Suicide rates and Assisted Dying policy (FOI)

​​​​​​​​​​​​Request

​​New research finds that Voluntary Assisted Dying (VAD) has failed to reduce the rate of ‘unassisted suicide’ in Victoria, Australia. Published in the Journal of Ethics in Mental Health, this paper found that suicide among older people (over 65s) has increased by more than 50% – one more suicide per week than before the introduction of VAD. 

Did the Voluntary Assisted Dying Act 2017 Prevent “at least one suicide every week”?.pdf (jemh.ca)​

Euthanasia, Assisted Suicide, and Suicide Rates in Europe: Reference Professor David Albert Jones (Article Peer reviewed)

EAS and suicide rates in Europe.pdf (jemh.ca)​

Abstract

It has been argued that, paradoxically, legalising euthanasia or assisted suicide (EAS) might save lives. If people had the security of knowing that these were options then they might not take their lives prematurely. However, data from the United States demonstrates that assisted suicide is associated with a significant increase in total suicide (inclusive of assisted suicide) and no reduction in non-assisted suicide. In contrast, Lowe and Downie have asserted, reassuringly, that after EAS was introduced in Europe, “non-assisted suicide rates have remained constant or decreased”. This paper shows that when European data are placed in the context of (1) neighbouring non-EAS countries; (2) relevant dates; (3) deaths by EAS; and (4) separate data for men and women, then the prima facie data are not reassuring. Introducing EAS is followed by considerable increases in suicide (inclusive of assisted suicide) and in intentional self-initiated death. There is no reduction in non-assisted suicide relative to the most similar non-EAS neighbour and, in some cases, there is a relative and / or an absolute increase in non-assisted suicide. Furthermore, the data from Europe and from the U.S. indicate that it is women who have most been placed at risk of avoidable premature death.

Suicide Rates 

Due to the relatively small population of Jersey, suicide rates vary year on year. However, there has been great public concern in Jersey regarding deaths by suicide.

A

When is the suicide prevention policy going to be published?

B

What consideration has been given to what impact promoting and publicising an assisted dying service will have on suicide rates?

C

What is the 5-year average general suicide rate in Jersey, and how does this compare to the annual rate in other larger jurisdictions in Europe and in Victoria State in Australia?

D

What assurance of adequate safeguards will the Policy team be proposing to mitigate the risk of increased suicide rates with the proposed legalisation of Assisted Dying?

Response

A

The Suicide Prevention Strategy is expected to be published in the summer, subject to receiving the necessary approvals.

B.

As set out in the report and proposition (P.18/2024 - page 25) linked below, the Government of Jersey’s policy position is that: “Assisted dying is not suicide– whilst both assisted dying and suicide result in intentionally ending one’s own life, when a person dies by suicide it is a lonely act, carried out outside of a legal framework, and is accompanied by mental and physical pain and fear. Suicide invariably leaves behind a legacy of stigma and irresolvable grief for loved ones. Assisted dying can be the exact opposite, it provides a safe, calm and considered environment in which a person – most often with the support of their loved ones – can end their life and associated suffering. The law will set out that assisted dying is not suicide.” 

States of Jersey Assisted Dying.pdf (statesassembly.gov.je)​

Prior to determination of the position, the Government of Jersey has considered published research which examines the relationship between assisted dying and suicide rates to determine if providing an assisted dying service will have an impact on suicide rates. As set out in the assisted report and proposition (P.18/2024): 

• Several studies have been undertaken to try to understand if there is a link between assisted dying and increased rates of suicide, but these studies reach different findings.[1] [2] [3] Recent data shows that overall suicide rates have increased in recent years in some jurisdictions since the introduction of assisted dying (for example, the US[4]  and the Netherlands[5] ) but declined in others (for example, Belgium[6]  and Canada[7] ).  
• A 2022 UK Office of National Statistics bulletin shows that there are elevated rates of suicide in patients with severe health conditions in the UK, where assisted dying is not currently permitted. For example, for people diagnosed with chronic obstructive pulmonary disease (COPD) and chronic heart conditions, the suicide rate is two times higher than for the rest of the population with similar socio-economic characteristics.[9] 

Please see the links below:

[1] How does legalization of physician assisted suicide affect rates of suicide?  (research.stmarys.ac.uk) 

[2] Perma Does Legalization of Medical Assistance in Dying Affect Rates of Non-assisted Suicide? (perma.cc) ​

[3] The effect of assisted dying on suicidality: a synthetic control analysis of population suicide rates in Belgium (link.springer.com) 

[4] Suicide mortality rate (per 100,000 population) - United States (data.worldbank.org) ​

[5] Suicide mortality rate (per 100,000 population) – Netherlands (data.worldbank.org) 

[6] Suicide mortality rate (per 100,000 population) - Belgium (data.worldbank.org)​

[7] Suicide mortality rate (per 100,000 population) - Canada (data.worldbank.org) ​

[9] Suicides among people diagnosed with severe health conditions, England: 2017 to 2020 (ons.gov.uk) 

Furthermore, Government is aware of a recent study (which is not referenced in P18/2024) lined below, investigating the relationship between assisted dying and suicide, which concluded that any increases in suicide (in jurisdictions where assisted dying is permitted) were not statistically significant when sociodemographic factors were controlled. 

Investigating the relationship between euthanasia and / or assisted suicide and rates of non-assisted suicide: systematic review (ncbi.nlm.nih.gov) ​

The Government of Jersey also gave consideration to the concerns raised by Islanders and other respondents during both phases of its consultation. During Phase 1 some respondents expressed concern that the introduction of assisted dying would lead to a rise in the rate of suicides, whilst others suggested the reverse; that the introduction of assisted dying would provide an alternative for people currently considering suicide because of the suffering associated with severe health conditions. During Phase 2 consultation received feedback that was both supportive of the statement ‘assisted dying is not suicide’ (for example, a submission from the Attorney General of South Australia) and feedback that was opposed to this statement (for example, submissions from campaigning organisations, including the Christian Institute).

​C

Latest information on suicide rate for Jersey can be found in the Mortality Report. In this report suicide rate is expressed as a 3-yearly age-standardised mortality rate (ASMR) for deaths due to suicide, to aid in comparability to England, Guernsey and other jurisdictions. 

Jersey Mortality Report 2022.pdf (gov.je)

Jersey’s 5-yearly age-standardised suicide rate (over the most recent 5-year period for which data is available 2018-2022) is 8.5 per 100,000 population overall. 

Data from other larger jurisdictions in Europe and in Victoria State in Australia is not held by Government of Jersey, Article 3 of the Freedom of Information (Jersey) Law applies.  

D

The Government of Jersey’s Public Health Intelligence Team produce an annual mortality report. Suicide rates are monitored as part of mortality report ensuring that the Director of Public Health and the Health Minister would be sighted on fluctuations in rates. In the event that there were to be unexplained or unusual fluctuations, the associated causes would be examined. 

As set out in Part B above, at present data from other jurisdictions does not provide evidence of a correlation between the introduction of assisted dying and increased rates of suicide.  

The report and proposition P.18/2024 (page 168) provides information about high-level information about some of the key risks associated with the development of assisted dying legislation, which includes the identification of risks associated with suicide. See below:

​Article applied 

Article 3 - Meaning of “information held by a public authority”

For the purposes of this Law, information is held by a public authority if –

(a)     it is held by the authority, otherwise than on behalf of another person; or

(b)     it is held by another person on behalf of the authority.​