Executive Director, Euthanasia Prevention Coalition
Jones's research is significant as the assisted death lobby has continually argued that legalizing assisted death prevents other suicides. This argument was accepted by the Supreme Court of Canada in its Carter decision which led to the legalization of euthanasia and assisted suicide in Canada, now referred to as MAiD.
In other words, the Carter decision in Canada found that prohibiting assisted death directly affected the right to life because some people will die earlier by suicide, if assisted death is not an option.
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| David Jones |
This paradoxical hypothesis played a key role in the Carter v Canada decision of 2015. It was argued that the right to life was engaged because lives were endangered by the prohibition of “physician-assisted dying” (which in this context referred to euthanasia and/or assisted suicide): [57] The trial judge found that the prohibition on physician-assisted dying had the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable. On that basis, she found that the right to life was engaged. [58] We see no basis for interfering with the trial judge’s conclusion on this point. The evidence of premature death was not challenged before this Court. It is therefore established that the prohibition deprives some individuals of life. (Carter v. Canada [Attorney General], 2015)Jones explaines that in 2015, he was part of similar research concerning suicide data comparing American states that had legalized assisted suicide to American states that had not legalized assisted suicide. That study they concluded that legalizing assisted suicide may have resulted in a 6.3% increase in other suicide rates.
Jones comments on criticism of his study by Downie and Lowe, who stated that similar trends did not exist in European countries that had legalized euthanasia and/or assisted suicide. Jones states that Downie and Lowe didn't argue that the American study was inaccurate but rather that other jurisdictions conflict with his conclusions. Jones then states that this study examines the European data.
Jones first examines the data from Switzerland. Switzerland did not legalize assisted suicide, but rather it has permitted assisted suicide since 1942 unless done for "selfish reasons." Jones explains that assisted suicide remained rare in Switzerland until about 1998. Jones then states:
Lowe and Downie provide a graph including OECD suicide data in Switzerland which they label “non-assisted suicide rates per 100,000 residents” (2017, p. 7). However, in this Lowe and Downie are mistaken. OECD suicide rates only began to exclude assisted suicide from the overall suicide figures in Switzerland in 2009 (OECD, 2019). Prior to this the OECD suicide rate for Switzerland was the rate of suicide inclusive of assisted suicide. To estimate what the OECD non-assisted suicide rate for Switzerland would have been prior to 2009 and to estimate what suicide rate (incl. AS) would be from 2009, on the basis on OECD Suicide Data, it is necessary to draw on assisted suicide data collated by Dignitas.Jones then compares the suicide rate in Switzerland to that of Austria, a neighboring country to Switzerland. Jones found that:
From 1990, the non-assisted suicide rates in Switzerland and in Austria decline in parallel. There is a slightly larger drop in non-assisted suicide in Switzerland in 2003. This was the year Switzerland voted to reduce its army from 400,000 to 200,000 and it has been argued that this move reduced suicide among young men in Switzerland as fewer men had access to firearms (Reisch et al., 2013). However, overall, there is no discernible difference in the rate of decline of non-assisted suicide between the two countries over this period. In contrast, from 1998, the rate of suicide (incl. AS) increases in Switzerland relative to non-assisted suicide in Austria and, from 2010 to 2017, Swiss suicide incl. AS increases in absolute terms (from 16.1 to 22.2). Indeed, the rate of suicide incl. AS was discernibly higher in 2017 (22.2) than it was in 1998 (19.0).Jones proves that the suicide rate in Austria, which prohibited assisted suicide decreased while between 2010 and 2017 the suicide rate in Switzerland increased. This does not prove a direct corelation but it does prove that legalizing assisted suicide does not reduce other suicide deaths.
When comparing the data with relation to men and women, there is a clear increase in the suicide rates for Swiss women as compared to Austrian woman. The data for women, who tend to have a much lower suicide rate, indicates a clear increase for Swiss women as compared to Austrian women.
Jones states:
By 2017 the suicide rate (incl. AS) for females in Switzerland is roughly twice the rate it was 1998 (from 9.4 up to 18.6) while the non-assisted suicide rate of females in Austria over this period declined from 8.7 to 5.0 and the non-assisted suicide rate of females in Switzerland declined by a similar amount (from 8.8 to 5.8). This dramatic rise in suicide inclusive of assisted suicide among women in Switzerland (which is the way the OECD suicide rate was calculated prior to 2009) is driven by large increases in assisted suicide and is associated with no discernible reduction in non-assisted suicide in Switzerland relative to Austria.Jones concludes:
The rate of suicide incl. AS has clearly risen in Switzerland relative to Austria. At the same time, there is no indication of a relative decrease in non-assisted suicide.
Jones then analyses data from Luxembourg as compared to France and Germany. I will not comment on this data since Luxembourg is a very small country.
Jones then compares the suicide data in the Netherlands to that of Germany. Jones states:
In both jurisdictions there was a decline in non-assisted suicide between 1990 and 2001 which continued until 2007. However, whereas rates of non-assisted suicide in Germany remained relatively flat between 2007 and 2016 (as mentioned earlier), the rates of non-assisted suicide in the Netherlands have increased steadily since 2007. The rate of intentional self-initiated death in the Netherlands, which had been declining when the law was passed, has also risen steeply since 2007.Jones concluded:
Overall, the Netherlands, which is the country with the longest continuous history of euthanasia in Europe, has seen the highest increases in non-assisted suicide in Western Europe between 2001 and 2016. From the statistics provided by OECD Suicide Data (2021), the only other EU country that saw a higher net increase in non-assisted suicide in this period was Greece, but the rates in Greece are still at much lower levels than those in the Netherlands (4.0 in Greece in 2016 compared with 10.5 in the Netherlands). Note also that Greece suffered a catastrophic economic collapse over this period.
In relation to the Netherlands it is certainly false to say that, “suicide rates either stayed the same or decreased after MAID legislation” (Dembo et al., 2018, p. 453). Non-assisted suicide in the Netherlands rose between 2001 and 2016 from 9.1 to 10.5 while in Germany, it fell from 12.8 to 10.2. Furthermore, this has happened at the same time as there have been dramatic rises in rates of intentional self-initiated death (up from 21.9 to 46.3 per 100,000). These patterns were all more pronounced in females.The Netherlands suicide rate has increased since 2001 as compared to Germany. In 2001 the suicide rate was lower in the Netherlands than Germany and now it is significantly higher.
Finally Jones examines suicide data in Belgium as compared to France. Jones chooses France, for comparison, because 40% of Belgians speak French as their native language and the Belgian suicide data is very similar to that of France. Jones explains that unlike the Netherlands and Switzerland Belgium has seen a drop in the non-assisted suicide - suicide rate but the drop in suicide in Belgium is not as great as the drop in other European nations including France. Jones states:
Belgium introduced euthanasia by law in 2002 and, in contrast with the Netherlands and Luxembourg, has seen a decline in non-assisted suicide since passing the law. Nevertheless, the fall in non-assisted suicide in Belgium from 2002 to 2016 (19.5 to 15.9) is not as great as that in France (17.6 to 12.3). Indeed, in 2016 Belgium had the highest non-assisted suicide rate in Western Europe. Within the European Union, only the former communist countries Hungary, Slovenia, Latvia, and Lithuania had higher rates of non-assisted suicide (OECD Suicide Data, 2021).Jones research article proves that Lowe and Downie were wrong when they opined that in Switzerland, Luxembourg, the Netherlands, and Belgium “suicide rates either stayed the same or decreased after MAID legislation” (Dembo et al., 2018, p. 453). Jones then proves that:
The increase in non-assisted suicide relative to France, especially among females, at a time when non-assisted suicide rates where declining across Europe, explains how, by 2016, Belgium came to have the highest non-assisted suicide rate among women of any EU country, former communist countries included (OECD Suicide Data, 2021).
• In all of the four jurisdictions (Switzerland, Luxembourg, Netherlands and Belium) there have been very steep rises in suicide (incl. AS) or in ISID after the introduction of EAS. A striking example is the suicide rate (incl. AS) of women in Switzerland which has roughly doubled since 1998. Many more people have died prematurely after these changes.For Canadians, Jones proves that the assertion that legalizing euthanasia and assisted suicide will prevent suicide is not borne out by the data, even though the Supreme Court of Canada falsely agreed that legalizing assisted death was necessary to protect the Constitutional Right to Life.
• In none of the four jurisdictions did non-assisted suicide rates decrease after introduction of EAS relative to the most similar non-EAS neighbour. There is no indication of prevention of non-assisted suicide at a population level.
• In one of the four jurisdictions, the Netherlands, which has the longest history and greatest number of deaths by EAS in Europe, the rates of non-assisted suicide have increased since EAS was legalised by statute. This was both an increase in absolute terms and an increase relative to its only non-EAS neighbour: Germany.
• In another of the four jurisdictions, Belgium, which has the second highest rate of the death by EAS in Europe, while the rates of non-assisted suicide decreased in absolute terms, they increased relative to its most similar non-EAS neighbour: France. It is striking that Belgium now has the highest female non-assisted suicide rate in Europe, based on OECD Suicide Data.
• In all these respects the pattern that emerges from the European data conforms with the pattern that Jones and Paton discovered in the United States data.
Jones states:
Indeed, if one considers the community as a whole, it is not the prohibition of EAS but the introduction of EAS that is associated with “evidence of premature death” (Carter v. Canada [Attorney General], 2015, para. 58). Furthermore, the data from Europe and from the U.S. indicate that subsequent to the introduction of EAS, it is women who have most been placed at risk of avoidable premature death from changes in rates of intentional self-initiated death and from changes in rates of non-assisted suicide.Legalizing euthanasia and/or assisted suicide does not lessen the rate of other suicides and may directly corelate to an increase in other suicides.
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