Suicide and euthanasia

SIGNIFICANCE: Suicide ranks among the ten leading causes of death in the United States, and when it occurs, law enforcement generally investigates its circumstances. Euthanasia takes many forms, some of which are illegal and require criminal justice responses.

Suicide occurs among almost all population groups, but rates of suicide vary greatly by demographic group.

For example, in the year 2021, suicide rates rose among Americans to 14 per 100,000 people. In 2022, according to the CDC, 49,476 Americans committed suicide. Men were 3.85 times more likely to die by suicide, yet women attempted suicide 1.3 more times than men. Men tend to be at greater risk of suicide than women for a variety of reasons, including their higher rate of alcoholism, their greater familiarity with firearms, and their lower inclination to seek help for mental troubles.

Likewise, the rate of suicide among White Americans as a group is typically about double that of African Americans (14.7 vs. 5.5). This may be because White people end to have more favorable attitudes toward suicide and are more likely than African Americans to internalize their aggressive feelings and blame themselves for life’s problems. While African Americans tend to externalize their aggression, perhaps because of their history of facing discrimination, they also have a homicide rate four times greater than that of White Americans (22.1 vs. 4.9 per 100,000). Risk of suicide is also high among people with damaged ties to society and people living under unusual stresses, such as those who are divorced or widowed, those low in religiosity, the unemployed, and the poor.

Police Suicide

Police are generally believed to have higher than average suicide rates, but data supporting that view may be inconclusive. Job stresses that might contribute to police suicide include frequent danger of death and injury, public dislike of police, and having to work changing and often inconvenient shifts. These stress factors can, in turn, increase marital and other problems. According to an ABC News report in 2024, about 184 police and correctional officers per year die by suicide. Over the period of 2016 to 2022, 1,287 police and correctional officers died by suicide.

The findings of more than twenty-five studies of police suicide have been mixed. A common flaw in many of the studies has been a failure to compare police suicide rates to race- and gender-matched control groups. For example, a New York Times story published during the early 1990s reported on the “high” rate of suicide among police in New York City: about 21 per 100,000 population. The Times pointed out that this rate was almost twice the national average of 12, but the story neglected to take into consideration the fact that the composition of the police matched that of a demographic group—White male adults—that already had a high suicide rate. That failing diminished the report’s conclusions about police suicide rates. In actuality, the suicide rate among New York City police is lower than that for all men of working age.

Well-designed studies make such controlled comparisons. For both the United States as a whole and Germany, once controls are incorporated for demographic factors such as age and gender, police are not at an elevated risk for suicide. However, no study has focused specifically on police officers on patrol. It may be that suicide risk for such officers is much higher than that for the many officers who work primarily in clerical and managerial capacities, away from dangers on the streets.

Suicide in Correctional Facilities

Correctional officers and prison guards also work in unsafe environments. Moreover, they serve clients who are criminals and receive low pay in return. Nevertheless, studies undertaken with controls for demographic factors, find that the suicide rate of prison guards is not significantly higher than that of the rest of the working-age population.

On the other hand, suicide rates among inmates of jails and other correctional facilities tend to be higher than those for demographically comparable nonprison populations. According to the Bureau of Justice Statistics in 2021, between the years of 2001 and 2019, suicide rates increased 85 percent in state prisons, 61 percent in federal prisons, and 13 percent in local jails. White male inmates had a suicide rate of 93 per 100,000 while Black male inmates had a rate of 18 per 100,000.

Prisoners who commit suicide are most apt to do so during the first week of their confinement. The most suicides occur during the first twenty-four hours of prisoners’ confinement, a period of rapid and stressful change. New prisoners experience sudden breaks with work, loss of daily contacts with families and loved ones, loss of familiar environments, and sudden subjection to rigorous institutional regimentation. Feelings of disorientation, depression, and anxiety and other psychological states associated with suicide risk are high during this time frame.

Euthanasia

Passive euthanasia involves aiding the termination of other persons’ lives by withdrawing life-support assistance, such as medical treatments, medications, respirator equipment, respirators, nutrition, and water. Active euthanasia involves the administration of treatments or medications designed to end life. Euthanasia is considered to be voluntary when victims request it and involuntary when persons other than the victims request it. Physician-assisted suicide differs from active voluntary euthanasia in that physicians do not perform the actual killings but merely provide the means for suicide, such as a prescription for a lethal dose of drugs. In some jurisdictions all forms of euthanasia are illegal. In 1999, a Michigan court sentenced Dr. Jack Kevorkian to prison after he had assisted in the suicides of 130 persons.

The first nation to legalize assisted suicide was the Netherlands, which went through a long process of legal decisions between 1973 and 2001 before the practice was fully legal. The Netherlands, Canada, Belgium, Colombia, and Luxembourg all have legalized assisted dying. In January 2017, Victoria, Australia, became the country's first state to legalize assisted dying. Oregon became the first US state to legalize the practice, when its voters approved the Death with Dignity Act in 1997. Over the next two years, forty-three people in the state committed suicide with the assistance of physicians. As of 2024, Oregon, Washington, Montana, Vermont, California, Colorado, Washington, DC, Hawaii, New Jersey, Maine, and New Mexico had enacted laws that allow aid in dying. Some state laws, however, are explicit in asserting that the act is not suicide. However, most persons who received permission for assisted suicide never completed it. This is an indication that mandatory waiting periods and rigorous application procedures tend to discourage the practice.

Little systematic research has been done on why people choose assisted suicide over unassisted suicide. However, in contrast to the pattern for suicide in general, about two-thirds of people who apply for permission for assisted suicides are women.

Some research has been done in the impact of physician-assisted suicide and euthanasia on society. The one consequence has been the promotion of more favorable attitudes toward suicide in general. Research in thirty-one nations has found that societies with high public approval rates of euthanasia tend to have higher acceptance of suicide in general. In the United States, the percentage of people supporting suicides of terminally ill patients rose from 39 percent in 1977 to 53 percent in 2023. An analysis of a variety of factors found that the increase in television coverage of euthanasia in this time period was a leading predictor of increased public support for suicide. A study in the Netherlands determined that legal endorsements of assisted suicide were associated with increases in suicide in general.

Bibliography

Barr, Luke. "About 184 Law Enforcement Officers Die by Suicide Each Year." ABC News, 20 Mar. 2024, abcnews.go.com/Politics/184-law-enforcement-officers-die-suicide-year-report/story?id=108260786. Accessed 10 July 2024.

Berger, Arthur S., and Joyce Berger, eds. To Die or Not to Die? Cross-Disciplinary, Cultural, and Legal Perspectives on the Right to Choose Death. New York: Praeger, 1990.

Brody, Baruch A., ed. Suicide and Euthanasia: Historical and Contemporary Themes. Dordrecht, Netherlands: Kluwer, 1989. Collection of articles on a variety of suicide issues from the nation that has pioneered in the legalization of assisted suicide.

Fenton, Jenifer. "Report: Jail Suicide Is the Leading Cause of Death of US Inmates." Al Jazeera. Al Jazeera America, 5 Aug. 2015. Web. 31 May 2016.

Hahn, Josephine Wonsun. "How to Lower the High Level of Jail Suicides." Brennen Center for Justice, 17 Aug. 2022, www.brennancenter.org/our-work/analysis-opinion/how-lower-high-level-jail-suicides. Accessed 10July 2024.

Humphry, Derek. Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. 2d ed. New York: Dell, 1996. Classic guide to methods of committing suicide with discussions of related legal issues. This book has been controversial because of public perceptions that it encourages readers to commit suicide; however, its emphasis on the practical difficulties of committing suicide may have the opposite effect.

Kaste, Martin. "The 'Schock of Confinement': The Grim Reality of Suicide in Jail." NPR. NPR, 27 July 2015. Web. 31 May 2016.

Institute of Medicine. Reducing Suicide: A National Imperative. Washington: National Academies Press, 2002. Overview of the distribution and causes of suicide, together with policy recommendations for its reduction.

Larue, Gerald A. Euthanasia and Religion: A Survey of the Attitudes of World Religions to the Right to Die. Los Angeles: Hemlock Society, 1985. Broad survey of the place of suicide in religious beliefs, published by an organization that advocates legalizing assisted suicide.

Lester, David. Why People Kill Themselves: A 2000 Summary of Research Findings on Suicide. 4th ed. Springfield, Ill.: C. C. Thomas, 2000. Summary of all research on suicide published in English between 1990 and 1997, compiled by a leading authority in the field of assisted suicide.

"The Right to Die." The New York Times, 30 Jan. 2022, www.nytimes.com/2022/01/28/podcasts/the-daily-newsletter-euthanasia-athlete.html. Accessed 10 July 2024.

Roleff, Tamara L., ed. Suicide: Opposing Viewpoints. San Diego, Calif.: Greenhaven Press, 1998. Collection of essays addressing suicide from different perspectives; designed for young adult readers.

Rosenfeld, Barry. Assisted Suicide and the Right to Die: The Interface of Social Science, Public Policy, and Medical Ethics. Washington, D.C.: American Psychological Association, 2004. Analyzes how social science can be used to inform the debates on end of life matters such as how untreated depression may form the basis for requests for physician-assisted suicide.