For the integrated multidisciplinary approach to patient care

Return to the Southern Medical Journal

Current User S2 Access Level: -1 ()
CAN NOT ACCESS LEVEL 2

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

David Albert Jones, DPhil, David Paton, PhD
Volume: 108 Issue: 10 October, 2015

Abstract:

Objectives: Several US states have legalized or decriminalized physician-assisted suicide (PAS) while others are considering permitting PAS. Although it has been suggested that legalization could lead to a reduction in total suicides and to a delay in those suicides that do occur, to date no research has tested whether these effects can be identified in practice. The aim of this study was to fill this gap by examining the association between the legalization of PAS and state-level suicide rates in the United States between 1990 and 2013.

Methods: We used regression analysis to test the change in rates of nonassisted suicides and total suicides (including assisted suicides) before and after the legalization of PAS.

Results: Controlling for various socioeconomic factors, unobservable state and year effects, and state-specific linear trends, we found that legalizing PAS was associated with a 6.3% (95% confidence interval 2.70%–9.9%) increase in total suicides (including assisted suicides). This effect was larger in the individuals older than 65 years (14.5%, CI 6.4%–22.7%). Introduction of PAS was neither associated with a reduction in nonassisted suicide rates nor with an increase in the mean age of nonassisted suicide.

Conclusions: 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.

Article:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Images:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

References:

1. Nordt C, Warnke I, Seifritz E, et al. Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000-11. Lancet Psychiatry 2015;2:239-245.
 
2. Gassman-Pines A, Oltmans Ananat E, Gibson-Davis CM. Effects of statewide job losses on adolescent suicide-related behaviors. Am J Public Health 2014;104:1964-1970.
 
3. Stack S, Kposowa AJ. The association of suicide rates with individual-level suicide attitudes: a cross-national analysis. Soc Sci Q 2008;89:39-59.
 
4. Kelleher MJ, Chambers D, Corcoran P, et al. Religious sanctions and rates of suicide worldwide. Crisis 1998;19:78-86.
 
5. Spoerri A, Zwahlen M, Bopp M, et al. Religion and assisted and nonassisted suicide in Switzerland: National Cohort Study. Int J Epidemiol 2010;39:1486-1494.
 
6. Bostwick JM, Rummans TA. Spirituality, depression and suicide in middle age. South Med J 2007;100:746-747.
 
7. Elder RW, Lawrence B, Ferguson A, et al. The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. Am J Prev Med 2010;38:217-229.
 
8. Anderson DM, Rees DI, Sabia JJ. Medical marijuana laws and suicides by gender and age. Am J Public Health 2014;104:2369-2376.
 
9. Niederkrotenthaler T, Fu KW, Yip PS, et al. Changes in suicide rates following media reports on celebrity suicide: a meta-analysis. J Epidemiol Community Health 2012;66:1037-1042.
 
10. Sisask M, Varnik A. Media roles in suicide prevention: a systematic review. Int J Environ Res Public Health 2012;9:123-138.
 
11. Oregon Health Authority. Death with Dignity Act. http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx. Published 1997. Accessed August 18, 2015.
 
12. Washington State Department of Health. Death with Dignity Act, Initiative 1000. www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct. Published November 2008. Accessed August 18, 2015.
 
13. Vermont Department of Health. Patient Choice and Control at End of Life Act. http://healthvermont.gov/family/end_of_life_care/patient_choice.aspx. Published May 2013. Accessed August 18, 2015.
 
14. Casebriefs. Baxter v. Montana. Mont. Sup. Ct., 2009 MT 449, 354 Mont. 234, 224 P.3d 1211 (2009). www.casebriefs.com/blog/law/health-law/health-law-keyed-to-furrow/medically-assisted-dying/baxter-v-montana. Accessed August 18, 2015.
 
15. Tang NK, Crane C. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med 2006;36:575-586.
 
16. Bazalgette L, Bradley W, Ousbey J. The Truth about Suicide. London: Demos, 2011.
 
17. Swiss Federal Statistical Office. Causes of death statistics 2009: assisted suicide and suicide in Switzerland. http://www.bfs.admin.ch/bfs/portal/en/index/themen/14/02/04/dos/04.html. Accessed August 18, 2015.
 
18. Shen X, Millet L. Suicide in Oregon: trends and risk factors. http://www.oregon.gov/oha/amh/CSAC%20Meeting%20Shedule/Suicide-in-Oregon-report.pdf. Published 2012. Accessed August 18, 2015.
 
19. Posner RA. Aging and Old Age. Chicago: University of Chicago Press, 1997.
 
20. Carter v. Canada (Attorney General), 2015 SCC 5 (CanLII), paragraphs 15, 57, 58.
 
21. United Kingdom Parliament. Assisted Dying Bill [Hl]. Columns 775, 905. www.publications.parliament.uk/pa/ld201415/ldhansrd/text/140718-0001.htm. Published June 18, 2014. Accessed August 18, 2015.
 
22. EXIT-Deutsche Schweiz. FAQ. http://www.exit.ch/en/faq/. Accessed August 18, 2015.
 
23. Centers for Disease Control and Prevention. About compressed mortality, 1999-2013. http://wonder.cdc.gov/cmf-icd10.html. Accessed August 18, 2015.
 
24. Waite-Simpson L. Death with dignity law after one year. www.rutlandherald.com/apps/pbcs.dll/article?AID=/20140522/OPINION04/705229941?template=printart. Published May 22, 2014. Accessed August 18, 2015.
 
25. Freeman DG. Drunk driving legislation and traffic fatalities: new evidence on BAC 08 laws. Contemp Econ Policy 2007;25:293-308.
 
26. Marijuana Policy Project. State policy. http://www.mpp.org/states. Accessed August 18, 2015.
 
27. World Health Organization. Preventing suicide: a resource for media professionals. http://www.who.int/mental_health/prevention/suicide/resource_media.pdf. Published 2008. Accessed August 18, 2015.
 
28. Callahan J. The ethics of assisted suicide. Health Soc Work 1994;19:237-244.
 
29. Steck N, Junker C, Maessen M, et al. Suicide assisted by right-to-die associations: a population based cohort study. Int J Epidemiol 2014;43:614-622.

CME:

Portions of this issue may be available for CME credit. Please email education@sma.org for a complete listing of current Southern Medical Journal activities, as well as other SMA educational offerings.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Permissions