Australia: Legalising Assisted Dying Has Led to More Suicide

The Anscombe Bioethics Centre Press Release, 9 January 2024

New research published in the Journal of Ethics in Mental Health has found that the introduction of Voluntary Assisted Dying (VAD) has failed to reduce the rate of unassisted suicide in the State of Victoria. 

In fact, since the law came into force, suicide among older people in Victoria has increased by more than 50%.

New CDC Data Shows Suicide Was Leading Cause of Death Among Oregon Youth in 2018

Note: Oregon's suicide rate began rising after physician-assisted suicide became legal in 1997. This is "the elephant in the living room," not mentioned by the article below. 

To learn more about suicide contagion in Oregon, click here. To view the article below in its entirety, click here. 

Salem, Ore. -- In February the Centers for Disease Control and Prevention released data showing that suicide was the leading cause of death among Oregon youth ages 10 to 24 in 2018, up from the second leading cause of death in 2017. Oregon is now ranked 11th highest in the nation for youth suicide death rates (up from 17th in 2017).

Speaking in Washington State USA

Margaret Dore

This evening, Margaret Dore, a lawyer and president of Choice is an Illusion, was the featured speaker at St. Louise Parish Hall in Bellevue, Washington State.

Her main topics included problems with assisted suicide in Washington and how to win in the future against legalization. She also discussed suicide contagion in Oregon.

To learn more about assisted suicide in Washington State, click here, here and here.

Special thanks to Debby Ummel who organized the event.

The Letter the Kansas City Star Refused to Print

Wrong on Suicide

Dear Editor

I am an attorney and president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia. Formed in 2010, Choice is an Illusion fights against assisted suicide and euthanasia throughout the US and in other countries. 

David Grube’s guest commentary claims that Oregon’s suicide rates “overall have gone down ... since its Death with Dignity Act went into effect in 1997.” This claim is false.

Legal Assisted Suicide Encourages Other Suicide

https://www.kansascity.com/opinion/letters-to-the-editor/article216928250.html

I am an attorney and president of Choice is an Illusion, a 501(c)(4) non-profit. Formed in 2010, Choice is an Illusion fights against assisted suicide and euthanasia throughout the United States and in other countries.

David Grube’s Aug. 5 guest commentary in The Star said Oregon’s suicide rates “overall have gone down ... since its Death with Dignity Act [legalizing assisted suicide] went into effect in 1997.” I disagree with this claim.

According to the Centers for Disease Control and Prevention’s “Vital Signs” website, Oregon’s suicide rate went up 28.2 percent from 1999 to 2016. 

Legal assisted suicide encourages other suicide. Don’t be fooled.*

Hey Kansas City Star: Oregon’s Suicide Rate Went Up 28.2%, Not Down! Correct This Error.

On August 4, 2018, the Kansas City Star published this false statement:

"National and state level data from the Centers for Disease Control and Prevention’s National Vital Statistics System suggest that suicide rates have varied slightly, but overall have gone down in Oregon since its Death with Dignity Act went into effect in 1997."

Per the Centers for Disease Control (CDC), Oregon’s suicide rate WENT UP, NOT DOWN, 28.2 %

An Open Letter to the Center for Disease Control

Thank you for your press release regarding increased suicide rates in the US. Please consider the following factors not mentioned in the release.

1. The release discusses rising suicide rates begining in 1999. Oregon's assisted suicide law, legitimizing and encouraging suicide, had gone into effect just two years prior, in late 1997.

Local media then glorified assisted suicide deaths, for example, of Lovelle Svart, who was filmed taking the lethal dose and then dying at a suicide party. Indeed, local media encouraged readers to both listen and watch as Ms. Svart drank the lethal dose.

New Zealand: Cultue of Glamorizing Death Behind Suicide Rise?

http://www.investigatemagazine.co.nz/Investigate/21439/culture-of-glamorizing-death-behind-suicide-rise

Several years ago, against the advice of many, restrictions on discussing suicide in the news media were lifted.

Change advocates, with the best of intentions, argued that our suicide problem had to be brought into the open in order to change things.

Opponents relied on research showing that wider discussion of suicide tended to tip already vulnerable people over the edge.

Now the figures are in. New Zealand is enduring a big jump in suicides, particularly in the 18-24 age group, and experts are again wondering whether we are discussing it too much.

Coupled with a continual push in parliament every year for the introduction of euthanasia, and the accompanying sympathetic news media coverage glamorizing what is in effect a culture of death, is it any surprise that vulnerable people are seizing opportunities to top themselves and add to the national hand-wringing that is building up?

There would be few adults who haven't - even if only for a split second - considered the option in response to what seems like an overwhelming problem at the time.

Reasons for suicide are complex. Commentators argue economic pressure is a factor, and on the surface that is undoubtedly true. But it is more about 'expectations'. Our media and society create expectations about what life should be like in NZ, and if life doesn't match the dream we get depressed.I was shocked fifteen years ago when we sent an Investigate magazine journalist to the Philippines to discover that our suicide rate was much higher than that country where kids raided garbage bins for food. The people there, despite their lot, were collectively happier than rich but
dissatisfied New Zealand.

Sometimes suicide is purely about glamour, like a series of high school kids who killed themselves in 1984 in Auckland as part of a cult of death they'd become emotionally entangled in. They were not individually suicidal as such, but peer pressure and the sadness spread like a virus.

The bigger issue is: is talking about it every day in the media, and endorsing it as an option via euthanasia, sending a blunt message to the vulnerable? We cannot on the one hand decry suicide, yet on the other speak up in favour of killing yourself in other circumstances. A mentally unwell person doesn't make the fine distinction between physical pain from a terminal illness and the mental pain they themselves are suffering - they just hear community support for suicide.

Maybe it's time to think again about how much attention we give suicides in the media.

In Oregon, Other Suicides Have Increased with the Legalization of Physician-Assisted Suicide

By Margaret K. Dore, Esq.

Since the passage of Oregon’s law allowing physician-assisted suicide, other suicides in Oregon have steadily increased. This is consistent with a suicide contagion in which the legalization of physician-assisted suicides has encouraged other suicides. In Oregon, the financial and emotional impacts of suicide on family members and the broader community are devastating and long-lasting.[1]

A.  Suicide is Contagious 

It is well known that suicide is contagious. A famous example is Marilyn Monroe.[2] Her widely reported suicide was followed by “a spate of suicides.”[3]

With the understanding that suicide is contagious, groups such as the National Institute of Mental Health and the World Health Organization have developed guidelines for the responsible reporting of suicide, to prevent contagion. Key points include that the risk of additional suicides increases:

[W]hen the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death.[4] 

B. Physician-Assisted Suicide in Oregon

In Oregon, prominent cases of physician-assisted suicide include Lovelle Svart and Brittany Maynard.

Lovelle Svart died in 2007.[5] The Oregonian, which is Oregon’s largest paper, violated the recommended guidelines for the responsible reporting of suicide by explicitly describing her suicide method and by employing “dramatic/graphic images.” Indeed, visitors to the paper’s website were invited “to hear and see when Lovelle swallowed the fatal dose.”[6] Today, ten years later, there are still photos of her online, lying in bed, dying.[7]

Brittany Maynard reportedly died from physician-assisted suicide in Oregon, on November 1, 2014. Contrary to the recommended guidelines, there was “repeated/extensive coverage” in multiple media, worldwide.[8] This coverage is ongoing, albeit on a smaller and less intense scale.

C. The Young Man Wanted to Die Like Brittany Maynard

A month after Ms. Maynard’s death, Dr. Will Johnston was presented with a twenty year old patient during an emergency appointment.[9] The young man, who had been brought in by his mother, was physically healthy, but had been acting oddly and talking about death.[10]

Dr. Johnston asked the young man if he had a plan.[11] The young man said "yes," that he had watched a video about Ms. Maynard.[12] He said that he was very impressed with her and that he identified with her and that he thought it was a good idea for him to die like her.[13] He also told Dr. Johnston that after watching the video he had been surfing the internet looking for suicide drugs.[14] Dr. Johnston’s declaration states:

He was actively suicidal and agreed to go to the hospital, where he stayed for five weeks until it was determined that he was sufficiently safe from self-harm to go home.[15]

The young man had wanted to die like Brittany Maynard.

D. In Oregon, Other Suicides Have Increased with Legalization of Physician-Assisted Suicide

Oregon government reports show the following positive correlation between the legalization of physician-assisted suicide and an increase in other suicides.  Per the reports:

• Oregon legalized physician-assisted suicide “in late 1997.”[16]
• By 2000, Oregon’s conventional suicide rate was "increasing significantly."[17]
• By 2007, Oregon's conventional suicide rate was 35% above the national average.[18]
• By 2010, Oregon's conventional suicide rate was 41% above the national average.[19]
• By 2012, Oregon's conventional suicide rate was 42% above the national average.[20]
• By 2014, Oregon's conventional suicide rate was 43.1% higher than the national average.[21]

E. The Financial and Emotional Cost of Suicide in Oregon 

Oregon’s report for 2012 describes the cost of suicide as “enormous.” The report states:

Suicide is the second leading cause of death among Oregonians aged 15 to 34 years, and the eighth leading cause of death among all ages in Oregon. The cost of suicide is enormous. In 201[2] alone, self-inflicted injury hospitalization charges in Oregon exceeded $54 million; and the estimate of total lifetime cost of suicide in Oregon was over $677 million. The loss to families and communities broadens the impact of each death. (footnotes omitted).[22]

F. The Significance for Montana

In Montana, the law on assisted suicide is governed by   the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234 (2009). Baxter gives doctors who assist a suicide a potential defense to criminal prosecution.[23] Baxter does not legalize assisted suicide by giving doctors or anyone else immunity.[24]

The decision, however, is also confusing so that it can be read different ways. More importantly, some doctors are claiming to have assisted suicides in Montana. If nothing is done to clarify the law, there will at some point be de facto legality.

Montana already has a higher suicide rate than Oregon.[25] If Baxter is not overturned and/or the law clarified that assisted suicide is not legal, the suicide problem in Montana will only get worse. Montana does not need the Oregon experience.

Footnotes:

[1]  Shen X., Millet L., Suicides in Oregon: Trends and Associated Factors. 2003-2012, Oregon Health Authority, Portland Oregon, p.3, Executive Summary. 

[2]  Margot Sanger-Katz, “The Science Behind Suicide Contagion,” The New York Times, August 13, 2014.

[3]  Id.

[4]  "Recommendations for Reporting on Suicide,” The National Institute of Mental Health. See also “Preventing Suicide: A Resource for Media Professionals,” World Health Organization, at http://www.who.int/mental_health/prevention/suicide/resource_media.pdf.

[5]  Ed Madrid, “Lovelle Svart, 1945 - 2007, The Oregonian, September 28, 2007. 

[6]  Id.

[7]  The still shots at this link, are still up today, July 7, 2017.

[8]  The worldwide coverage of Ms. Maynard in multiple media started with an exclusive cover story in People Magazine. Other coverage has included TV, radio, print, web and social media.

[9]  Declaration of Williard Johnston, MD, May 24, 2015. 

[10]  Id.

[11]  Id.

[12]  Id.

[13]  Id.

[14]  Id.

[15]  Id.

[16]  Oregon's Death with Dignity report for 2016, p. 4, first line. 

[17]  Oregon Health Authority News Release, September 9, 2010, at https://choiceisanillusion.files.wordpress.com/2017/07/news-release-09-09-10.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000").  

[18]  Suicides in Oregon: Trend and Risk Factors, issued September 2010 (data through 2007). 

[19]  Suicides in Oregon: Trends and Risk Factors, 2012 Report (data through 2010). 
[20]  Suicides in Oregon: Trends and Associated Factors, 2003-2012 (data through 2012). 
[21] Oregon Vital Statistics Report 2015 (data through 2014;
at page 6-26, third full paragraph)

[22]  See https://choiceisanillusion.files.wordpress.com/2017/07/suicides-in-oregon-2003-2012-p-6.pdf  

[23]  Greg Jackson, Esq. & Matt Bowman, Esq., "Analysis of Implications of the Baxter Case on Potential Criminal Liability," April 2010.
[24]  State Senator Jim Shockley and Margaret Dore, Esq., "No, physician-assisted suicide is not legal in Montana: It's a recipe for elder abuse and more," The Montana Lawyer," The State Bar of Montana, November 2011.
[25]  CDC Centers For Disease Control and Prevention, "QuickStats: Age Adjusted Suicide Rates by State, United States, 2012," published on November 14, 2014.

Quick Facts: District of Columbia B21-38

By Margaret Dore, Esq., MBA

Margaret Dore Esq., MBA, Councilmember
Yvette Alexander

For more information, see Memo Opposing B21-38 and attachments. See also Suicide Contagion Memo and attachments.

1.  Overview

B21-38 legalizes physician-assisted suicide and euthanasia as those terms are traditionally defined. Legally authorized participants include health care providers and family members.

2.  Definitions

Assisted suicide means that someone provides the means and/or information for another person to commit suicide. When a physician is involved,

Brittany Maynard's Story Sends the Wrong Message to Young People

Will Johnston, MD

Dear Editor:

I agree with the Gazette editorial board that legal assisted suicide sends the wrong message to young people. ("Vote 'no' on more suicide," 09/26/16). I also write to describe the damaging impact of the highly publicized case of Brittany Maynard, on my young adult patient who became actively suicidal after watching her video. I understand that her story is now being used to promote assisted suicide legalization in Colorado.

Ms. Maynard died in November 2014. A month later, I was presented with my young adult patient during an emergency appointment. He was physically healthy. His mother told me that he had been acting oddly and talking about death.

Montana: Say "No" to the Oregon Experience

By Margaret Dore, Esq., MBA

To view pdf version with footnotes, click here.

Since the passage of Oregon’s law allowing physician-assisted suicide, other suicides in Oregon have steadily increased. This is consistent with a suicide contagion in which the legalization of physician-assisted suicides has encouraged other suicides. In Oregon, the financial and emotional impacts of suicide on family members and the broader community are devastating
and long-lasting.

Military Veteran Groups Threatened by Assisted Suicide Study Bill in NH; Bill Defeated 174 to 123!

From True Dignity Vermont
http://www.truedignity.org/military-veteran-groups-threatened-by-assisted-suicide-study-proposals-in-nh/

To hear Representative Baldasaro's speech, click here

Rep Al Baldasaro

Rep. Al Baldasaro of the New Hampshire Legislature on May 11 gave an impassioned speech against a proposed “study committee” to look at “end of life choices.” Speaking on behalf of Veterans’ PTSD/TBI Commission, he cited the fact that New Hampshire is facing an epidemic of suicides among Veterans, and said, “What message are you sending to the community out there and all the good work every one of us has done to protect people from killing themselves? Now we want to make it easy?”

He said that opening the door to such a practice would have grave consequences for veterans at risk for suicide, and that even studying such a bill would threaten efforts to help veterans.   He clearly states that euphemisms such as “aid in dying” don’t change the fact that such laws promote suicide and threaten efforts to protect people from killing themselves.

***

On May 11, 2016, the New Hampshire House of Representatives defeated the bill, 174 to 123.

Robert Falcon Ouellette Parliament Speech

http://www.nationalrighttolifenews.org/news/2016/05/robert-falcon-ouellette-suicide-assisted-suicide-speech-in-parliament/#.Vy1XCSghzzJ

Editor's Note Mr. Ouellette, a 38-year-old Cree, references Attawapiskat. Last month the Canadian parliament held an emergency debate on Aboriginal suicides after 11 people, nine of them minors, attempted suicide in one weekend in Attawapiskat, a remote community of 2,000 in northern Ontario.

The following is excerpted from the speech delivered by Robert Falcon Ouellette MP (Winnipeg Centre Liberal) on Monday May 2.

Robert Falcon Ouellette MP

"[Bill C-14] is taking us down a path that is very 

dangerous, and we do not know where it ends."

Madam Speaker, a report in The Globe and Mail on April 24, 2016, says 13-year-old Sheridan Hookimaw killed herself on the banks of the river that winds through Attawapiskat. The sickly girl had been flown out for weekly medical appointments. She wanted to end her pain, and in the process, she set off a chain reaction not only in her community but in communities right across this country, which we are still dealing with today.

Why on Earth is Anyone Surprised By the Rise in US Suicides? Advertising Works.

"Though the economy may well have contributed to this rise,
True Dignity calls everyone’s attention to a fact that is being ignored. 1998 was the year in which Oregon became the first state in the nation  to put legalized assisted suicide into practice."

From True Dignity Vermont:

News sources are reporting with surprise and seeming alarm on the Center for Disease Control's newly released statistics showing that deaths by suicide in the entire US are on the rise.  Why the surprise?  It has been common knowledge since the rise of mass media, and even before, that advertising works.

True Dignity has neither the expertise nor the time to analyze the CDC report’s statistics  in detail.   A few quotes will suffice to paint the picture of our current situation.

“The suicide rate in the United States increased by 24% from 1999 through 2014…among all groups.  The increase in suicide rate has been steady since 1999, before which there was a consistent decline since 1986…”  (USA Today, April 22, 2016, http://www.usatoday.com/story/news/2016/04/22/suicide-rate-rise-us/83284568/).

The Cost of Physician-Assisted Suicide.

By Margaret Dore, Esq., MBA*
Updated November 25, 2015 

It is often assumed that legalizing physician-assisted suicide will save states money. Don’t be so sure. In Oregon, legalization is correlated with an increase in other suicides, the cost of which is "enormous."

More Suicide

Oregon's law legalizing physician-assisted suicide went into effect “in late 1997.”[1] Since then, Oregon has reported a small, but steadily rising number of deaths.[2]

Oregon's other suicides, which are tracked separately, have also increased. Indeed, by 2000, Oregon's suicide rate for other suicides was "increasing significantly."[2] By 2007, Oregon's suicide rate for other suicides was 35% above the national average.[3] By 2010, Oregon's suicide rate for other suicides was 41% above the national average.[4]

The Financial Cost

The financial cost of these other suicides (and suicide attempts) is huge for Oregon, a smaller population state. The Oregon Health Authority states:

The cost of suicide is enormous. In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars; and the estimate of total lifetime cost of suicide in Oregon was over 680 million dollars. (Footnotes omitted).[5]

California Prohibition Against Assisted Suicide is Constitutional.

Margaret Dore, Esq., MBA

A California trial court has upheld the constitutionality of that state's criminal statute prohibiting assisted suicide, which states:

Every person who deliberately aids, or advises, or encourages another to commit suicide, is guilty of a felony.

Penal Code § 401

The court's reasoning is contained in a 19 page "Ruling on Demurrer," filed on July 24, 2015. The ruling uses the term, "Aid in Dying" to mean physician-assisted suicide.  The term also means euthanasia. The court states in part:

Since "Aid in Dying" is quicker and less expensive, there is a much greater potential for its abuse, e.g,, greedy heirs-in-waiting, cost containment strategies, ímpulse decision-making, etc. Moreover, since it can be employed earlier in the dying process, there is a substantial risk that in many cases, it may bring about a patently premature death. For example, consider that a terminally ill patient, not in pain but facing death within the next six months, may opt for “Aid in Dying”' instead of working through what might have been just a transitory period of depression. Further, "Aid in Dying" creates the possible scenario of someone taking his life based upon an erroneous diagnosis of a terminal illness illness, which was, in fact, a mis-diagnosis that could have been brought to light by the passage of time. After all, doctors are not infallible.

Delaware Talking Points

1.  HB 150 legalizes assisted suicide for persons with a "terminal disease," which is defined as having less than six months to live.  In Oregon, which uses the same definition, young adults with chronic conditions such as diabetes are "eligible" for assisted suicide.  Such persons can have years, even decades, to live.  Consider also, Jeanette Hall, who was adamant that she would do assisted suicide, but was convinced to be treated instead.  Today, nearly 15 years later, she is "thrilled to be alive."  See  http://www.montanansagainstassistedsuicide.org/2013/04/if-kress-had-been-my-doctor-in-2000-i_27.html

2.  In Oregon, it is well-documented that Medicaid steers people to suicide through coverage incentives.  Private insurers have this same ability.  For more information, see the affidavit of Kenneth Stevens, MD, at this link:  https://maasdocuments.files.wordpress.com/2014/08/dr-stevens-affidavit_001.pdf

3.  Legalization of assisted suicide is a recipe for elder abuse. Once the lethal dose is issued by the pharmacy, there is no oversight.  Even if the patient struggled, who would know?

4.  In Oregon, other (conventional) suicides have increased significantly with the legalization of physician-assisted suicide.  In Oregon, conventional suicides are a $41 million problem due to hospitalization costs, etc.  See http://www.choiceillusion.org/2014/03/the-high-financial-cost-of-regular.html  Legalization, regardless, sends the wrong message to young people that suicide is an acceptable solution to life's problems.

For a short article about Washington's similar law, please go here: https://www.kcba.org/newsevents/barbulletin/BView.aspx?month=05&Year=2009&AID=article5.htm

California: Memo to Senate Appropriations Committee: "Vote 'NO' on SB 128: The financial impact is potentially 'enormous.'"

By Margaret K. Dore, Esq., MBA

To view a pdf version,  please click here.

A. Introduction

SB 128 seeks to legalize physician-assisted suicide.  The bill is based on a similar law in Oregon, which was enacted in 1997.  In Oregon, the law is rarely used, but since passage, there has been a significant increase in other (conventional) suicides.  This increase is consistent with a suicide contagion in which legalization and promotion of physician-assisted suicide has led to an increase in other suicides.  Moreover, the financial cost is “enormous.”  A government report from Oregon states:

In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars.

This Committee must vote NO unless the proponents can show that California will not have a similar increase in conventional suicides. Otherwise, the financial cost in California could be “enormous.”

California: "SB 128 has the potential for a large and adverse financial impact."

LETTER submitted to the Senate Appropriations Committee (edited for the web):

Please accept this cover letter and memo in opposition to SB 128 for the purpose of the May 11th hearing. 

Based on the "Oregon experience," passage of SB 128 has the potential for a large and adverse financial impact on the state of California.  The cover letter explains why as follows:

SB 128 seeks to legalize physician-assisted suicide. 

In Oregon, which has had a similar law since 1997, legalization is statistically correlated with an increase in other suicides.  This increase is consistent with a suicide contagion in which the legalization of one type of suicide (physician-assisted) has led to an increase in other (conventional) suicides.  Moreover, the financial cost is "enormous."  A government report from Oregon states:

"In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars."  (Emphasis added).

Here are the full links:  

https://choiceisanillusion.files.wordpress.com/2015/05/dore-ltr-ca-sen-appr-com_001.pdf

https://choiceisanillusion.files.wordpress.com/2015/05/sb-128-senate-appropriations-memo-updated.pdf

Thank you for your consideration.

Margaret Dore, Esq., MBA, President
Choice is an Illusion, a nonprofit corporation
Law Offices of Margaret K. Dore, P.S.
www.choiceillusion.org 
www.margaretdore.com 
1001 4th Avenue, Suite 4400
Seattle, WA  98154