Thursday, October 4, 2012

Suicide - Longing for a consistent approach

The following article was written by Paul Russell, the leader and founder of HOPE Australia. Russell is examining the suicide statistics in Australia and commenting on the fact that people can demand more to be done to stop suicide while supporting the concept of assisted suicide. The article is entitled: Suicide - Longing for a consistent approach.

Paul Russell
By Paul Russell - October 5, 2012

Recently I was discussing suicide with a person I’d just met. He was surprisingly open about his views which, as it happened, largely coincided with my own.

The conversation then turned to assisted suicide, I proffered the opinion that, if someone was, say, standing on a precipice and about to leap to their death, that I had an obligation to try to stop them. My acquaintance agreed but offered the caveat about someone who, in his example, was a quadriplegic and who had ‘no quality of life’, suggesting that they should be allowed to kill themselves (how exactly we did not discuss).

Thinking about that later it occurred to me that this kind of argument is essentially a form of discrimination – we’re okay with stopping someone from attempting suicide if they’re fit, young and otherwise okay; but if they have some disease or condition or have ‘had a good long life and simply want to go’ then somehow we’re inclined to look upon their suicide attempts differently. This is discrimination on the basis of age, disability and/or diagnosis
This is basically ‘I’m-really-glad-I’m-not-in-their-shoes’ thinking; applying then a misguided sense of compassion that in some strange way works to suppress our natural instincts to help.

‘My life – my choice!’  I hear some say. Too right – yes, suicide has been decriminalized and with good reason. But we cannot overplay decriminalization and the principle of autonomy to the extent that we no longer care or only care selectively on the basis of our own perception of the quality of someone’s life. None of us can judge that – it’s offensive to do so.

I did mention to my acquaintance that I had known of quadriplegics (using his example) that, though their lifestyles were more limited than he or I, were nonetheless enjoying life to the fullest. Once again his retort was to return to the principle of choice. Although quite a popular line of thinking, it really does lack logic.

If choice is the highest principle, then why would we want to stop anyone from killing themselves? After all, the hypothetical young person on the precipice might have unseen physical or psychological difficulties – how would we know? Should we simply walk away because of this person’s choice no matter whether the exercise of that choice has been compromised or distorted or whether or not he might feel better in the morning?

And what about the implications of adopting a ‘some suicides are okay’ approach? (which is precisely what legalising assisted suicide would do) This would be more than just a ‘mixed message’, it would become a downright double standard that can only serve to confuse.

Australia has made a significant contribution to reducing the rate of youth suicide over the last decade and more. This success can be seen in the statistical data where the most significant drop in suicide by age category can be seen in the 25 to 39 age ranges; that is: those who were aged between 15 and 29 years a decade ago. Yet from a statistical low in 2004 (2,098 reported deaths) the total annual deaths from suicide has risen to 2361 in 2010.

As the graph shows, virtually every 5 year increment from 35 to 39 onwards shows an increase in the number of deaths (2010 on 2005). I cannot offer an explanation, only an observation that the movement in the graph wave to the right does reflect the five year gap (2005 to 2010). While that accounts for the maintenance of the shape of the wave, it does nothing to explain why suicides are increasing from middle age onwards.

What this should tell the health authorities is that there probably needs to be an increasing focus on prevention in the later years of life. I recently searched a number of suicide prevention websites and found only one that had a section specifically devoted to this cohort. (That’s not to criticize any of the other worthy initiatives which all have their place and perhaps a different focus)

All of the prevention websites have a healthy approach to mental health. The RU okay? Day launched in 2009 is one such initiative – there are many others. But what do we know of them and could you or I find these sites in a hurry if we needed help for ourselves or for others?  World Suicide Prevention Day occurred this year in mid-September. Did you notice? I know I didn’t see much in the way of media reporting. All forms of media have a crucial role to play here.

This is why I found it objectionable in the extreme that SBS television should choose to show a pro-suicide documentary on the evening of the 23rd of September – less than two weeks after World Suicide Prevention Day. Produced by UK fiction writer and assisted suicide advocate, Sir Terry Pratchett, the documentary, Choosing to Die features the assisted suicide death of a UK businessman in the Swiss Dignitas death facility. It shows the death of British Hotelier, Peter Smedley who is seen to choke and ask for water as he dies holding the hand of his wife.

I said at the time, ‘In deciding to air this macabre program, SBS is acting as a cheerleader 
the pro-suicide brigade’. There’s really no other way to look at it and no posting of suicide prevention hotlines after the program changes that view.

All media outlets have a responsibility to adopt and follow the World Health Organisation guidelines on suicide portrayal. Of the eleven ‘dot points’ in the WHO guidelines, the airing of Choosing to Die  by SBS is in breach of at least five by my reckoning. WHO cites over 50 published studies that draw the same conclusion: media reporting of suicides can lead to imitative suicidal behaviours.

In fact, two separate news reports from the UK in September pointed clearly to the Pratchett documentary as having influenced the decisions of two men to die by assisted suicide. We can only hope that the same effect does not happen in Australia and that those in need will seek help from our excellent suicide prevention services rather than seeking out the likes of Exit International.

Returning to the Australian statistics, it is true, as Philip Nitschke points out, that hanging is the single largest cause of death by suicide and has been so for the last decade at least. Whereas Nitschke’s point is to say that hanging is undignified (pointing to his methods as being somehow more dignified) is it not better by far to observe that this statistic screams to us that more needs to be done to prevent such deaths? By the way, what Nitschke fails to tell us is that included in the ‘hanging’ category are also deaths by asphyxiation which might include people who have used Nitschke’s bag death method. So much for a dignified death!

This brings me back to my first observation about discrimination; about the subtle acceptance that perhaps some suicides are okay. And I wonder at what effect the seemingly constant attempts at legalising euthanasia have in this respect – not to mention the macabre media grandstanding on suicide by the likes of Philip Nitschke which seems to pass without criticism in our national media.

We all have some responsibility here because we will all, at some time, know someone who is contemplating suicide.  We need to reject the subtle and not-so-subtle messages that might, overtime blur our minds to the reality that regardless of circumstances, no suicides are all right. 

We should constantly remind ourselves to keep on asking: R U Okay? The answer to that question always matters.

Australian Suicide Prevention Agencies:

Beyond Blue                            
RU Okay?                                
Suicide Prevention Australia  (peak body)
Crisis Support Services         
Reach Out                                

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