The effect of assisted dying on suicidality: a synthetic control analysis of population suicide rates in Belgium
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The effect of assisted dying on suicidality: a synthetic control analysis of population suicide rates in Belgium Harmeet Nanner1
© Springer Nature Limited 2020
Abstract Adoption of assisted dying has rapidly grown, but many groups caution that these policies can cause suicide contagions. If those urging caution are correct, jurisdictions with these policies will experience increased suicides. This study aimed to determine the changes in population suicide rates in Belgium before and after its 2002 policy using the synthetic control method (SCM) and generalized synthetic control method (GSCM). As comparisons we used additional European Union members that have not adopted these policies. GSCM showed an average annual suicide rate increase of 0.73 per 100,000 population (95% CI − 5.7 to 7.2; p = 0.80). Placebo testing based on the SCM analysis showed equal outcomes for Belgium and the comparisons. This study failed to show evidence of association between implementation of legislation legitimizing assisted dying and population suicide rates. The threat of suicide contagion has influenced policy discussions in the past, but this study suggests that there is presently no indication for policy-makers to view suicide contagions as a concerning side effect of assisted dying legislation. Keywords Assisted dying · Synthetic control · Belgium · Suicide rates
Introduction Suicide contagion is a phenomenon where exposure to the suicide of a peer, family member, or in the media triggers suicidal behaviour in vulnerable individuals (where pre-existing suicidal ideation constitutes vulnerability) [1–4]. Since at least the early 1990s, many groups have claimed that assisted dying policies Electronic supplementary material The online version of this article (https://doi.org/10.1057/s4127 1-020-00249-8) contains supplementary material, which is available to authorized users. * Harmeet Nanner [email protected] 1
University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada Vol.:(0123456789)
H. Nanner
(see Supplemental Appendix A for terminology) can cause suicide contagions, and this manifests as an increase in the number of suicides [5]. Activists, policymakers, and researchers that believe this association exists caution against legalization of these policies by arguing that when a society embraces assisted dying, it sets a precedent that death is an acceptable solution for suffering [5–8]. These advocates state that this occurs because of increased sympathy, normalization, romanticization, and destigmatization of dying to alleviate suffering. However, assisted dying has never been positively correlated with suicide contagion in the literature; more generally, information about such an association is scarce [7]. With the number of jurisdictions that allow assisted dying growing rapidly [9], policy-makers and other stakeholders will increasingly be challenged by questions of potential widespread societal harm caused by assisted dying. For future policy decisions made out of conc
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