By Andre Schutten
and Anna Nienhuis
Action inspires action. This is often positive, as people’s activities motivate others to engage in positive service too. But there are times when action inspires deadly action. As the Senate continues its review of Bill C-7’s dramatic expansion of medical assistance in dying (MAiD), possibly proposing amendments before sending it back to the House of Commons, Senators should consider the evidence for copycat and coupling effects when it comes to suicide, and how that will likely impact MAiD.
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Copycat suicides have long been recognized. Evidence repeatedly shows that, following a publicized celebrity suicide, suicide rates in the area increase, especially among those in a similar demographic. The connection is further proven by the fact that the means used to commit suicide disproportionately mirror the method reportedly used by the celebrity.
In his book Talking to Strangers, Malcolm Gladwell talks about the “coupling effect” as it relates to suicide. He shows from research that suicide can often be coupled to a certain place, environment, or event, and if that setting is not present or available, the suicide will not take place.
Some people struggling with mental illness or permanent disability may be looking for an accessible and relatively clean way to end their own life. But if such an option is not available, they do not, as many people often assume, seek out other options for ending their life. They go on living. This is demonstrated through the experience of Britain in the 1960s and ’70s.
In 1963, renowned author Sylvia Plath put her head in her oven to inhale enough coal gas to kill herself through carbon monoxide poisoning. Coal gas was the most common form of gas in British homes in the 1960s, and Ms. Plath was not alone in using it to commit suicide: 44 per cent of the suicides in Britain that year involved carbon monoxide poisoning.
When the country switched over to natural gas in the 1970s – natural gas has considerably lower concentrations of carbon monoxide – the suicide rate fell dramatically. Suicide was “coupled” with easy access to coal gas: when the gas was no longer available, significantly fewer people committed suicide.
How does this apply to the current discussion around MAiD in Canada, and the goal of Bill C-7 to expand access to euthanasia?
The false assumption that a suffering person with suicidal ideation will find any way to die shaped the Supreme Court of Canada’s legal analysis in the Carter decision when they legalized assisted suicide. The first paragraph of the decision reads:
It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.
The Supreme Court wrongly assumed that people facing suffering will choose another “violent or dangerous” method to end their life if doctor-assisted suicide was not made available. The Court also fallaciously argued there are only two options when facing suffering: end your own life early or suffer until you die. But as many experts have been arguing for years, physical and psychological suffering can be effectively relieved through palliative medicine and appropriate counselling.
FROM THE ARCHIVES: Medically assisted dying cases need stronger review to safeguard us all by Catherine Frazee
Knowing the danger of copycat suicide, journalists now receive training on how to cover suicide stories responsibly. When rock star Kurt Cobain took his own life in 1994, the media coverage deliberately focused on the negative impact Cobain’s suicide had on the family he left behind, on suicide prevention, and on getting help for mental illness. One study hypothesizes that the media deserves credit for the following effect: not only did the expected copycat suicides not occur, but the suicide rate decreased, while calls to suicide crisis lines increased.
But when it comes to doctor-assisted suicide, the narrative is completely flipped. The media seems to have no qualms about promoting doctor-assisted suicide. Journalist André Picard spoke about this deliberate choice at a pro-MAiD conference in Vancouver in 2019, where he shared the media’s search for “tug at the heartstrings” stories, and the conscious shift away from words like “euthanasia” and “assisted suicide” to the more palatable “assisted dying.”
A small sampling of media headlines profiling MAiD over the past few years describe medical suicides in terms of a dignified party, a celebration of the gift of death, and a romantic means of dying together with your loved one.
Based on the wealth of research available on copycat suicides, and emerging research on coupling effects and suicide, it is no surprise that the annual statistical reports indicate “steady year-over-year growth” in MAiD deaths. In 2016, the year assisted suicide was legalized, doctors euthanized about 1,500 patients. In 2019, that number was more than 5,600. Now, Parliament is looking to expand euthanasia by lowering eligibility thresholds. The focus is on including those with disabilities whose deaths are not reasonably foreseeable.
With doctor-assisted suicide now widely available and broadly supported, will it become for the disabled or chronic pain communities the coal gas of the suicidal in 1960s Britain?
Societal focus on assisted suicide has been directed to a positive narrative of choice, control, and the ability to end suffering through the ending of human life. Our vulnerable neighbours and friends deserve so much better from our media, our legislators and judges, and our culture. They deserve the right to suicide prevention, like the rest of us. We need to put a stop to Bill C-7 and focus instead on the need for better care, particularly palliative care, for those who are suffering.
André Schutten is General Legal Counsel with the Association for Reformed Political Action (ARPA) Canada since 2011. Anna Nienhuis is a policy analyst with ARPA Canada, and principal drafter of their latest report on Elder Care.