Prevent Suicide and Legalize Assisted Suicide?

Yesterday was World Suicide Prevention Day, an event that the UN honored with the theme, "Suicide Prevention in Different Cultures." A press release issued by the United Nations highlights the day's events and reminds us that 1 million people around the world die each year from suicide; it is the 10th leading cause of death globally and like so many causes of death, preventable.

Many anti-death with dignity advocates have postulated that legalizing aid in dying, or "assisted suicide," undermines efforts to prevent suicide. If we allow "suicide" among one group in society (the terminally ill, as with Death with Dignity), how can we work to prevent it in others?

The question about assisted suicide arose in a press conference held by Werner Obermeyer, Senior External Relations Officer of the World Health Organization (WHO) and Brian Mishara, President of the International Association for Suicide Prevention (IASP). While they stressed that suicide was preventable and discussed how it afflicts cultures around the world, when asked about assisted suicide, the release emphasizes the relatively small number of those who elect and follow-through with assisted suicide.

More interesting to me, as we watch the Baxter v Montana case over the next few months, is the distinction to be made between depression as a main cause for suicide in culture and the desire for a painless, dignified death among the terminally ill. Often we assume that desire for death is unnatural or that it can only be a result of mental illness or depression. This narrative - that only the depressed can wish to die and because depression is treatable, we are obligated to not honor these wishes but treat patients for depression - prevents us from seriously addressing the autonomy, dignity, and privacy of the terminally ill. To admit that sometimes life really is not worth living represents yet another "slippery slope" to some.

Yet I suspect that once we address a desire to end ones life separately from depression or mental illness, we will better understand it - at the end of life or any other time.

From the press release:

In 90 per cent of cases, the cause of suicide was related to mental disorders, such as depression and substance abuse. In Eastern European countries, alcohol played a big role in suicide, while in Asia the ingestion of pesticides was used in many suicides. Indigenous people, particularly in developed countries, were heavily affected by suicides, an issue that would be addressed at the next session of the United Nations Permanent Forum on Indigenous Issues. Suicide prevention required a multisectoral approach involving education, labour and the media, among others.

Mr. Mishara said that, despite the high rate, little attention was paid to the phenomenon. The suicide rate in European countries and countries in the Asian Pacific region were declining, however, because of national suicide prevention strategies. The highest risk group for suicide were men over 85 years old. That group, however, was now being targeted as a risk group.

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Addressing a question about assisted suicide, he said that practice was legal in Oregon and Washington, United States, and the Netherlands, although the practice was rarely used. Assisted suicide had never been legalized in Switzerland, but there was no law to prohibit the practice. Of the few requests for assisted suicide in Oregon, 43 per cent of those who had obtained medicine to end their life did not take it. Most suicidal people did not die by suicide, he stressed. Nearly everybody had, at some point in their life, considered suicide. There were, however, 100 attempts for every successful suicide. Most people changed their mind after they had started an attempt to end their life.