is abundant evidence now that individuals will often commit suicide rather than endure the ravages of their disease, because assisted dying is not available to them.

  1. Professor John Weaver did a major study on suicide deaths in NZ between 1900 and 2000. In the last 50 years of that period, he found that 5-8% of all suicides were what he termed ‘euthanasia deaths’ to prevent them having to die slowly from their disease. They were well characterised, often had letters explaining the situation, and were frequently very violent and undignified deaths.
  2. Knowing that the option of assisted dying is available to a patient should they need it, clearly allows peace of mind to individuals, and in some cases prolongs life. The issue was acknowledged by the Canadian Supreme Court February 2015 and they agreed with this.

Prepared by Dr Jack Havill, Past President of End-of-Life Choice

Revised Jan 2019

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