Would the Falconer Bill Increase the Suicide Rate?

This is just a quickie – I promise.

A tweet this morning from Kevin Yuill raises what he sees as a scary prospect:

The Falconer bill will treble suicides amongst the terminally ill, according to Dignity in Dying. Is that what we want? Reject this bill.

He bases his claim on two things, both from Dignity in Dying: first, this document, which estimates that 332 of the 4513 suicides in the England in 2012 (p 1); second, this document, which estimates that there would be 1000 assisted deaths in England and Wales under an Oregon-like law (p 10).

Dignity in Dying has disputed his interpretation of the figures, and I’ve spotted a couple of problems with them.  Some of those who committed suicide while terminally ill may not have committed suicide because they were terminally ill; that might skew the figures.  So might the leap from “England” to “England and Wales”.  And, most importantly, we don’t know how many people would have killed themselves but for the current legal setup.  (Neither does DiD.)  Hence the trebling rate is at best an educated guess, but probably not even that.

But I’m going to allow that Yuill’s interpretation is reasonable for the sake of the argument.  I’ll also allow – in keeping with the Falconer Bill – that all legal assisted deaths in the UK would be assisted suicides, rather than allocides.  It occurs to me, though, that his claim still doesn’t do quite what he thinks it does, or wants it to do.  Importantly, he assumes that an increase in suicides would be a bad thing – and that DiD has therefore blundered in admitting that the rate would rise.

I’m not so sure.  Suicide may be a bad thing, but it isn’t necessarily bad in the way Yuill thinks.

Here’s one consideration.  Assume that some people who are terminally ill would take assistance to kill themselves were it available, but don’t kill themselves under the current regime.  Maybe they’re housebound and can’t procure the means, for example.  Something like the Falconer Bill would make suicide easier for them; and so we’d expect the rate to increase.  But we oughtn’t to forget the alternative, which is not not dying, but dying from a different cause.  This being the case, it isn’t necessarily going to matter too much to a defender of assisted dying that the suicide rate would increase, since his whole position would be that being able to end your own life in the way you choose is preferable to dying without any control.

In other words, the defender of assisted dying could, I think, accept that the suicide rate’d increase, and point out that, in a way, that is the whole point.  An increase in the suicide rate may be, in a certain light, a welcome development, not something to be feared.  I don’t know whether DiD would endorse that view, but it seems coherent, and not obviously vicious; hence Yuill seems to have committed an ignoratio elenchi.

And this leads to another consideration, which is that you don’t – as far as I can see – have to deny the badness of suicide to defend assisted dying.  All you have to think is that there are circumstances in which it’s less bad than the alternative.  Being the better option doesn’t mean it’s a good option, in just the same way that amputation of a limb may be preferable to dying from gangrene without that meaning that amputation is a particularly good thing in its own right.

Even if Yuill’s use of the figures is statistically sound, his claim doesn’t have any of the normative punch he thinks it does.

 

  • Roger Symes

    Yes, “amputation of a limb may be preferable to dying from gangrene” but the best option would be to not get gangrene in the first place! We need to direct our efforts to ensuring that terminally ill and disabled people do not see premature death as their preferable option. When they reach that stage it means they have been denied (or expect to be denied in the future) the medical, social and/or emotional support they need. That places complex responsibilities on every one of us. Doctors’ status in society means they are often expected to take a lead and offer guidance. If doctors start to premature death a treatment option it will be a sad day. Doctors telling patients, “You’d be better off dead mate!” and “I can make it happen!”. No thanks.

    • Indeed, the best option is not to have gangrene. I don’t think that any defender of AD would deny that it’s a solution to a problem, and it’s better all round for problems not to exist in the first place.

      However, you do seem to be trading on the idea that one is either for AD, or for better care. That’s a false dichotomy; it’s possible to be for both. There’re lots of reasons why people might seek AD, though – it’s not the case that people want it simply because they’re not afforded care. And this means that it’s perfectly coherent to have the best possible care available, but still to prefer AD. (Dependence may undermine one’s sense of pride or dignity, or one might simply want to get the inevitable done with; there’s a million reasons why people might want AD, and a lack of care is only one of them.)

      The idea that doctors (or anyone) being able to assist in someone’s death is a long way from their being able to suggest it, too; that seems to be another fallacy (or scare-tactic) of some anti-AD campaigners…

      • Roger Symes

        Hi Iain, thanks for the above. Sorry but I don’t believe it is possible to be for AD and for better care. AD is the quicker, simpler and cheaper option. It is guaranteed to make the problem (person) go away. It requires minimal effort and no imagination. So it will always win out over more difficult and costly options. You say, “there’s a million reasons why people might want AD”. I think they probably can all be distilled into one – fear of the future. Yet not a single organisation of or for terminally ill and disabled people supports a change in the current UK law. Why? Because they understand that AD will undermine personal support networks, both formal and informal. Terminally ill and disabled people need everyone around them to be routing for them. AD will sow seeds of doubt in individuals, families, friends, professionals and politicians. As for your last paragraph, Doctors might not suggest AD but they will be asked about it. If it becomes a legal option, patients will want their Doctor’s advice.

        • I honestly don’t see why you think it’s impossible to favour good/ better care and the availability of AD. I can think of plenty of people who would support both – so that alone breaks the back of your argument (unless you can provide a knock-down and a priori argument for their being deluded). There is simply no incompatibility between providing top-notch end-of-life care, and support for the terminally ill, and providing the option of assistance to die should that be the preferred option. Neither is there any reason to think that it may never be genuinely the preferred option. Neither is there any reason to think that your reductionist account is the correct one.

          Maybe (some) people do fear the future; I don’t see that that’s the whole story, but suppose it explains a particular person’s desire for assistance. Well, so what? People have all kinds of preferences.

          As for your final point: well, it’s conceivable that a person would have decided that they simply don’t want to play the game any more, and ask about ways not to. Fair enough: I don’t see the problem with that.