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

BMJ 2022; 377 doi: (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

The ONS analysis reported on in this article matched patients with newly diagnosed physical health conditions with controls to examine risk of suicide after diagnosis of physical illness. Matching accounted for various sociodemographic characteristics (age, gender, etc), but did not account for severe mental illness or depression. There is a well described association between physical and mental illness. The higher rate of suicide among those recently diagnosed with physical illness in this study may therefore represent a higher prevalence of mental illness in this group.

The cohort examined in the ONS study were predominantly people with a new diagnosis of Ischaemic Heart Disease or COPD. Let’s imagine, instead, that they were young women with newly diagnosed eating disorders. It is highly likely that a similar analysis would find a higher rate of suicide among these participants too. But it would be shocking if this finding were used to call for legalisation of assisted dying. Instead, there would be clamouring (rightly) about the need for better mental health support. Why, when the cohort comprises older people with COPD and heart disease, is a different conclusion acceptable?

The ONS data were covered extensively in the media as part of a Dignity in Dying campaign that describes the cohort as ‘dying’. But this is not accurate. The ONS helpfully provide data tables from which it is possible to calculate the rate of non-suicide death among cases with newly diagnosed physical illness. Overall, 72% of the cohort survived for more than 2 years (after which no data is provided). This is not surprising – people can survive for years, sometimes decades, following a diagnosis of ischaemic heart disease or COPD. It is highly misleading (though probably increases public sympathy) to suggest that the group were ‘dying’.

Dr Jacky Davis is quoted as saying that the findings provide evidence that “the laws that govern how we die in this country lack compassion and are in urgent need of reform”. We disagree: the ONS data provide no evidence, either for or against, assisted dying legislation. Of note, there is no evidence from the report that the people who died by suicide would even be eligible for assisted dying under a law that Davis and other individuals quoted in Hurley’s piece are campaigning for, where access is restricted to people whose prognosis is less than 6 months.

The BMJ is open about its editorial policy in support of assisted dying. This position should not preclude careful scrutiny of the data. Understanding why there is a higher rate of suicide after diagnosis of physical illness, and how to reduce this, is essential. It is concerning to see this new and ‘experimental’ (as described by the ONS) analysis used to support a campaign to legalise assisted dying, rather than to call for better mental health care for people diagnosed with physical illnesses.

Competing interests: No competing interests

23 April 2022
Katherine E Sleeman
Professor in palliative care, honorary consultant in palliative medicine
Joanna M Davies
King's College London
Cicely Saunders Institute