Action Life Submission to the Special Joint Committee on Medical Assistance in Dying

Action Life Ottawa is an educational pro-life group with approximately 4,000 supporters in Ottawa and the surrounding region. We have worked to foster respect for human life from conception to natural death for more than 50 years. Our organization believes that life affirming solutions are the natural and dignity enhancing response to life’s difficulties. The Special Joint Committee has been asked to study a number of questions pertaining to euthanasia and assisted suicide now legally known in Canada as medical assistance in dying.  We wish to express our concern with an ever increasing expansion of access to euthanasia in conjunction with an alarmingly broad interpretation of eligibility under the law.

Media reports have highlighted a number of troubling cases where patients have been euthanized because their medical, financial and social needs where not met. In other cases, families have maintained that their relative did not meet legal requirements for euthanasia. Consider:

A 51 year old woman with chemical sensitivities was approved for and died by euthanasia in Ontario because she could not find suitable living accommodation. She said that during Covid restrictions, her apartment felt like a dungeon, with cigarette and marijuana smoke and disinfectant used in the hallways aggravating her medical condition. “The government sees me as expendable trash, a complainer, useless and a pain in the a**,” ‘Sophia’ said in a video filmed on Feb. 14, eight days before her death, and shared with CTV News by one of her friends.”

Roger Foley, 45 years of age, lives with spinocerebellar ataxia. Testifying  before the Standing Committee on Justice and Human Rights in November 2020, he said:

“I have been coerced into assisted death by abuse, neglect, lack of care and threats. For example, at a time when I was advocating for assistance to live and for self-directed home care, the hospital ethicist and nurses were trying to coerce me into an assisted death by threatening to charge me $1,800 per day or force-discharge me without the care I needed to live. I felt pressured by these staff raising assisted dying rather than relieving my suffering with dignified and compassionate care.”

Alan Nichols a 61 year old man with a history of depression was euthanized following admittance to Chilliwack General Hospital for a psychiatric episode in 2019. His family greatly distressed had tried in vain to stop his euthanasia.  “They killed our brother”, Alan’s brother Wayne told National Post last month.”

Donna Duncan, a former psychiatric nurse, was injured in a car crash. Her daughters say that the effects of the concussion she sustained led to a deterioration of her mental health worsened by Covid restrictions as treatments were unavailable for months. They asked the police to investigate the circumstances surrounding their mother’s euthanasia.  They state on their petition page: “While we have been advocates of death by Medical Assistance in situations where there is a terminal diagnosis or death is imminent, we had no idea that Canada’s laws leave considerable room for interpretation by activist doctors.” 

According to Avis Favaro at CTV News, another Ontario woman ‘Denise’ (not her real name) with environmental and chemical sensitivities has been approved for euthanasia. Denise, 31 years of age, uses a wheelchair due to an injury suffered six years ago. Denise is seeking euthanasia because her basic needs and medical needs are not being satisfied:

“She desperately wants to move to an apartment that’s wheelchair accessible and has cleaner air. But her only income is from Ontario’s Disability Support Program (ODSP). She receives a total of $1,169 a month plus $50 for a special diet. “I’ve applied for MAID essentially…because of abject poverty,” she said.’

The physicians who assessed Denise for euthanasia did not contact Dr. Bray, Denise’s physician. Avis Favaro reports that Dr. Bray commented: “Society is failing these patients,”

“My hope is that we can just put a stop to this very easy out that MAID is providing and start acknowledging that these people need to be helped,”

Canadians face waiting lists for health care, including access to psychiatric care. Inadequate support and services for persons with disabilities will cause suffering as evidenced by these stories.  Providing euthanasia should not be our response.

Dr. Leonie Herx, a palliative care specialist testified before the Special Joint Committee on Medical Assistance in Dying saying: “With almost six years of lived experience now, we have seen significant deleterious effects of the impact of MAiD implementation on palliative care, including diminished resources and increasing distress experienced by palliative care clinicians.”

Brian Bird, an assistant professor at the Peter A. Allard School of Law, University of British Columbia wrote in an opinion piece: “At times, euthanasia has even undermined access to palliative care. In British Columbia, a private hospice — a facility dedicated to caring for individuals nearing death — was shuttered last year after it conscientiously refused to offer euthanasia. Provincial authorities forced the hospice to close even after it proposed to operate without public funds, though it was reopened under direct public control.”

The Supreme Court ruled in its 2015 decision that euthanasia should be available for competent persons 18 and older whose natural death was reasonably foreseeable. From Bill C-14 in 2016, Parliament has progressed to Bill C-7 which allows euthanasia for persons with disabilities and persons whose sole medical condition is mental illness become eligible for euthanasia in 2023.

Any further expansion of euthanasia puts more vulnerable Canadians at risk. There is serious potential for abuse with advance directives, especially for persons with dementia. Every person should retain the right to change their mind and refuse euthanasia regardless of cognitive ability.

As for mature minors, we oppose any extension of euthanasia to this age group. Children are particularly vulnerable and need protection from harm.

Our organization has always advanced that the best safeguard to protect vulnerable individuals from euthanasia is prohibition. Suicide affirmation and suicide prevention cannot exist.  It is our hope that life affirming care will be the road chosen rather than continued expansion of euthanasia.

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Down Syndrome main reason for Irish disability abortion in Britain, not ‘fatal’ conditions


Life Institute Ireland

21 June 2022

The Life Institute has called for a review of how a diagnosis of a disability for an unborn child is shared with parents, after shocking new figures show that the number of abortions for babies with Down Syndrome has tripled for women travelling from Ireland since 2018.

Spokeswoman Megan Ní Scealláin said that abortion campaigners, including the National Women’s Council, were misrepresenting the figures to claim that most of the babies aborted had what they called a “fatal anomaly,” when that was not the case. 

“The British abortion statistics show that the number of abortions carried out on women travelling from Ireland to England and Wales because the baby has Down Syndrome have, in fact, tripled since 2018,” she said. 

“The number has increased year on year but 2021 showed a sharp rise, driving to a shocking 3.7 fold jump between 2018 and 2021.” 

“In 2018, there were 16 babies aborted because the child had Down Syndrome. That jumped to 27 babies in 2019, and 35 in 2020,” she said. “In 2021, a heart-breaking total of 59 abortions were carried out in Britain on Irish babies who had Down Syndrome.” 

The shocking rise comes at at time when the number of British abortions continue to soar, with 2021 reporting the highest number of terminations on record as some 214,256 babies were aborted. 

Ms Ní Scealláín said that evidence from parents of children with Down Syndrome, and the recent baby Christopher case in the National Maternity hospital hospital where a baby boy was aborted after a misdiagnosis, showed that parents felt pushed towards abortion after a diagnosis of a disability. 

“These numbers suggested that parents are increasingly pushed towards abortion and this has enormous implications for people with Down Syndrome,” she said. “When are we going to wake up and take this form of deadly discrimination seriously, when we reach a situation such as they have in Denmark where 98% of babies with Down Syndrome are aborted.” 

And she was sharply critical of abortion campaigners for what she described as a “deliberate attempt to mislead people and to muddy the waters.” 

“Today we saw the National Women’s Council claim that there was an increase in ground E or disability abortions carried out carried out on Irish residents in England and Wales – and claim that this suggests “that there are significant problems with access to abortion care in Ireland post-12 weeks on the grounds of fatal foetal anomaly.”

“This is both dishonest and disingenuous,” Ms Ní Scealláín said. “As NWCI will be well aware, the largest number of ground E abortions are now because of a diagnosis of Down Syndrome – and the number of abortions in Britain for Irish women on the ground of conditions which are actually life-limiting such as anencephaly or Patau Syndrome have fallen dramatically, precisely because those abortions are now happening in Ireland.” 

“The NWCI needs to be honest and say that it wants Down Syndrome and other conditions included in disability abortions here, rather than pretending that these are ‘fatal’ conditions,” she said. 

“But far more importantly, we as a society need to ask ourselves if we are happy to let this appalling trend develop where increasing numbers of babies with Down Syndrome are aborted to the point where there are none being born, as has happened in other countries,” she added. 

Ms Ní Scealáin also called for better supports for people with disabilities and said families of people living with disabilities were being persistently failed by the state. “Its not good enough, she said.” The state’s failure to help families is a factor in pushing parents towards abortion.” 


For further information call 086 1729908

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Major newspaper issues correction after falsely claiming thousands of women died from illegal abortions

by Micaiah Bilger

February 4, 2022

A major British news outlet issued a correction this week after a pro-life scholar debunked its claim that “roughly 12,000 women die from back street abortions” every year in Malawi.

The correction published by The Telegraph is a major victory for truth in the abortion debate as leftist news outlets and pro-abortion groups frequently misinform readers about abortion facts.

Read more at:

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Adverse reaction to abortion pill regimen

unborn child 8 weeks after conception

Pat Maloney of Run with Life blog filed Access to information requests to find out about adverse reactions to Mifegymiso, the abortion pill regimen. This regimen consists of two drugs, mifepristone and misoprostol. You will hear this type of drug induced abortion referred to as medical abortion. This post concerns the life threatening reaction of one 37 year old Canadian woman.

 by Pat Maloney

Mifegymiso case 37 year old, life threatening and involved or prolonged inpatient hospitalization

In 2017 a 37 year old woman suffered “life threatening and involved or prolonged inpatient hospitalization”.

From her Adverse Reaction Report:

“Report received [date]. 37 year old woman with unknown medical history. Received Mifegymiso. Patient was 45 days gestation.

Patient presented for follow-up appointment with heavy bleeding and vasovagal (See below). Ultrasound scan detected retained product of conception in and around cervix that physician attempted to remove. An assessment of stat hemoglobin was ordered, then patient called at home to [be] given results at 130. A date for dilation and curettage was booked by clinic. Patient reported passed large clot size of an orange on way home and felt much better. 

On [date], nurse called in the morning and patient said bleeding was only spotting and she felt better and cancelled dilation and curettage.

On [date], patient reported being admitted to hospital with hemorrhage and loss of consciousness on date with low hemoglobin and iron. She underwent emergency dilation and curettage and blood transfusion.”


“Loss of consciousness, Low hemoglobin, Low iron, Hemorrhage, Transfusion, D&C, Syncope vasovagal, Retained product of conception, Heavy bleeding”

Notice the use of Retained product of conception. A human being by any other name.

Vasovagal syncope (vay-zoh-VAY-gul SING-kuh-pee) occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope.

The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness.”

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Choosing life when you receive a difficult prenatal diagnosis

In her book Perfectly Human: Nine months with Cerian, Sarah C. Williams writes about her experience carrying a child with a fatal medical condition. In an article featured in The Plough magazine, she also addresses concerns regarding the practice of prenatal screening when it is used to eliminate by abortion those babies deemed unworthy of life because of a disability. While abortion is often presented as a choice, parents receiving a difficult prenatal diagnosis have recounted how they felt pressured to abort their child.

Sarah William writes in The Plough:

The ultrasound technician put her hand on my arm and said the words every expectant mother hopes she will never hear: “I’m afraid there is something wrong with the baby. Within an hour, it was clear that a skeletal dysplasia would claim my daughter’s life either at birth or shortly after. It was also clear that everyone expected me to have a termination”.

Later she continues:

“For my family the consequence of prenatal screening was an unbearable choice. When presented with information we never imagined we would face, we were forced to choose. But we discovered that although a termination was presented in the language of choice, it was the only recommended medical option. Hospital budgets were weighted towards fertility technology, not obstetric care for high-risk pregnancies. When I chose to carry my baby to term, the quality of my subsequent care was adversely affected by institutional policies that anticipated a certain parental choice and no other. I encountered a system shaped by a certain kind of expectation.’

She comments on the very real consequences of prenatal screening on society:

“Prenatal screening practices reflect – but also shape – our perceptions of what it means to be human. By making personhood contingent upon the majority definition of normality, these practices undermine the core values on which our civil society depends – the fundamental dignity and equality of all persons. “

From : The hidden costs of prenatal screening : Testing for fetal abnormalities is not a neutral practice. It sends a message.

by Sarah C. Williams, December 6, 2021.

Plough Quarterly magazine


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Euthanasia for mental illness. Killing people without a certain prognosis.

Tuesday, April 12, 2022

by Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Canada expanded its (MAiD) euthanasia law by passing Bill C-7 in March 2021, Many people are unaware that one of the bill’s provisions legalized euthanasia for people with mental illness alone. This means that a person who is not physically ill or dying but is living with mental illness can be killed by euthanasia.

At that time the federal government put a 2-year moratorium on euthanasia for mental illness to enable the government to establish protocols for this catagory of killing. I have stated that the two-year moratorium is unenforceable making euthanasia for mental illness legal already. 

Recently an acquaintance told me that her friend’s mother (a person who I do not know) recently died by MAiD after living with chronic depression for more than twenty years. I certainly understand the suffering related to chronic depression but when did killing become a treatment for chronic depression?

A recent article by Sharon Kirkey titled: Canada will soon offer doctor-assisted death to the mentally ill. Who should be eligible? examines the issue by first interviewing Dutch research Psychiatrist Dr Sisco van Veen who says that mental illness cannot be identified like other diseases. van Veen states:

You can’t see depression on a scan. With the exception of dementia, where imaging can show structural brain changes, “in psychiatry, really all you have is the patient’s story, and what you see with your eyes and what you hear and what the family tells you,” van Veen says. Most mental disorders lack “prognostic predictability,” which makes determining when psychiatric suffering has become “irremediable,” essentially incurable, particularly challenging. Some say practically impossible…

… In the Netherlands, MAID for irremediable psychiatric suffering has been regulated by law since 2002, and a new study by van Veen and colleagues underscores just how complicated it can be. How do you define “grievous and irremediable” in psychiatry? Is it possible to conclude, with any certainty or confidence, that a mental illness has no prospect of ever improving? What has been done, what has been tried, and is it enough?

Kirkey outlines the government time-table on euthanasia for mental illness:

Sometime in April, an expert panel struck by the Liberal government to propose recommended protocols for MAID for mental illness will present its report to the government. A joint parliamentary committee studying the new MAID law has been given a mandate to report back by June 23. The expert panel’s chair declined an interview request, but her 12-member assembly has been tasked with setting out proposed parameters for how people with mental illness should be assessed for and — if found eligible — provided with MAID, not whether they should be eligible.
Kirkey speaks to Dr Sonu Gaind, a critic of euthanasia for mental illness.

For Dr. Sonu Gaind, a past president of the Canadian Psychiatric Association, the most fundamental safeguard has already been bypassed, because there is no scientific evidence, he says, that doctors can predict when a mental illness will be irremediable. Everything else goes out the window.

Gaind isn’t a conscientious objector to MAID. He’s the physician chair of the MAID team at Humber River Hospital in Toronto, where he’s chief of psychiatry. He works with cancer patients. He’s seen the positive, the value that MAID can bring. But unlike cancer, or progressive, neurodegenerative diseases like ALS, “we don’t understand the fundamental underlying biology causing most major mental illnesses.”

“We identify them through the clustering of various symptoms. We try to target treatments as best we can. But the reality is, we don’t understand what’s going on, on a fundamental biological level, unlike with the vast majority of these other predicable conditions.” Without understanding the biological underpinnings, what do you base your predictions on, he asks. He’s heard the argument that it’s difficult to make firm predictions about anything in medicine. But there’s a world of difference between the degree of uncertainty between advanced cancers and mental illnesses like depression, he argues.

“There’s no doubt that mental illnesses lead to grievous suffering, as grievous, even more grievous in some cases than other illnesses,” Gaind says. “It’s the irremediability part that our framework also requires and that scientifically cannot be met. That we cannot do. That’s the problem.”

Kirkey then reports, as I previously reported, that euthanasia for mental illness has already been happening in Canada. Kirkey writes:

Euthanasia for mental illness has, in fact, already occurred in Canada. Testifying before a Senate committee studying Bill C-7 last year, Vancouver psychiatrist Derryck Smith told the story of “E.F.”, a 58-year-old woman who suffered from severe conversion disorder, where a person’s paralysis, or blindness or other bizarre nervous system symptoms can’t be explained by any physical findings. She suffered from involuntary muscle spasms. Her eyelid muscles had spasmed shut, leaving her effectively blind. Her digestive system was a mess, she was in constant pain and needed to be carried or use a wheelchair. In May 2016, Alberta’s Court of Queen’s Bench allowed her an assisted death.

Smith took part in another case involving a 45-year-old Vancouver woman who had suffered from anorexia nervosa since she was 17. She’d endured a “gauntlet” of treatments, he said, had been certified several times under the Mental Health Act, involuntarily hospitalized and force fed by a tube in a manner that left her feeling “violated.” “At the time I assessed her, she had virtually no social life … no joy in her life.” Smyth determined the woman had capacity to agree to assisted death.
Gaind also explains how euthanasia for mental illness is far more prevalent for women than men.
“But when you expand it to sole mental illness conditions, the entire demographic shifts, and it’s people who have unresolved life suffering that also fuels their request,” Gaind says. A stark gender gap also emerges: when MAID is provided to the imminently dying, it’s a 50-50 gender split. As many men as women seek and get it. Experience in the Netherlands and other countries shows that twice as many women seek and receive MAID for mental illness.
Kirkey points out that, unlike the Netherlands, Canada’s (MAiD) euthanasia law does not require people to try effective treatment before being approved for death. We don’t know if Canada will require people who request euthanasia for mental illness alone to try effective treatment first.

Jocelyn Downie, Dalhousie University professor of law and medicine and Canada’s leading pro-euthanasia academic as saying that, based on autonomy, we don’t require Canadians to try effective treatments for other conditions. But Downie wants to ignore that fact that death by lethal injection is an irreversible decision with an immediate effect, whereas refusing treatment for cancer will result in a natural death. Downie also wants MAiD to be seen as a medical treatment decision that is equal to all other medical treatment decisions. Even if Downie accomplishes her goal, people in general will never and should never consider death by lethal injection as a medical treatment.

Sadly, Canada rushed into passing Bill C-7 in March 2021. Most Canadians have no idea that euthanasia for mental illness is permitted and previous opinion polls showed that most Canadians opposed euthanasia for mental illness alone.

I am expecting a report from the one-sided federal government appointed committee that was established to create rules for MAiD for mental illness alone. I am very concerned.


Republished with permission of the Euthanasia Prevention Coalition
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Meet the advertising expert who inspired today’s anti-population propaganda

by Peter Jacobsen 

Billboards have begun to pop up throughout Portland with a surprisingly personal message: stop having kids. While the idea itself is a bad one, as I’ll discuss later, one interesting question to ask is, where did this sentiment come from?

I’m not interested in diving into the history of the particular organization behind this campaign. Instead, a more interesting question is where and when did this sentiment in the United States originate?

To understand the roots of this misanthropic movement, we need to meet the advertising expert who used his fortune and expertise for the primary purpose of decreasing the number of humans: Hugh Moore (1887–1972).

Although not all roads lead to Moore, a significant portion of anti-population activities are connected to him. Moore’s most well-known claim to fame is his founding of the Dixie Cup Company, but he was aided by years of working in advertising.

Moore worked as an advertising solicitor for various publications including The Reform in Kansas City and then for The Packer where he was promoted to ad manager while in his second year of attendance at Harvard. Moore left the advertising business to run the Dixie cup company, but he never gave up on his interest in advertising. In fact, he channeled it elsewhere: anti-population propaganda.

Moore was inspired by William Vogt’s book Road to Survival which convinced him population growth would lead to the spread of wars and communism, among other calamities. So Moore got to work using his money and power to influence population discourse and policy.

Arguably, Moore’s most important influence was over Maj. General William Henry Draper Jr. General Draper’s influence on President Nixon was particularly important. Draper, a friend of Moore’s, was convinced of the dangers of population in part by Moore.

Moore’s influence through Draper began with the Draper Committee formed by then President Eisenhower. The committee itself was noted for being “top heavy with military men,” in the words of Senator William Fulbright.

The day after the committee was assembled, Hugh Moore sent his friend a lengthy wire which concluded, “If your committee does not look into the impact and implications of the population explosion, you will be derelict in your duty.”

The Draper committee made three recommendations:

a) assistance to “developing” countries in establishing programs to check population growth

b) increased assistance to maternal and child health programs

(c) support for research programs on population, including research by other countries and the United Nations.

According to the United Nations Fund for Population Activities (UNFPA), this report and the conclusions were central to USAID (the international aid branch of the US government) establishing an Office of Population under President Richard Nixon.

Nixon wasn’t the first president to be influenced by the newly forming population lobby. His predecessor, Lyndon Johnson, was also influenced by Draper. In 1965, Draper and other members of the population establishment began to work on changes to the “Food for Peace” law which would give additional funding to countries which utilized population policies.

Outside of government, Moore worked diligently to tie aid success to population control. In 1969 he sponsored newspaper advertisements with the heading, “Latin American Aid Nullified by Population Explosion.”

And throughout his presidency, LBJ was thoroughly convinced of the relevance of population to aid. In a call with an advisor on famine in India, Johnson argued the country should be withheld aid because of their population.

“I’m not going to piss away foreign aid in nations where they refuse to deal with their own population problems,” Johnson said.

Over the next decade, India would take on one of the largest forced sterilization campaigns in history. The UNFPA went on to give India (and China) an Award for the population program in 1983.

As previously mentioned, Draper’s report was extremely influential on Richard Nixon as well. During Nixon’s administration, a new report was commissioned which would become one of the most infamous pieces of US population policy history.

In the early 1970s Nixon commissioned a report later made national policy by President Ford—National Security Study Memorandum 200. The report is surprisingly candid. NSSM 200 states,

“The U.S. economy will require large and increasing amounts of minerals from abroad, especially from less developed countries… That fact gives the U.S. enhanced interest in the political, economic, and social stability of the supplying countries. Wherever a lessening of population pressures through reduced birth rates can increase the prospects for such stability, population policy becomes relevant to resource supplies and to the economic interests of the United States.”

In other words, the US government was interested in lowering foreign populations in order to increase US access to raw materials. The report recognizes this sort of policy sounds bad. The solution? Don’t get caught.

“We must take care that our activities should not give the appearance to the LDCs of an industrialized country policy directed against the LDCs. Caution must be taken that in any approaches in this field we support in the LDCs are ones we can support within this country. ‘Third World’ leaders should be in the forefront and obtain the credit for successful programs. In this context it is important to demonstrate to LDC leaders that such family planning programs have worked and can work within a reasonable period of time” (NSSM 200).

The report discusses in detail how non-government organizations and foreign organizations can be used to provide cover. Lastly, and most chillingly, the report offers no clear condemnation of involuntary programs.

“In these sensitive relations, however, it is important in style as well as substance to avoid the appearance of coercion” (Emphasis added).

The report recommends influencing external actors to create, “improved world-wide support for population-related efforts” through “increased emphasis on mass media and other population education and motivation programs.”

Moore’s influence wasn’t limited to his influence on Draper. Moore’s public propaganda campaign began with his 1954 publication of the proactively titled pamphlet, “The Population Bomb.”

Demographers concerned about population were initially surprised by his colorful tactics, but Moore trusted his own marketing savvy. He told one demographer, “[y]ou’ve been raised in academic halls. I’ve been raised in the market place. I’m used to presenting facts dramatically. Students of demography have talked for years and nobody listened.”

The population bomb propaganda was a hit. The New York Times ran an article echoing the propaganda called The Population Explosion in May, 1961.

Moore’s phrase was also adopted by someone whose popularity overshadowed his own. Ecologist Paul Ehrlich asked if he could borrow the title for his 1968 book. Moore was happy to support Ehrlich’s book, which gained widespread popularity and even led to Ehrlich appearing on the TV show at the center of American television: Johnny Carson Tonight.

Hugh Moore paid for a slew of advertisements through his self-financed organization The Hugh Moore Fund. In a letter to Draper, Moore admitted to his intentional strategy of using mass marketing gimmicks.

“[W]e must gather the best and most clever public relations people, motivation experts, advertising specialists, sociologists…who can contribute to a no-fail campaign…There are geniuses in communications and selling who have sold the American public every gee-gaw and gimmick conceivable.”

The vehicle of paid space in newspapers was chosen. In his notes he wrote,

“[t]he Hugh Moore Fund has tried within its slender resources to meet this need by using paid space, for in paid space you can tell people what they should do, when they should do it and where.”

In 1967, Moore’s fund created “The Campaign to Check the Population Explosion” with Emerson Foote, the famous ex Tobacco advertising mogul, as the chair. The campaign created several advertisements. Here are two examples:

The first ad, particularly heavy handed, suggests if population growth continues unchecked, you may be mugged! These are just two examples, but the ads targeted society, politicians, and even the Catholic church.

Along with the Hugh Moore fund and the Campaign to Check the Population Explosion, Moore supported, headed, and founded several other anti-population organizations. Notably, Moore became the president of The Human Betterment Association and renamed the organization The Association for Voluntary Sterilization, to more boldly articulate its mission.

Moore also founded the Population Crisis Committee (with Draper), which later changed its name to what it is today—Population Action International. Moore was also Chairman of the Population Reference Bureau, a think tank dedicated to supporting “evidence-based policies” related to demography and health. He also served as VP of the International Planned Parenthood Federation.

Many of these organizations continue to exist today and attempt to influence public policy and public opinion in the same way Moore did during his lifetime. So although the billboard in Portland couldn’t be Moore’s personal handiwork seeing as he died in 1972, it’s likely that the legacy of Moore’s money, advertising strategy, and influence on ideas is somewhere at the root.

In a recent Atlantic article, Derek Thompson explores why US population has cratered. The author concludes, “U.S. has too few births, too many deaths, and not enough immigrants” (emphasis added). One can’t help but wonder if the millions of dollars spent on anti-population activity is to blame.

Unfortunately for the world, Moore spent the last years of his life promoting an idea that’s simply wrong. This ideology, which persists today (as seen in Portland) is an overly simplistic view of population.

Moore, Draper, Ehrlich, and the modern anti-natalists share an incomplete view of humanity. Anti-natalists generally share a modified version of the thesis of Thomas Malthus in his Essay on the Principle of Population.

The thesis is simple: human beings are consumers, and their consumption grows faster than their ability to produce with their laborer. Malthus argued that food growth is linear but population growth is exponential.

Another way to understand Malthus’ fear of population is with the law of diminishing marginal returns (which Malthus originated). The law says that, beyond some point, the more of a homogeneous input (like labor) you add to the production process, the less productive each additional unit will become.

Since the addition is decreasing while consumption needs remain the same, eventually the population will outpace productive powers. Malthus’s concern was about food, although the same argument is occasionally made with reference to the environment, for example.

The problem with this argument is that humans are, in fact, not homogeneous blobs of labor. People are creative and entrepreneurial, and they use those talents to create new products and institutional systems which allow “finite” resources to effectively multiply.

This does not mean the law of returns isn’t true, only that it requires everything else to be held constant. But, in the real world, things are rarely held constant. Advances in technology and production processes can cause returns to increase.

For example, with the invention of more fuel efficient vehicles, a fixed supply of oil is able to produce more services than before. Likewise, anti-pollution technologies can actually cause environments to improve as countries grow richer. This logic has been confirmed empirically by Nobel Prize winner Simon Kuznets’ environmental Kuznets curve.

Not everyone was fooled during Moore’s campaign. Economist Julian Simon noticed that the data simply didn’t reflect the doom and gloom of these anti-natalists. Simon challenged and beat Ehrlich in a bet on improving resource availability, and poked fun at Moore’s “HAVE YOU EVER BEEN MUGGED?” propaganda in the first edition of his book, The Ultimate Resource.

The only source of solutions to the environmental problems we face today exist in the human mind. Future generations will be at the forefront of solving today’s problems, and more minds are better than fewer.

So don’t let a billboard in Portland based on decades-old propaganda made by advertising moguls deter you. Don’t stop having kids. If you want kids—have kids. The world will be better off for it.

Peter Jacobsen
Peter Jacobsen

Peter Jacobsen is an Assistant Professor of Economics at Ottawa University and the Gwartney Professor of Economic Education and Research at the Gwartney Institute. He received his PhD in economics from George Mason University, and obtained his BS from Southeast Missouri State University. His research interest is at the intersection of political economy, development economics, and population economics. 

This article was originally published on Read the original article.

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Missing the mark on a profound social change with MAiD for mental illness

A Quebec commission appointed by the National Assembly recently recommended against allowing medical assistance in dying (MAiD) for people whose sole underlying medical issue is mental illness.

In a recent article in Policy Options, Dr. Mona Gupta, chair of a separate federal panel charged with drawing up the terms for implementation of MAiD for the sole reason of mental illness, and Jocelyn Downie, criticize the Quebec commission’s report as being “based on misleading statements and logical inconsistencies.”

As illustrated below, it is Gupta and Downie who present skewed and selective arguments for a profound social change that will place some non-dying Canadians at discriminatory risk of premature death.

Gupta and Downie claim that the Quebec commission’s recommendation “is out of step with the evolving thinking on this issue found in jurisprudence, federal legislation and the recommendations of Quebec’s regulatory authorities and professional associations.”

With respect to jurisprudence, let’s be clear: A single Quebec Superior Court judge ruled in 2019 in Truchon v Canada that the previous Canadian and Quebec MAiD laws were unconstitutional because they required people requesting MAiD to be in a state where death was “reasonably foreseeable” (federal) or where the person was at the “end of life” (Quebec). The lower court decision was not appealed despite what we think are compelling legal and policy reasons to do so. Therefore, there is no higher court endorsement of the reasoning behind the decision.

Ottawa’s answer to the Quebec court was Bill C-7, which took effect March 2021. It no longer restricted MAID to situations where death is “reasonably foreseeable,” and introduced a new de facto access track for disabled Canadians whose death is not “reasonably foreseeable.” Additionally, the Trudeau government suddenly reversed its previous commitment to exclude MAiD for mental illness alone, with NDP and Conservatives in clear opposition. It accepted a Senate-introduced “sunset clause,” which delayed MAiD for the sole reason of mental illness until March 2023. We believe the decision to rush through the legislation was political and failed to consider the unique dangers of expanding MAiD outside the end-of-life context and particularly for reasons of mental illness.

This expansion also goes far beyond the Truchon ruling, which did not involve mental illness. Gupta and Downie did not mention that in the major MAiD case on which the Supreme Court has ruled (Carter v Canada 2015) it explicitly restricted its decision to “the factual circumstances in this case,” that of a person living with ALS approaching her natural death, and it made “no pronouncement on other situations where physician-assisted dying may be sought.” It also explicitly stated that “euthanasia for … persons with psychiatric disorders” did “not fall within the parameters” of its ruling at that time. Given that neither the Quebec Court of Appeal nor the Supreme Court were asked to rule on Truchon in 2019, Bill C-7 remains open to a Charter challenge.

How Canada’s MAID law will sacrifice the medical profession’s Standard of Care

Assisted dying and “lives not worth living”

Some who defend the expansive new law invoke the right to equality. Yet, three United Nations rapporteurs and human rights experts, national disability and social justice organizations, Indigenous advocacy groups and leaders and elders, along with hundreds of medical and legal experts have argued that Bill C-7’s removal of the safeguard of “reasonably foreseeable death” for those with disabilities, including mental health disabilities, shows reckless disregard for equal protection of disabled persons against avoidable death.

From the world-renowned CAMH (Centre for Addiction and Mental Health) to the Canadian Association for Suicide Prevention, experts have warned that it is impossible to predict, as per the language of the law, the “irremediability” of mental illness for any individual. Critics say this raises the spectre of people who are not near death, but who have mental illness, being provided physician-assisted death based on unscientific assessments by physicians claiming supposed “irremediability” — at times where they may be suffering despair that is actually resolvable.

Suggesting there is emerging “consensus” in the mental health community, Gupta and Downie refer to professional organizations endorsing MAiD solely on the grounds of mental illness. One of the reports they invoke, the Quebec AMPQ report, of which Gupta was a key author, explicitly acknowledged that those who may get MAiD for mental illness could have “regained the desire to live at some point in the future” (i.e. their condition may not have been irremediable). The report suggests that “assessors will have to answer this ethical question each and every time they evaluate a request,” meaning MAiD eligibility would depend on practitioners’ personal ethics rather than medical evidence. The previous MAiD law, Bill C-14, as well as the current Bill C-7 and the Canadian public, did not envision that irremediability was to be an “ethical” value-based decision. Instead, they trusted there would be some science and evidence behind it. Regarding autonomy and informed consent, how can someone with a mental illness make an informed capable choice about MAiD when experts say any prediction about their illness and future suffering as “irremediable” is meaningless?

The Canadian Mental Health Association and the Ontario Association for ACT & FACT (experts providing front-line care to those with the most severe mental illnesses) both stand in strong opposition. In a recent survey the overwhelming majority of Ontario psychiatrists who responded said they oppose the sunset clause and MAiD solely on the grounds of mental illness. Gupta and Downie’s article paints a false impression of a “fait accompli” consensus that does not exist.

The authors surprisingly criticize as lacking in detail the argument raised by the Quebec commission that “mental disorders have specific characteristics that distinguish them from other illnesses such as cancer or lung and heart disease.” Most lay people need no convincing that when issues of people seeking death and suicidality are involved, there are obvious differences between mental illnesses and other illnesses. Any psychiatrist knows that no other medical illnesses have suicidality as a potential diagnostic criterion. A wealth of evidence shows that people suffering mental illness with related symptoms of despair and hopelessness make different decisions than they otherwise would.

Gupta and Downie further minimize the Quebec commission’s worry about “distinguishing suicidality from a request for MAiD” in cases of mental illness. This is particularly surprising given that Gupta and Downie sat on the Council of Canadian Academies (CCA) expert panel that issued this key finding: “Some people who have sought psychiatric euthanasia and assisted suicide in jurisdictions that permit it share certain characteristics with people who attempt suicide.”

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic. The fact that MAiD for suicidal thinking in those suffering from physical disease is allowed does not make the failure to prevent suicide of people solely on the grounds of mental illness any more acceptable, as Gupta and Downie appear to suggest. Of further concern, they do not mention the fact that those getting MAiD because of mental illness in the few European countries that provide it disproportionately seek relief because of marginalization, including unresolved social suffering and loneliness – problems that are remediable.

Gupta and Downie characterize as ‘inconsistent’ that a person with schizophrenia could be denied MAiD for that condition, yet return the next day and get MAiD for cancer. Once again, this neglects the obvious differences between mental illnesses and terminal/neurodegenerative diseases (where many Canadians support MAiD). The impossibility of assessing irremediability is absolutely particular to those with mental disorders and thereby singles them out as a distinctly identifiable group. Failing to recognize this difference is discriminatory and exposes these non-dying Canadians to unjustifiable deaths. The Quebec commission’s recognition of these key differences is consistent with evidence. It is Gupta and Downie’s discounting of these differences that should raise concern.

Lack of palliative care is a failure in too many MAiD requests

What’s the relationship between suicide and MAiD?

The authors conclude that not giving access to MAiD interferes in the lives of capable adults living with mental disorders, some of whom may have had many years of ineffective treatment. We find it startling to frame suicide prevention as an “interference” in people’s lives, and disturbing that Gupta and Downie do not mention the lack of access to care faced by Canadians suffering from mental illness. The Mental Health Commission of Canada tells us that fewer than one in three adults get the mental health care they need. Only one in five children can access early care that may prevent them from needing many years of professional care later because their diseases were not treated in a timely way. Canadians wait up to five years for specialized tertiary psychiatric care.

In this context, introducing in law a “painless death” through MAiD and ignoring the systemic failures of lack of access to mental health care seems beyond reckless. While this will save money (providing MAiD to non-dying persons with decades left to live is far cheaper than attempting to provide support for dignified living), it will come at the high cost of prematurely ending the lives of those who could possibly have recovered and enjoyed long meaningful lives with family and loved ones.

We think that in Gupta and Downie’s ledger, this may be seen as respecting autonomy and compassionately providing peaceful deaths to those suffering from mental illness who were irremediable. In our ledger, it will be making irresponsible predictions of “irremediability”’ and failing to allow for true informed consent, while providing premature deaths to potentially suicidal and marginalized individuals who might have improved.

Permitting MAiD solely on the grounds of mental illness fundamentally violates the right to equal protection of persons with mental illness against premature death. Gupta and Downie’s strong rejection of the Quebec commission’s recommendation is concerning, particularly when considering how such skewed arguments might influence the soon-to-be released recommendations of Gupta’s federal panel. One member of a mental health advocacy organization has already resigned from Gupta’s panel but this has not been announced by the panel or federal government. None of this bodes well for those of us hoping for a balanced and evidence-based approach.

Sonu Gaind, professor at the University of Toronto, chief of psychiatry and physician chair of the Humber River Hospital MAiD team and former president of the Canadian Psychiatric Association, co-authored this article.

This article first appeared on Policy Options and is republished here under a Creative Commons license.

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Dignity therapy : Making the last words count

Dignity therapy: Making the last words count

Guided conversations with the terminally ill are popular with patients, families and doctors who’ve experienced them. But are they truly beneficial? Researchers are looking beneath the anecdotal appeal.


In the mid-1990s, psychiatrist Harvey Max Chochinov and his colleagues were researching depression and anxiety in patients approaching the end of their lives when they became curious about this question: Why do some dying people wish for death and contemplate suicide while others, burdened with similar symptoms, experience serenity and a will to live right up to their last days?

Over the next decade, Chochinov’s team at the University of Manitoba in Canada developed a therapy designed to reduce depression, desire for death and suicidal thoughts at the end of life. Dignity therapy, as it is called, involves a guided conversation with a trained therapist to allow dying people to speak about the things that matter most to them. “It is a conversation that we invite people into, to allow them to say the things they would want said before they are no longer in a position to be able to say it themselves,” Chochinov says.

Dignity therapy is little known to the general public but it has captivated end-of-life researchers around the world. Studies have yet to pin down exactly what benefits it confers, but research keeps confirming one thing: Patients, families and clinicians love it.

These end-of-life conversations are important, says Deborah Carr, a sociologist at Boston University who studies well-being in the last stages of life and  explored the topic in the 2019 Annual Review of Sociology. A key need of people who know they are dying is tending to relationships with people who are important to them. This includes “being able to communicate their wishes to family and ensuring that their loved ones are able to say goodbye without regret,” she says.

And the closer we get to death, the more we need to understand what our lives have amounted to, says Kenneth J. Doka, senior vice president for grief programs for Hospice Foundation of America. “As people reach the end of life, they want to look back and say, ‘My life counted. My life mattered. My life had value, had some importance,’ in whatever way they define it,” Doka says. “I think dignity therapy speaks to that need to find meaning in life and does it in a very structured and very successful way.”

A dignified ending

Chochinov’s search to understand why some people feel despair at the end of life while others do not led him to countries like Belgium, the Netherlands and Luxembourg, where euthanasia and assisted suicide have long been legal. There he learned that the most common reason people gave for seeking assisted suicide was loss of dignity.

To learn more, Chochinov and his colleagues asked 213 terminal cancer patients to rate their sense of dignity on a seven-point scale. Nearly half reported a loss of dignity to some degree, and 7.5 percent identified loss of dignity as a significant concern. Patients in this latter group were much more likely to report pain, desire for death, anxiety and depression than those who reported little or no loss of dignity.

Dignity at the end of life means different things to different people, but in interviews with 50 terminally ill patients, Chochinov and his colleagues found that one of the most common answers related to a dying person’s perception of how they were seen by others. “Dignity is about being deserving of honor, respect or esteem,” Chochinov says. “Patients who felt a lost sense of dignity oftentimes perceived that others didn’t see them as somebody who had a continued sense of worth.”

Dignity therapy is tailored to enhance this sense of worth. In a session, a therapist — typically a clinician or social worker — carefully leads the patient through a series of nine questions (see graphic) that help a person express how their life has been worthwhile. “It’s not like a recipe, that you can just read out these nine questions and then call it dignity therapy,” Chochinov says. “We train therapists so that we can help them guide people through a very organic kind of conversation.”

The session typically lasts around an hour. About half is spent gathering biographical highlights, and the other half focuses on what Chochinov calls the “more wisdom-laden” thoughts that the patient wants to share. A few days later, the patient receives an edited draft for review. “There’s an ethos of immediacy — your words matter, you matter,” he says. “They can edit it and they can sign off on it to say, ‘That is what I want as part of my legacy.’”

But does it work?

Miguel Julião, a physician in Lisbon, Portugal, specializes in helping patients who have difficult symptoms, which is why he was asked one day a few years ago to see a patient suffering with unbearable pain. “The minute I got into his room, he told me ‘I would like you to help me die soon,’” Julião says. “I told him, ‘I don’t agree with euthanasia and I don’t do it, but I would like to know about you as a person and what you are most proud of in your life.’”

In the next few minutes, Julião learned about the man’s pride in raising “two good human beings” and stories of their life as a family. And he received an invitation to return for more conversations, which continued until the man died a month later.

The encounter prompted Julião, who was pursuing his doctorate at the time, to pivot his research and focus squarely on dignity therapy. He has had lots of company. Chochinov estimates that nearly 100 peer-reviewed research papers, and at least four in-depth analyses — “systematic reviews” of the accumulated science — have been published so far, and more studies are ongoing. The largest study yet, of 560 patients treated at six sites across the country, is now being conducted by Diana Wilkie, a nursing professor at the University of Florida, and colleagues.

Wilkie also helped conduct the first systematic review, published in 2015, which came up with a conundrum. When all studies were viewed together, the evidence that dignity therapy reduced desire for death was lacking. “The findings have been mixed,” she says. “In the smaller studies, you see benefit sometimes and sometimes not; in the larger studies, not.”

The most definitive study — Chochinov’s original clinical trial, completed by 326 adults in Canada, the United States and Australia who were expected to live six months or less — found that the therapy  did not mitigate “outright distress such as depression, desire for death or suicidality,” although it provided other benefits, including an improved quality of life and a change in how the patients’ family regarded and appreciated them. A few years later, however, Julião conducted a much smaller trial in Portugal in which dignity therapy  did reduce demoralization, desire for death, depression and anxiety.

Julião thinks that the different outcomes reflect differences in the patient groups: His study focused on people experiencing high levels of distress, while Chochinov’s did not. But Julião also notes that his study was small, with only 80 participants. “We still need more evidence,” he says. “But, on the other hand, you see a high interest among clinicians, because they see it work in daily practice.”

Positive and negative results also may depend upon how studies measure “success.” Scott Irwin, a psychiatrist at Cedars-Sinai Cancer in Los Angeles, worked at a San Diego hospice that introduced dignity therapy in 2009. “It was absolutely worthwhile — no question,” Irwin says. “Not only did the patients love it, but the nurses loved it and got to know their patients better. It was sort of a transformative experience for patients and the care team.”

Indeed, Wilkie’s literature review reported “overwhelming acceptability, rare for any medical intervention.” Patients seem to get something out of it, even if that “something” isn’t captured by measures like reduced desire for death. In  one study of 100 terminally ill patients who received dignity therapy, 91 percent reported feeling satisfied or highly satisfied; in another, 93 percent gave high ratings of satisfaction.

In Portugal, family members of dying individuals have prompted Julião to develop new uses for the therapy. He and Chochinov first adapted the interview to be appropriate for adolescents. More recently, two individuals told Julião they regretted that their loved ones had died without receiving dignity therapy, prompting the researchers to create a posthumous therapy for surviving friends and family members.

In a study of this interview protocol for survivors, “we have wonderful, wonderful comments from people saying, ‘It’s like I’m here with him or with her,’” Julião says. Doing dignity therapy posthumously could be useful in helping families deal with bereavement, he says — an idea he’d like to test.

Barriers to use

But for all its appeal, few patients actually receive dignity therapy. Though the tool is well-known among clinicians and social workers who specialize in caring for seriously ill patients, it is not routinely available in the US, Doka says.

A primary barrier is time. The therapy session is designed to last just one hour, but in Irwin’s experience at the hospice, patients were often too tired or pain-ridden to get through the entire interview in one session. On average, a therapist met with a patient four times. And the interview then had to be edited by someone trained to create a concise narrative that is true to the patient’s perspective and sensitive in dealing with any comments that might be painful for loved ones to read.

Julião says he transcribes each patient’s interview himself and also edits it into the legacy document. The entire process typically takes about eight days; he suspects this is why he is one of only two people who provide dignity therapy in Portugal. He says he has enthusiastic responses from clinicians and social workers attending the lectures and workshops he has conducted since 2011. “But they don’t do it clinically because it’s hard for clinicians to dedicate so much time to this.”

Dignity therapy is most widely available in Winnipeg, its birthplace, where all clinicians at Cancer Care Manitoba, the organization that provides cancer services in the province, have been trained in the protocol. If a patient expresses interest, or a clinician thinks a patient might be interested, a referral is made to one of the therapists, among them Chochinov.

“And then I see them, either in their hospital bed or more typically at their home,” he says.

A few months ago, he spent about an hour with a dying woman. She told him about her proudest accomplishments and shared some guidance for her loved ones.

A few days after he delivered a transcript of the conversation, the woman thanked him by email for their discussion and for the document that “will give my family something to treasure.”

“Dignity therapy is part of the bridge from here to there, from living my life fully to what remains at the end,” she wrote. “Thank you for helping me to tell this story.”

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

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In Europe, suicides rise after ‘right-to-die’ is legalised says bioethicist –

Not a single country has experienced a subsequent reduction in its rates of violent suicides.

Right-to-die campaigners often claim that legalising assisted suicide and euthanasia will result in a fall in the number of suicides. UK bioethicist David Albert Jones studied the record in European countries where these have been legal for a number of years. His finding were published earlier this month in the Journal of Ethics in Mental Health. MercatorNet interviewed him about his research.

by David Albert Jones

You’ve just published an article about what happens to the overall suicide rate when euthanasia and assisted suicide are legalised. Could you give us a snapshot?

The key finding was that, in Europe, after introducing euthanasia or assisted suicide the total number of people taking their own life or having it ended on request rose significantly when compared to neighbouring countries. At the same time there was no evidence of any reduction in unregulated non-assisted suicide when compared to neighbouring countries. In some cases non-assisted suicide also increased.

Even the Canadian Supreme Court was persuaded that euthanasia and assisted suicide do away with the need for “intentional self-initiated death”. It adopted the paradoxical notion that assisted suicide and euthanasia save lives. Is this widely accepted?

It is not widely accepted among clinicians or researchers. The published evidence all points in the opposite direction: that legalising euthanasia or assisted suicide is followed by an increase in intentional self-initiated death. However, it is quite a popular argument among lobby groups and campaign organisations. They say that legalising euthanasia or assisted suicide would help prevent intentional self-initiated death.

This is a good example. They point to a problem of suicide among chronically and terminally ill people and claim that the problem would be “greatly alleviated” by “voluntary assisted dying”. They are right about the problem but wrong about the solution. There is no evidence that it helps.

It is true that some people feel secure knowing that assisted suicide is available and this helps them to live. However, if you give people lethal drugs to end their lives some people will take the drugs and it should be no surprise that, overall, more people die.

It is also very wrong to say that people are “forced to” take their own lives when voluntary assisted dying is not available. Suicide is not forced on people by circumstances and suicide should never be presented as a reasonable solution to the challenges of life. Suicide can be prevented where people are given the right support.

But even if more people die overall is that necessarily a bad thing? What counts is how you die. Surely it is better to have your life ended by voluntary assisted dying than resort to these violent means of suicide.

This argument assumes that people will use voluntary assisted dying (euthanasia or assisted suicide) instead of non-assisted suicide and so the number of non-assisted suicides will be reduced. However, when we look at what actually happens, what we find is that the number of non-assisted suicides does not go down. Even in countries where every year thousands of people have their lives ended by “assisted dying”, there is no evidence of any reduction in non-assisted suicide. The Netherlands has the highest rate of euthanasia in Europe and it is one of the few countries in Europe where the rate of non-assisted suicide is rising.

Your paper involved a lot of number-crunching. Just briefly, what data did you use and what comparisons did you make?

The data I use was from the OECD. They collect comparable health data from different countries including suicide rates per 100,000 people. It is freely available on the website and anyone can access it and look at suicide rates in their own country when compared with other countries. I also used official figures for reported euthanasia and assisted suicide in Luxembourg, the Netherlands and Belgium. For assisted suicide in Switzerland I used figures made available by the assisted-suicide provider Dignitas. They collate figures not only of deaths in their own clinics but of all assisted suicides by Swiss citizens. All these data are publicly available.

I compared Switzerland with Austria (its most similar non-assisted-suicide neighbour) and Luxembourg, the Netherlands and Belgium with France and Germany (their non-euthanasia neighbours).

And what did you find, overall, for Switzerland, Luxembourg, the Netherlands, and Belgium?

I found in every case that the number of self-initiated deaths went up after introducing euthanasia or assisted suicide. I found that in some countries non-assisted suicides had gone down and, in some countries, they had gone up, but compared to neighbours that had not introduced euthanasia or assisted suicide the rate of non-assisted suicide never went down. It stayed the same or increased.

You did a similar study about the situation in the United States? Is the data stronger for Europe?

The 2015 study that I was involved in, looking at US data, used a more robust statistical method. It controlled for different factors and calculated figures for state and year effects.

The present study uses neighbouring countries as controls and does not provide any estimate of statistical significance. Nevertheless, this gives some indication of large scale effects and the patterns that I found were repeated in different countries and also replicated the results of the earlier study in the United States.

It adds to the evidence that if you introduce euthanasia or assisted suicide more people will die by their own hand and the study gave no indication of any reduction in non-assisted suicide.

How about the suicide rate for women?

That is a good question. It was very noticeable that in all the countries I looked at the changes were greater in women. For example, while the rate of total suicide, inclusive of assisted suicide, in Switzerland increased somewhat since 1998 (from 19 per 100,000 population to 22.2), the rate of total suicide for women increased dramatically, almost doubling (from 9.4 to 18.6).

Again, in Belgium since the law changed in 2002, the non-assisted suicide rate has not gone down as much in Belgium as in neighbouring non-euthanasia countries. Because of this, by 2016 it had the fifth highest suicide rate in Europe, exceeded only by the former communist countries Hungary Slovenia, Latvia and Lithuania. However, for women the contrast with other countries was even stronger.

By 2016, Belgium had the highest suicide rate among women of any country in Europe at 8.8 deaths by suicide per 100,000 population. For comparison, the respective figure the United Kingdom was 3.3 while in New Zealand and Australia it was 6.1 and 6.0 respectively.

The reasons for this are not clear. It may be because women who die by suicide more often chose a means that is similar to assisted suicide, that is, the ingesting of a lethal dose of drugs. Men more often chose more violent methods. However, this is speculative. More research is needed to explore why these changes have a greater adverse impact on women.

This is beyond the scope of your paper, but why do more people commit suicide overall after legalisation? Is there some sort of suicide contagion?

The paper was about what happens, not why. However, it has been argued that introducing euthanasia or assisted suicide makes it acceptable to end one’s own life, a message at variance with that of suicide prevention campaigns. In my view, in countries where euthanasia or assisted suicide is legal there is still a question of whether these practices should be encouraged or whether countries should address the reasons why people seek to end their lives prematurely. Death is inevitable — but it is not inevitable that someone dies by their own hand or at their own request. People can be helped to avoid this.

International helplines can be found at In the US, the National Suicide Prevention Lifeline is at 800-273-8255 or chat for support. You can also text HOME to 741741 to connect with a crisis text line counsellor. In the UK and Ireland, Samaritans can be contacted on 116 123 or email or In Australia, the crisis support service Lifeline is 13 11 14.

David Albert Jones


Professor David Albert Jones is Director of the Anscombe Bioethics Centre, Oxford; he was appointed in 2010. He is also a Research Fellow at Blackfriars Hall, Oxford University and Professor of Bioethics…

First published by on February 18, 2022.
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