How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?

by David Jones and David Paton, Southern Medical Journal, 2015;108(10):599-604

Jones and Paton have researched the relationship between suicide and assisted suicide in the United States.

In particular, they were interested in testing the 1997 conjecture by Richard Posner that ‘Physician Assisted Suicide’ (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.”

That was the theory. How did it play out in reality?

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.

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