Doherty Anne M, Axe Caitlyn J, Jones David A
School of Medicine, University College Dublin, Ireland.
School of Bioethics, University of Washington, Washington, USA.
BJPsych Open. 2022 Jun 3;8(4):e108. doi: 10.1192/bjo.2022.71.
Euthanasia and assisted suicide (EAS) are practices that aim to alleviate the suffering of people with life-limiting illnesses, but are controversial. One area of debate is the relationship between EAS and suicide rates in the population, where there have been claims that availability of EAS will reduce the number of self-initiated deaths (EAS and suicide combined). Others claim that legislation for EAS makes it acceptable to end one's own life, a message at variance with that of suicide prevention campaigns.
To examine the relationship between the introduction of EAS and rates of non-assisted suicide and self-initiated death.
We conducted a systematic review to examine the association between EAS and rates of non-assisted suicide and of self-initiated death. We searched PubMed, Scopus, PsycINFO and Science Direct, until 20 December 2021. Studies that examined EAS and reported data on population-based suicide rates were included.
Six studies met the inclusion criteria; four reported increases in overall rates of self-initiated death and, in some cases, increased non-assisted suicide. This increase in non-assisted suicide was mostly non-significant when sociodemographic factors were controlled for. Studies from Switzerland and Oregon reported elevated rates of self-initiated death among older women, consistent with higher rates of depressive illnesses in this population.
The findings of this review do not support the hypothesis that introducing EAS reduces rates of non-assisted suicide. The disproportionate impact on older women indicates unmet suicide prevention needs in this population.
安乐死和协助自杀旨在减轻患有绝症者的痛苦，但存在争议。争议的一个领域是安乐死和协助自杀与总体自杀率之间的关系，有人声称安乐死和协助自杀的可得性会减少自主死亡的数量（安乐死和协助自杀与自杀的总和）。另一些人则声称，安乐死立法使自杀变得可以接受，这与自杀预防运动传达的信息相悖。
研究安乐死和协助自杀的合法化与非协助自杀率和自主死亡率之间的关系。
我们进行了一项系统综述，以研究安乐死和协助自杀与非协助自杀率和自主死亡率之间的关联。我们检索了截至2021年12月20日的PubMed、Scopus、PsycINFO和Science Direct数据库。纳入了研究安乐死并报告基于人群自杀率数据的研究。
六项研究符合纳入标准；四项研究报告自主死亡的总体发生率有所上升，在某些情况下，非协助自杀率也有所上升。在控制了社会人口统计学因素后，这种非协助自杀率的上升大多不显著。来自瑞士和俄勒冈州的研究报告称，老年女性的自主死亡率有所上升，这与该人群中较高的抑郁症发病率一致。
本综述的结果不支持引入安乐死和协助自杀会降低非协助自杀率这一假设。对老年女性的不成比例影响表明该人群的自杀预防需求未得到满足。
