Research centre’s conclusions about suicide rates and voluntary assisted dying laws don’t stack up

Drawing conclusions about changes in suicide rates based on the impact of a single, isolated factor is inherently flawed, as the Anscombe Bioethics Centre should know. So why has it weighed in on the debate about voluntary assisted dying in Australia?

Professor David Albert Jones – the director of Anscombe Bioethics Centre in the UK – has published a research paper claiming there is no prima facie evidence that VAD laws have reduced the number of suicides among terminally ill people in Victoria. 

Jones is a staunch opponent of VAD, and is on the public record arguing against its introduction in Australia, the UK, Europe and the US.

In his latest paper, he has criticised proponents of VAD for arguing that laws will help prevent desperate and violent suicides among terminally ill Australians who, prior to the advent of VAD, had no alternative to end their own suffering. 

Suicide rates have fallen slightly in Australia since 2019, when Victoria became the first state to give access to VAD. Analysing data from the National Mortality Database and state suicide registers, Jones contends that if VAD was a factor, then Victoria, as the first jurisdiction, should have seen a bigger fall than other states. He focuses especially on suicides in people above the age of 65, which have increased in Victoria compared to NSW since 2021.

Jones’s conclusions are flawed for various reasons, which we discuss in detail below.

Suicide is a statistically rare event with many complicating factors

Professor Jones’ main assertion – that if VAD prevents some suicides then this should show up in official statistics – is misguided. 

Suicide prevention organisations will tell you that many factors interact to increase or decrease suicide risk, including poverty, unemployment, homelessness, alcohol use and domestic violence. Any one change – such as the introduction of VAD laws – is highly unlikely to show up in data in the short term, and is certainly unlikely to manifest in just four years.

One reason is that the base rate of suicide is, statistically speaking, very low. When considering the suicide rates of people aged 65+ or with debilitating or terminal illness, as Jones attempts to do, we are looking at a fraction of an already small group, which only increases the challenges.

It is a brave or foolhardy researcher who attempts to draw conclusions about patterns and trends from small data sets over short periods of time.  

Voluntary assisted dying doesn’t operate in isolation

A key event that Professor Jones mentions in his research – but then fails to consider – is the COVID pandemic. Melbourne was one of the most locked-down cities in the world in 2020 and 2021, with six lockdowns spanning more than 250 days. We know that isolation has particularly negative impacts on the suicide risk of older people, which could explain the vastly different experience of older people in Victoria. Jones has chosen to ignore this.

No compelling evidence either way

What, then, can we safely say about the impact of VAD laws on suicide rates in Victoria since 2019? The answer is very little. 

We cannot know what the suicide rate might have been had VAD not been legalised. It may indeed be true that there is no compelling prima facie (at first glance) evidence that VAD has reduced the overall rate of suicide, but there is also no compelling case that it hasn’t.

More importantly, Jones’s claim about what VAD advocates, including Go Gentle, said about VAD and suicide is simply untrue. Proponents never said that VAD laws would reduce the rate of suicide, only that a number of suicides (and attempted suicides) would be prevented if terminally ill people had an alternative to end their suffering. We know this because coroners, medical professionals, dying people and their carers, told us so. 

One of those dying people was 74-year-old Victorian Allan Cornell who, in the end stages of MND and desperate to end his suffering, said he had considered various methods to take his own life, all of them incredibly violent. Approved for VAD in 2020, he was grateful he hadn’t had to go through with his plans: ”That’s messy. It’s messy on the people who find you. It’s a very badly thought-out plan. It’s desperation at its worst,” he said.

Allan’s daughter Kristin, a medical doctor, was also relieved: “I do believe he would have taken his own life when he physically could have, but his knowing about VAD in Victoria gave him the courage to continue on and live with us for longer.” 

Ulterior motives?

So who is Professor Jones and why has the UK-based Anscombe Bioethics Centre weighed in on this debate now?

Some clues: 

• The Anscombe Bioethics Centre, which Jones directs, is the preeminent UK research institute devoted to “serving the Catholic Church”. Its purpose is to promote the Church’s view on a range of ethical and medical issues. The Catholic Church is vehemently opposed to assisted dying, describing it as an “intrinsically evil act in every situation and circumstance”.
• Jones is also a staunch personal opponent of VAD. Professor of Bioethics at St Mary’s University, he is a regular contributor to the Catholic Church’s Bishops Conference of England and Wales; and the author of several studies critical of VAD, alongside other theological publications including Approaching the End: A Theological Exploration of Death and Dying (2007); The Soul of the Embryo (2004); and Angels: A Very Short Introduction (2011).
• The debate about legalising VAD has reached a pivotal point in the UK, where the Anscombe Centre is based and where Jones lives. The Isle of Man is on track to become the first part of the British Isles to legalise assisted dying for the terminally ill, while Westminster, Jersey and Scotland are also progressing bills. 

Jones fails to disclose these background details anywhere in his research. Readers of his paper deserve to know so they can assess any conflict of interest for themselves. 

A final call for restraint

The author’s fascination with the impact of VAD laws on suicide rates in the short term misses the point. If VAD laws prevent even one of these tragic deaths – and help to avoid the terrible and lasting impacts on families, carers and first responders – that is a welcome outcome.

VAD’s potential to prevent some suicides was just one argument among many that was put forward and accepted by parliaments around the country to support legalisation. Just as crucial was the evidence that VAD reduces suffering and brings choice and comfort to terminally ill people and their loved ones. 

Since VAD laws first took effect in Australia, they’ve been regularly scrutinised by independent oversight bodies in every jurisdiction. Time and again we’ve heard that they are operating as intended, safely and with care and compassion. 

Perhaps most importantly, they continue to be widely supported, particularly by those with terminal illnesses and their families. People like Mary-Kate Pickett and her husband John Street, who accessed VAD in 2023.

“John and I were both so grateful,” Mary-Kate said of her state's VAD service. “The care we both received from all of the professionals was respectful and kind. Both of us saw the availability of VAD as an important part of John’s cancer journey and it was his preferred way to end that journey.”