Webcast archive: 18/06/15

In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:

  • New CDC report on rising US suicide rates
  • American Medical Association to continue studying its position on assisted suicide

Please note that this text is only a script and that our webcast contains additional commentary.

NEW CDC REPORT ON RISING US SUICIDE RATES

  • This week, the Centers for Disease Control and Prevention in the US (known as the CDC) released a report on the trends they identified in suicide rates from 1999-2016.  Most data were taken from the National Vital Statistics System, looking at people aged 10 and over.
  • The biggest “headline” taken from the report is that suicide rates have increased by 30% since 1999. Suicide is the tenth leading cause of death in the US. In 2016, almost 45,000 people died by suicide.  Adults aged 45–64 showed the largest increase, from around 13 people per 100,000 in 1999, to about 19 per 100,000 in 2016. Most of the deaths fell within this age range as well; there were 232,108.
  • The survey does not include assisted suicides. States where assisted suicide was legal during the survey period (Oregon, Washington and Vermont), do not count assisted suicide in their suicide statistics.
  • Suicide rates increased in every state but Nevada; its rate was consistently high throughout the study. Increases greater than 30% were seen in half the states, and there were 12 states where the increase ranged from 38% to 58%. The biggest rise in suicide rates for the 17-year period was 58% in North Dakota. Overall, the number of suicides increased by 1.5% per year. Among men, the suicide rate went up 1.1% every year; the annual increase among women was 2.6%.
  • Some of the contributing factors mentioned by researchers include:
    • Being male
    • Belonging to a racial minority
    • Relationship problems, including break-ups or deaths
    • Legal problems
    • Eviction or loss of one’s home
    • Physical health problems,
    • Job or financial problems,
    • Access to lethal means among persons at risk, and
    • Poor coping and problem-solving skills.
  • Since “suicide prevention largely focuses on … mental health treatment and preventing reattempts,” the social and economic factors – including those related to disability and isolation – are being overlooked.
  • In response to a 2012 private members’ bill sponsored by Harold Albrecht, Canada came up with a national suicide prevention framework in 2016. The framework sets out the Government of Canada’s strategic objectives, guiding principles and commitments related to suicide prevention.
  • It discusses who is likely to consider suicide and why, and briefly touches on the role that government and non-profit agencies can play in preventing suicide. But most of the proposed actions are related to the spread of information, “awareness,” continuing research, and “defining best practices.” Meanwhile, nearly 4,000 people have ended their lives since AS/E was legalized two years ago.
  • Canada’s suicide prevention framework doesn’t say much about disability. People with disabilities are among the groups about whom “knowledge gaps” exist in the current research. Disability supports are also mentioned as necessary for some veterans of the Canadian Armed Forces.  And that’s it for references to disability.
  • The word “suicide” is not actually defined anywhere in the framework.
  • Also, though the framework came out after Canada’s assisted suicide and euthanasia legislation was adopted, there is no mention of these practices.
  • Canada could learn much from the suicide prevention plan designed by the Suicide Prevention Resource Center for the state of Connecticut. Besides the necessary collection of data, it includes a wide variety of practical procedures to reach disadvantaged groups before, during and after a crisis. The proposal recommends:
    • Mandatory suicide prevention training for social workers and licensed mental health providers;
    • Integration of suicide prevention into staff training for domestic violence centres and legal services specializing in immigrant populations;
    • Incorporating suicide prevention into school curricula;
    • Connecting hospital emergency rooms with organizations specializing in outpatient care; and
    • Offering assessment services in “atypical” locations, like places of worship and community centres.
  • The Connecticut plan also includes specific provisions related to disability:
    • It identifies disability-specific risk factors for suicidality, including:
      • changes in health status;
      • difficulties navigating social and financial services;
      • stress of chronic stigma and discrimination;
      • loss or threat to independent living supports; and
      • institutionalization or hospitalization.
    • The Connecticut plan cites advocates and researchers who have personal experience with disability, including professors Carol Gill and Bill Peace.
    • The plan also recommends:
      • training practitioners to work specifically with disabled people;
      • avoiding the assumption that suicide is a reasonable response to disability, and
      • focusing instead on mental health and other social circumstances that could make life seem unbearable, regardless of existing disability.
  • In a disturbing trend, suicide prevention organizations continue to try to redefine suicide to exclude deaths facilitated by the medical profession. In 2016, the Canadian Association for Suicide Prevention released a statement saying that they “are not talking about suicide” when they refer to “physician-assisted death.” They are supposedly two different acts, with different intentions. (We discussed the distinction on our webcast of August 26, 2016.) Similarly, the American Association of Suicidology (AAS) said last year that “legal physician assisted deaths should not be considered cases of suicide”. In response, advocates from Not Dead Yet in the US leafletted at the AAS’ annual conference this past April. NDY’s Research analyst Stephen Drake said that the AAS has wrongly “begun to narrow its mission … by declaring the suicides of some people to not be suicides at all.”
  • In addition, broadening eligibility criteria are eroding the very idea of suicide prevention.  The Council of Canadian Academies is considering extending eligibility for Canada’s AS/E program to mature minors, people with psychiatric disabilities, and to incompetent people via advance directive; follow the links for our webcasts on these topics. (Their recommendations are due in December.)  As the Netherlands and Belgium euthanize ever larger numbers of people with mental illness, or who are “tired of life,” what used to be suicidal risk factors are now becoming valid reasons to justify euthanasia.

AMERICAN MEDICAL ASSOCIATION TO CONTINUE STUDYING ITS POSITION ON ASSISTED SUICIDE

  • You may remember we reported in our webcast of May 18, the American Medical Association’s Council on Ethical and Judicial Affairs recommended that the AMA continue to oppose assisted suicide as “fundamentally incompatible with the physician’s role as healer” and to avoid euphemisms such as “medical aid in dying” and “death with dignity.”
  • At the Association’s annual meeting this week, 56% of delegates voted to send the matter back to the CEJA for further study.  The current policy will stay in place until a new vote is taken.
  • Matt Vallière, executive director of the Patients’ Rights Action Fund, pointed out that referring the question back to the committee was “a lost opportunity and a failure to stand against a policy that has grave consequences for everyone, but especially persons living with illness, disabilities, or socioeconomic disadvantage. Assisted suicide is not medical care.”