Medical Examiner

Do Death With Dignity Laws Increase the General Suicide Rate?

The new evidence against assisted suicide is simply not true.

assisted suicide.
Death with dignity laws do one thing, and one thing only: give terminally ill patients the choice to end their lives comfortably rather than prolonging their suffering.

Photo illustration by Juliana Jiménez. Photo by Katarzyna Bialasiewicz/Thinkstock.

Death with dignity laws do one thing, and one thing only: give terminally ill patients the choice to end their lives comfortably rather than prolonging their suffering. Relieving people of physical agony from which there is no hope of recovery is morally appealing to many, and opponents of these laws have struggled to devise a compelling counterargument. Many of the objections to these laws are rooted in religion, but few are rooted in science. Now conservative Christian ethicist Aaron Kheriaty believes he has found one. In a Washington Post op-ed titled “The Dangerously Contagious Effect of Assisted-Suicide Laws,” Kheriaty suggests that death with dignity laws have “wider social consequences”—namely, they encourage otherwise healthy people to end their lives.

If real, these allegedly empirical “consequences” would certainly be concerning. But they are not real: They are made up. This fact is stated plainly in the exact study Kheriaty cites to prove his thesis. How did Kheriaty manage to distort data favorable toward death with dignity laws to craft an article opposing them? Let’s walk through his misrepresentations step by step.

Kheriaty begins by criticizing the notion that end-of-life options are “an issue of personal autonomy and privacy.” What if, Kheriaty ponders, “it turns out that the individuals who make this choice in fact are influencing the actions of those who follow?” He then declares that “an important study” demonstrates “a rise in overall suicide rates—assisted and unassisted” in states that have passed death with dignity laws. This result, he says, “should not surprise anyone familiar with the literature on the social contagion effects of suicidal behavior. You don’t discourage suicide by assisting suicide.”

Kheriaty is not an expert on suicide. He is a conservative Christian ethicist and psychiatrist at the University of California–Irvine who believes that gay people can change their sexual orientation. (This is not some best-forgotten claim he made back in the 20th century; his work saying so was presented by a co-author at a conference just last month.)* He pulls a clever sleight of hand in the Post. Yes, suicide can be contagious: Suicide clusters are a real phenomenon, as is the spike in suicides after celebrities kill themselves. But isn’t physician-assisted suicide categorically different from typical suicide? Might not the psychological factors at play in “contagious” suicide trends be absent when a terminally ill person chooses to safely end her suffering?

The answer, from that “important study” Kheriaty cites, is a clear “yes.” Controlling for other factors, the study found no statistically significant increase in nonassisted suicide rates in states that passed death with dignity laws. At most, the increase was between 1.1 and 1.6 percent—well within the range of random variation and, the study notes twice, “not statistically significant.” The study did find a statistically significant increase in assisted suicide rates, but that is altogether unremarkable: It simply means that people who live in death with dignity states use the options available to them.

Curiously, Kheriaty leaves the critical data about nonassisted suicide rates out of his article, instead using irresponsible hazy language to insinuate that the study found the opposite of what it did. We read that suicide “is already a public health crisis” and are asked, “Do we want to legalize a practice that will worsen this crisis?” We learn that laws “permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living—and that suicide is a reasonable or appropriate way out.” We are told that this “message” will be “heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.” The intimation—bolstered by Kheriaty’s credentials and the prestige of the newspaper that published him—is that death with dignity will persuade healthy people to kill themselves.

How did Kheriaty get away with publishing such specious nonsense in a major newspaper? Newspaper opinion sections often strive to present a diversity of viewpoints; a column presenting an empirical objection to assisted suicide, which has been gaining traction both legally and in public opinion over the past few years, would add a new perspective. We saw the same eagerness to publish ostensibly empirical support for conservative views around same-sex parenting: Many respectable publications, including Slate, invited Mark Regnerus to write about his purported finding that gays made “suboptimal” parents. Regnerus’ studies turned out to be funded by the extremist anti-gay Witherspoon Institute; his research was quickly thoroughly debunked by other social scientists, and the journal that published his articles later criticized their “serious flaws and distortions” and concluded that “neither paper should have been published.” But the damage was already done: Regnerus’ work popped up in anti–gay marriage briefs across the country, and it’s still cited and defended by social conservatives who need its finding to be true to lend scientific credibility to their religious objections. Now the Post has fallen for the same trick, publishing an equally noxious distortion of science that basic due diligence should have caught.  

Toward the end of his piece, Kheriaty writes that “the law is a teacher: Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms.” I agree. With assisted suicide, we have a choice of what “cultural attitudes” we’d like the law to teach. Should we teach that all individuals have the innate liberty to end their lives with dignity rather than experiencing extreme physical pain with no hope of recovery? Or should we teach that terminally ill people must be forced to live through every second of that torment? Kheriaty prefers the latter lesson. That’s fine—but so long as he is peddling it in the pages of the Post, he should be honest that his view is not rooted in science.

*Correction, Nov. 30, 2015: This article originally misstated that Aaron Kheriaty gave a presentation on sexual orientation last month. He did not attend the conference personally; a co-author presented their paper. (Return.)