By Wesley J. Smith
A leading medical journal promotes an ‘all of government’ suicide-prevention policy — but ignores the role of assisted suicide.
Suicide is at a crisis level in the United States and around the world. According to the World Health Organization, more than 700,000 people committed suicide in 2019. In 2022, there were 49,476 self-inflicted deaths in the U.S. alone, or 14.2 per 100,000 people.
At the same time, assisted-suicide activism enjoys ever higher visibility, continually promoted in the media and popular culture as the best way to “die with dignity,” resulting in an increasing toll. Each year, well over 20,000 people around the world die by assisted suicide or euthanasia — which are generally not included in suicide statistics.
It is into this disturbing and paradoxical paradigm that The Lancet Public Health medical journal devoted an entire issue to suicide prevention. This should have been a welcome boost to saving lives. Instead, the mostly facile articles focus substantially on expanding government and promoting liberal policies as the best means of reducing suicides. Indeed, taken as a whole, the edition reflects the latest trend in medical-journal advocacy to transform political controversies — i.e., climate change, racism, and the like — into public-health crises to enable increased regulation and the imposition of left-wing public policies.
That is not to say that public health doesn’t have a significant role to play in suicide prevention. Of course it does. But the authors advocate shifting primary responsibility for suicide prevention from normal public-health activities and patient-centered clinical settings to an “all population approach” in which “all parts of government” will be “accountable” for the “social and commercial determinants of suicide risk.” In other words, everything government plans and executes would become ultimately about suicide prevention.
Economic policy would thus be reconceived as suicide prevention. Unsurprisingly, the proposed policies lean exclusively to the left. Governments should include departments of “finance, labor, education, and welfare” as suicide-prevention policy promulgators, one article argues. “Well-being budgets” should be instituted. Government spending should be increased. Guaranteed minimum incomes would see aid recipients receiving “cash transfers” rather than targeted assistance. The minimum wage should be made higher! If only the U.S. minimum wage had been increased by $2 per hour between 2009 and 2015, the reader is told, 25,900 suicides in the U.S. “could have been prevented.”
There is no question that a poor economy can lead to an increase in suicides, but the article failed to mention that increasing minimum wages can cause job loss, impacting the suicide rate. Indeed, when California raised its minimum wage for fast-food and restaurant workers to $20 per hour, nearly 10,000 jobs disappeared. Nor was the potential beneficial economic impact of reducing regulation and cutting taxes addressed. In other words, the discussion of economics was one-sided. The social impact of conservative policies improving financial well-being for individuals and families — and therefore, reducing suicides — went wholly unexamined.
The article on restricting the means of suicide carried the “all population” philosophical ball farther down the playing field. Unsurprisingly, the authors advocate gun control and, even, seizures — even though they admit that “there is less evidence that initiatives to restrict firearms affect suicides” in the U.S. But they note that in Israel, when military trainees were forced to keep arms at bases rather than at home, there was a “40% reduction in suicides in this group.” (The article does not mention how many fewer lives were lost.) More germanely, when Australia banned semiautomatic weapons from civilian possession, “there was a major reduction in firearm suicides, with no evidence of method substitution.”
Okay. But in the United States, what about the Second Amendment? Somehow, it wasn’t mentioned.
Pesticides are also used in suicides, and so the authors argue that if “national bans” on “highly hazardous pesticides” were instituted across 14 countries, it “could result in 28,000 fewer suicides each year.” Preventing people from jumping off bridges or in front of subway trains is also discussed, with the authors urging erecting barriers of the kind placed on the Golden Gate Bridge, improving fencing around railroad tracks, and installing gates on subway platforms that open only when the train arrives. “Improved amenities of the rail environment” are suggested as a means of attracting more passengers and theoretically reducing the opportunities for “rail suicides.” I’m all for better train service. Let’s hope Amtrak pays attention.
Some common analgesics — such as acetaminophen — can be used to commit suicide easily, “reflecting its wide availability both in households and through shop purchases.” What to do? The authors offer restricting “the number of tablets that can be purchased on a single occasion” or allowing these pain relievers to be purchased only “over the counter” (as we now must with medications such as Sudafed). The authors even suggest regulations controlling the manufacture of ceiling fans because some people have used the mechanisms to hang themselves. The costs, regulatory stifling, and impracticalities of these and other “all policies” approaches to restricting the means of self-killing? Barely considered.
It is ironic that the six papers advocating an “all policies” approach to preventing suicide do not even mention the legalization of euthanasia and assisted suicide, policies that both give a state’s imprimatur to some suicides and permit their legal facilitation. This despite studies demonstrating the legalizing assisted suicide appears to increase other suicides as well.
Making this lapse even more egregious, purveyors of popular culture and the media engage in the very behaviors the authors decry as adding to the risk that people will kill themselves:
Transmission of suicide risk via news and entertainment media: One of the papers rightly notes, “News reports that sensationalise or normalise suicide or provide detail about suicide methods have been shown to be associated with subsequent increases in suicides.”
Then why do the authors ignore the ubiquitous sensationalizing and normalizing of assisted suicide in film, novels, and the news media? The Room Next Door — a new movie intended by the filmmaker to promote assisted suicide as a human right — received this year’s Venice Film Festival best-movie award. And how often are assisted-suicide victims lauded in the media for “dying on their own terms”? CNN even named Brittany Maynard — the young woman who became the poster person for legalizing assisted suicide after she was diagnosed with brain cancer — as one of its “extraordinary people of 2014,” precisely because she killed herself.
News stories about suicides ignoring media guidelines: The authors urge the news media to follow reporting guidelines about suicide to prevent what is called the “Werther effect,” defined as “the phenomenon of increases in suicide following media presentations of suicide.” Thus, media are urged to not “romanticize suicide.” But assisted suicides are romanticized ubiquitously in the media. For example, a Washington Post story gushed about how a married couple “fulfilled their deepest wish to die together” after they died by euthanasia in the Netherlands:
The two, who . . . had been together 65 years, shared a last word, and a kiss, then died last month hand-in-hand — in a double euthanasia allowed under Dutch law, according to [the Dutch newspaper] De Gelderlander. “Dying together was their deepest wish,” their daughters told the newspaper, according to an English translation.
You can almost hear the violins.
Public-health anti-suicide messaging: The authors urge public-health officials to develop “media campaigns to transmit preventive messages to shape the way society understands and responds to suicide.” Yet, in jurisdictions where assisted suicide or euthanasia are legal, public-health messaging sometimes boosts assisted suicide’s legal availability. For example, in Canada, a hospital waiting room featured a prominent sign declaring, “MAiD [medical assistance in dying] is a medical service in Canada, whereby physicians and nurse practitioners help eligible patients fulfill their wish to end their suffering.” The PR notice then provided a toll-free phone number that people interested in being killed could call to obtain more information. Needless to say, the sign did not discuss suicide prevention nor the availability of palliative care.
The Lancet Public Health is to be applauded for focusing closely on the suicide crisis. Unfortunately, the authors focused more on expanding the scope of regulatory control through an “all of government” approach to prevention. Worse, little attention was paid to actions that could make a quick difference in reducing suicide, such as increasing local mental-health resources or improving clinical practices. The role of culture also went mostly unexplored. For example, the importance of religion and intact families in reducing suicide rates barely occurred to the authors, a puzzling lapse.
Moreover, failing to address the dichotomy of society opposing some suicides while energetic concomitant efforts are made to promote others by legalizing assisted suicide communicated an implied but insidious message that self-termination by the seriously ill doesn’t matter. That is like saying in an anti-smoking public-health campaign, “We wish you wouldn’t smoke — but if you do, use a cigarette filter.” The real message communicated subtly promotes the very act being supposedly inveighed against.
Too bad. Publishing an issue devoted to suicide prevention was a good idea. Unfortunately, the product disappoints and will have little impact on saving lives, a woefully missed opportunity.
Wesley J. Smith is an author and a senior fellow at the Discovery Institute’s Center on Human Exceptionalism.
This article has been reprinted with permission and can be found at alexschadenberg.blogspot.com/2024/09/preventing-suicide-must-include.html.