Does Legalization of Medical Assistance in Dying Affect Rates of Non-Assisted Suicide?
Health Law and Policy, Legalization of Medical Assistance in Dying, Non-assisted Suicide
In 2015, the Southern Medical Journal published a paper by Jones and Paton that explored the effects of legalizing physician-assisted suicide (PAS) on state-level suicide rates using empirical data from Oregon, Washington, Montana, and Vermont.(1) It is essential to assess this paper critically because: a) there is little literature on this topic and so any available papers may be given significant weight in public and policy debates on medical assistance in dying (MAiD) in Canada; b) the paper has been used in attempts to support particular policy positions in relation to MAiD in Canada (e.g., Sonier, 2016); and c) the paper may be referenced as an academic foundation for claims about the effects of legalization that will be made in the Charter challenge to the new Canadian MAiD legislation (Lamb v. Canada (Attorney General), 2016) and ongoing debates in Canada (including the statutorily mandated independent reviews (2) commissioned by the government and being conducted by an independent expert panel appointed by the Council of Canadian Academies (3) on three outstanding issues regarding access to MAiD in Canada). We present a description of the Jones and Paton paper’s objectives, methods, and results. We then explore its strengths and weaknesses, and illustrate the problems with interpreting the data as the authors have done. We conclude that the interpretations of the authors are not supported by the data presented and we caution against using the authors’ conclusions for the purposes of informing public opinion, litigation, and law reform. A quick comment about terminology is required here. “Medical assistance in dying” is the umbrella term used in the new Canadian legislation to capture both euthanasia (“the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death”) and assisted suicide (“the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death”) (An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), S.C. 2016, c.3, s.3). Jones and Paton refer to “physician-assisted suicide” because, under the American model for assisted dying (4), only assisted suicide is permitted and only physicians are permitted to provide the assistance.
Jocelyn Downie & Matthew Lowe, “Does Legalization of Medical Assistance in Dying Affect Rates of Non-Assisted Suicide?” (2017) 10 JEMH 1-9.