The Corner

U.S.

Suicide Prevention Researchers Leave Out Assisted Suicide

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It almost never fails. A learned article in a medical or bioethics journal laments our suicide crisis and urges greater efforts at prevention. And yet somehow, the authors never once mention the elephant in the room: i.e., the impact of ubiquitous suicide promotion by “death with dignity” activists, boosted by media commentators, in popular culture features, and as furthered by politicians.

It just happened again. An article published in the AMA’s JAMA Psychiatry: promises to “flatten the curve” of our rising suicide numbers, but doesn’t once mention assisted suicide as a contributor to the problem:

To drive this research agenda, we are acting on research that indicates suicide prevention efforts in health care settings have the potential to significantly reduce suicide rates. Nearly 30% of decedents had a health care visit in the 7 days before suicide; half were seen in health care settings within the preceding 30 days; and around 90% had visits in the year before death. Second, applying universal screening in the emergency care setting could double the number of individuals identified within usual care.

Similarly, the application of risk prediction algorithms to electronic health records can enhance prediction of suicide attempts and deaths, particularly when the data are enriched with screening information. Third, there is a growing suite of effective interventions and care practices that include medications and psychotherapies, a brief safety plan intervention, and follow-up efforts at high-risk, critical points of care transition such as “caring communication” contacts, and telephone calls to encourage ongoing social connection and care engagement. These practices can improve function and reduce the frequency of suicide attempts between 30% to 50% over the following year. The NAASP recommends that these practices be combined in a system of care and that health care organizations strive for this “Zero Suicide” approach.

I’m all for it. But pretending assisted-suicide deaths are not “suicide,” as most laws require, doesn’t make them not suicide, and merely sweeps that aspect of our crisis under the rug.

Active suicide promotion for the ill and disabled is something new in our history. Unless suicide-prevention researchers include the impact of such advocacy in their studies, assess the consequences of the “some-suicides-are-good” message communicated by laws legalizing doctor-prescribed death, and explore the shameful failure of doctors and hospice professionals to call in prevention services when someone asks for help in dying where assisted suicide is legal, this will be for naught.

To paraphrase Lincoln, we can’t be half suicide prevention and half suicide promotion. Sooner or later, we will be all one or the other.

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