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Some groups of terminally ill patients are twice as likely to die by suicide, data show

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1014 (Published 21 April 2022) Cite this as: BMJ 2022;377:o1014

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Re: Some groups of terminally ill patients are twice as likely to die by suicide, data show

Dear Editor,
It is strange that the BMJ does not recognise the complexities of the ONS data on suicide. The argument appears perverse logic - ‘people are dying by suicide, so we should have doctors assist suicide’.

The data does not indicate that doctors should provide lethal drugs on request. But it does indicate that our care systems are failing those devastated by a diagnosis of a poor prognosis cancer. The data also confirms that the highest risk time for suicide is at the time of diagnosis.

The populations compared are not comparable. They have not been matched for a history of mental illness nor for support received at the time of diagnosis, both of which are known to influence response to bad news, especially if imparted badly.

The selection of COPD and chronic ischaemic heart disease assumes a very poor prognosis in these patients from diagnosis, but ignores the linkage of these conditions to depression, and to the higher incidence of smoking in those with mental health disorders. As many live with COPD for years from the time of diagnosis, it is difficult to see why this group was deemed to have the same poor prognosis as those with cancers.

The ONS data is, as the report stated, experimental statistics - raising more questions than it answers. It underlines the deficits in care that are well known, but it does not lead to the conclusion that instead of providing care and suicide prevention strategies, doctors should now assist suicide by supplying lethal drugs.

Evidence from other jurisdictions shows that the rate of non-assisted and violent suicides does not fall when ‘assisted dying’ is legalised and in some has risen.

Competing interests: As a Parliamentarian I have opposed Baroness Meacher's Bill. I was co-founder of the think tank Living and Dying Well, and was on the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill. I am also a member of the APPG on Dying Well. I have spoken on the topic in the media and in Parliamentary and university debates.

22 April 2022
Ilora Finlay
Prof of Palliative Medicine
Ilora Finlay
House of Lords