The risk is real: Evidence cannot exclude link between suicide and euthanasia

Will euthanasia lead to an increase in suicides? The debate about legalising euthanasia ultimately comes back to the risks it creates and whether these can be safely managed. One of the risks is whether the legalisation of euthanasia will impact suicide rates.

New Zealand has some of the highest suicide rates in the world, now standing at 13.9 per 100,000 people and rising every year. The rate for Ma¯ori is almost double that for Europeans and the rates for adolescents and young men in their 20s reaches as high as 36.4 per 100,000.

In an open letter to MPs, 21 mental health practitioners, doctors and academics recently stressed the need for MPs to reconsider the potential connection between suicide and the legalisation of euthanasia.

Consultant psychiatrist Dr Chris Gale, one of the signatories, has noted that many MPs may have a false sense of reassurance on the basis of a departmental report by Ministry of Justice and Ministry of Health officials which concluded there was no evidence that assisted dying would increase suicide rates. Gale says the conclusion seems to have been based on a cursory analysis of one study in particular, and did not consider other factors, such as statistical patterns being seen in Oregon, the Netherlands and Belgium.

There is already anecdotal evidence of a link between euthanasia and an increase in non-assisted suicide rates as evidenced by numerous practitioners. South Auckland GP Janet Vaughan told the Justice Select Committee: “. . . we are telling youth that suicide is not the answer [to suffering] and yet, saying to our . . . terminally ill that it is. Those youth that have talked to me about the issue have mentioned the double standard.”

This resonates with me.

As a registered mental health nurse and therapist working with young people who have chronic and persistent suicidal thoughts and urges, I have observed my clients using end-of-life “choice” arguments around bodily autonomy and unbearable suffering to justify their suicidal inclinations. The risk is real.

While the evidence to date is largely anecdotal, this reflects that no one has yet researched this question. That said, there is more “suggestive evidence” emerging, based on international research and statistical analysis, that the introduction of euthanasia potentially will lead to an increase in non-assisted suicide rates.

For example, close examination of suicide statistics in overseas jurisdictions where some form of assisted death is available raises a number of red flags. In Oregon, where assisted suicide has been available since 1997, the non-assisted suicide rate dropped 18 per cent to a record “low” of 13.9 per 100,000 between 1986-1999. However, from 2000 onwards, Oregon’s suicide rates steadily increased, reaching 17.7 per 100,000 in 2012. By 2014, the suicide rate in Oregon was 43 per cent higher than the national average.

These statistics support the notion that euthanasia normalises suicide and emphasises the need for more research.

A similar situation exists in the Netherlands, where non-assisted suicides have also continued to rise despite the massive increase in persons dying by euthanasia. In the decade to 2017, the Netherlands observed a 33 per cent increase in non-assisted suicide rates, a trend that goes against the pattern in surrounding European countries which — Belgium excepted — have all seen falling rates of non-assisted suicide. Of further concern is the fact the increase occurred at the same time euthanasia rates in the Netherlands began to climb steeply.

Analysing the statistical trends are more complex for Belgium, which has a similar euthanasia regime to the Netherlands. Between 2002 and 2015, the rates in Belgium fell from 19.50 to 15.80 per 100,000, a drop of 19 per cent. This might seem to undermine the argument that there is a causal link between euthanasia and non-assisted suicides.

However, over the same period, the suicide numbers in Austria fell 31 per cent from 18.6 per 100,000 to 12.90. Similarly, in Germany, rates have fallen 38 per cent over 25 years from a high 17.1 in 1990 to a low 10.6 in 2015.

It would not be unreasonable to expect suicide figures in Belgium to have dropped by a similar rate. So, once again, a causal link to euthanasia cannot be excluded.

So, while Act MP David Seymour continues to deny there is a link, arguing there is “no evidence for that claim”, his claim neither stands up to scrutiny and nor is it based on evidence.

What evidence there is suggests a causal link cannot be excluded.

If we remain truly serious about curbing suicides, legalising euthanasia is simply too great a risk.