“Assisted dying” has implications for suicide prevention
In May 2015 the Scottish Parliament rejected the Assisted Suicide (Scotland) bill by 82 to 36 votes, partly because of concerns that “assisted dying” contradicts suicide prevention. Here is an excerpt from the official report by the Scottish Parliament Health and Sport Committee:
Suicide prevention strategy
269. Although there is no legal prohibition on suicide in Scotland,²⁰² the Scottish Government identifies suicide as a negative social phenomenon, and strives to reduce the incidence of suicide via its Suicide Prevention Strategy 2013-2016.²⁰³ This mirrors the view of the World Health Organization that “[s]uicide prevention is an important priority”.²⁰⁴
270. The Government’s Strategy notes that “The World Health Organization has adopted a global target that suicides will be reduced by 10% by 2020. During the period of this strategy, we want to continue the downward trend in the rate of suicide in Scotland and make progress towards the WHO target.”²⁰⁵
271. The Ministerial Foreword to the Strategy opens with the sentence: “Every suicide is a tragedy that has a far reaching impact on family, friends and the community long after a person has died.”²⁰⁶
272. The Suicide Prevention Strategy acknowledges that: “How we talk about suicide is important. We know that talking openly about suicide in a responsible manner saves lives. We have adopted that approach through the Choose Life campaigns ‘Suicide: Don’t hide it. Talk about it’ and ‘Read Between the Lines’.”²⁰⁷
273. The Committee acknowledges that discussion of the current Bill forms part of “how we talk about suicide”.
274. Living and Dying Well claim that the Bill “flies in the face” of suicide prevention strategies and social attitudes to suicide²⁰⁸ insofar as it “create[s] a class of people whose suicides it is appropriate to assist”.²⁰⁹ The Anscombe Bioethics Centre and the Scottish Council on Human Bioethics likewise raise the issue of suicide prevention.²¹⁰
275. There seem to be two main concerns about the way this Bill might interact with suicide prevention strategy. First, that enacting a Bill of this kind would undermine the aim of preventing suicide in two ways: (i) by seeming to contradict the wider suicide prevention message, or by watering it down with exceptions,²¹¹ and (ii) by “normalising” suicide: this argument is that when law permits a practice, this is perceived as endorsement, and as society absorbs that endorsement, the general perception of the practice changes.
276. Second, some of the written submissions express discomfort about the idea that there are any exceptions to the message that suicide is a tragedy which ought to be prevented. The concern is that, by allowing assisted suicide in some cases while seeking to prevent it in others, the law sends a message – both to society at large, and to vulnerable individuals – that not all lives are equally worthy of protection, or equally valuable or worthwhile, and that suicide is a reasonable response to the poor or low quality of some people’s lives.²¹²
277. The Committee acknowledges that discussion of the current Bill forms part of “how we talk about suicide”.
278. There appears to be a contradiction between a policy objective of preventing suicide, on the one hand, and on the other, legislation which would provide for some suicides to be assisted and facilitated.
279. The Committee notes that, unless assisted suicide is to be made freely available to all, any legislation permitting it must identify eligibility criteria. Where legislation to permit assisted suicide exists alongside a wider policy of suicide prevention, the eligibility criteria in the legislation serve to differentiate between circumstances in which suicide is to be regarded as a tragedy and prevented wherever possible, and circumstances in which suicide is to be regarded as a reasonable choice, to be facilitated and supported.
280. The Committee is concerned that this has the potential not only to undermine the general suicide prevention message by softening cultural perceptions of suicide at the perimeters, but also to communicate an offensive message to certain members of our community (many of whom may be particularly vulnerable) that society would regard it as ‘reasonable’, rather than tragic, if they wished to end their lives.
202 This is the majority view, but Professor James Chalmers believes that the position is unclear.
203 Scottish Government (2013) Suicide Prevention Strategy 2013-2016.
204 World Health Organization (2013) Comprehensive mental health action plan 2013–2020 http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R8-en.pdf.
205 Scottish Government (2013) Suicide Prevention Strategy 2013-2016, p6.
206 Scottish Government (2013) Suicide Prevention Strategy 2013-2016, p1 page1 (Ministerial Foreword).
207 Scottish Government (2013) Suicide Prevention Strategy 2013-2016, p8.
208 Health and Sport Committee. Official Report, 20 January 2015, Col 16.
209 Living and Dying Well. Written submission, page 1.
210 Anscombe Bioethics Centre. Written submission. Scottish Council on Human Bioethics. Written submission.
211 Living and Dying Well, p1. Written submission, page 1.
212 Anscombe Bioethics Centre. Written submission.