The Werther effect or “Copycat” Suicides

The Werther effect or “Copycat” Suicides

In 1774, Goethe’s novel “The Sorrows of Young Werther” which ends with a young man’s suicide was published. Quite a number of young readers imitated Werther, the book’s hero, to the point that the rise in suicide rates was a direct cause for having this book banned in many countries. Two hundred years later, in 1974, the American sociologist, David Philipps, confirmed the phenomenon of “The Werther effect, which is regularly demonstrated following the suicide of well-known figures.

In 1987, following the suicide of the singer Dalida, there was almost a 25% increase in suicides among 45-59-year-old women. The same phenomenon was also noted after the deaths of former Prime Minister Pierre Bérégovoy (1992), and singer Kurt Cobain (1994). In the weeks that followed each event, many people of the same age group, and often of the same sex, ended their lives, which corroborated a causal link between the celebrity’s suicide and their act. It is as if the celebrity’s act had broken the thread of life that kept these people holding on to life, giving them the “courage” or impetus to act. On the other hand, if the suicide is reported in a negative manner, the “copycat” effect has been found to be tempered or absent. Much to their dismay, many school and university leaders have sensed the contagious nature of youth suicides and observed the tragic consequences. Those who support the grieving friends of the deceased, fear that “copycat suicides” may occur. Therefore, the specialists in suicide prevention insist that suicide should never be presented in a positive manner, nor as a solution to suffering and despair, even less as a courageous act.

In 2014, Philippe Pozzo di Borgo, Tugdual Derville and Professor Jean-Louis Terra – a psychiatrist and specialist in suicide prevention also explained that it is difficult to distinguish between a suicidal crisis and a request for euthanasia. An extract from their article published in Le Figaro:

Assisted suicide? The very idea is an oxymoron by combining two contradictory words. It calls into question the legitimacy and purpose of suicide prevention teams. It discourages and demobilizes those who work out of solidarity against this scourge, which particularly affects those elderly people who are the most isolated. Every single act of suicide, without exception, is a failure. It is particularly brutal for loved ones, but also for society as a whole.

How would society determine what category of the population is “fit or eligible for suicide”? According to age, disability, disease? Just when the National Suicide Observatory has submitted its’ first report on the mobilization against physical and psychological suffering to the Health  Minister, we must not be deterred by ambiguity at the highest levels of government. Our country prides itself on having a suicide prevention policy that doesn’t exclude any category of citizens. This policy is focused on the “suicidal crisis”, on trying to detect that high-risk moment where despair threatens to irremediably push one over the edge. It is not easy to differentiate a case of suicidal crisis from a request for euthanasia. In the first case, there is moral pain and suffering, but the physical body is often unaffected. On the contrary, those who request euthanasia have lost hope because their body is worn-out by disease. Indeed, in severe physical ailments, the “psyche” and the “soma” are intertwined to the point that genuine depression is not easy to detect. »

Most of the time, the phase of the “suicidal crisis” may go unnoticed. The thing that helps people hold on to life is the prohibition to take one’s life, a message always conveyed by society, namely because society tries to rescue and prevent suicide: no one’s life should be considered vain, worthless or without meaning. Repressing any incentive to suicide carries the same meaning. In 1982, the publisher Alain Moreau caused a scandal when “Suicide: Mode d’Emploi” was printed, with its recipes for poisons “not to be missed”. Sales of the book thrived due to the controversy, and a hundred thousand copies were sold before the book was banned 9 months later.

On September 13, 2022, the “CCNE” (French National Consultative Ethics Committee) issued its recommendation N° 139, in which its ethical objections for “active assistance in dying” were repealed. The definition principally includes “assisted suicide”, but doesn’t rule out euthanasia, all under the guise of equality, for those who no longer have the physical capacity to self-administer lethal products. In the same recommendation, Appendix 6, entitled “The Semantics of Suicide”, discusses whether the word suicide should be replaced by an acronym (such as ‘SMA’ for Suicide, Medically Assisted) to distinguish it from suicide, which is considered pejorative. This latest note ends by advocating that the word suicide be kept. The reason for that is: “The neutrality of the term suicide, which is undoubtedly its’ most problematic aspect, should be established in order to focus more on the true points of debate, on what it designates, and less on what preconceptions are sometimes unconsciously associated with it.”

The idea of trying to confer “neutrality” to the word suicide, definitely ignores the Werther effect.

French Ethics Committee’s Deadly Volte-Face on Euthanasia, Assisted Suicide

French Ethics Committee’s Deadly Volte-Face on Euthanasia, Assisted Suicide

On September 13, 2022, the “CCNE” (French National Consultative Ethics Committee) published recommendation N° 139 entitled:  “Ethical Issues Relating to End-of-life: Autonomy and Solidarity“. It states that: “there is an ethical way to enact active assistance in dying, under certain strict, non-negotiable conditions”. The strict conditions are summarized (page 4), with more detailed information given at the end for the 20 points (page 35). Essentially it recommends for palliative care to be reinforced and for “some unavoidable ethical prerequisites” in the event that euthanasia and assisted suicide are legalized: a medium-term life expectancy, informed consent, making collegial medical decisions, documented by written records.

This viewpoint is an unprecedented volte-face for the Ethics Committee. In its’ 2013 recommendation N°121: “End-of-life, Individual Autonomy and the Desire to Die”, the CCNE excluded euthanasia. It declared that it is essential to maintain the legal distinction between “allowing someone to die” and “putting someone to death”.

It also reiterated that “by prohibiting doctors from deliberately provoking death, people are thereby protected at the end-of-life; it would be dangerous for society if doctors could participate in ‘imparting death’ “. At that time, assisted suicide was also ruled out. The committee considered that “any move towards authorizing active assistance in dying could be interpreted as a threat for those who are vulnerable, who might wonder if they would be truly accompanied with appropriate medical treatment if they expressed their wish to continue their lives until its’ natural end.”

The previous report focused on the essential distinction between natural death and inducing death, on protecting people at the end-of-life and their relationship with caregivers, and the need to reassure the most vulnerable that they would have access to care. Moreover, given the abuses which had already been observed abroad, they reiterated their reservations for legalizing euthanasia.

How does the Ethics Committee justify its volte-face?

Without mentioning the details of the composition of the Ethics Committee, which undoubtably plays a role in the vote, the CCNE gives some factors to justify its’ volte-face.

  • Context

The CCNE mentions some “developments that have become more pronounced“:

the end-of-life has gradually become more medicalized,

life expectancy continues to rise, combined with a likelihood of diminished health,

elderly persons are living in conditions where they become more and more socially isolated,

society increasingly retains individual autonomy and performance as being core values,

there is stronger public demand for legalization, which culminated in the recent attempt to pass the Falorni bill in April 2021, and some foreign countries are leaning towards legalization.

 

  • The case of individuals with medium-term life expectancy

The CCNE considers that “the current legal framework is satisfactory for those with short-term life expectancy”, which would seem to warrant keeping the legislative status quo. However, the CCNE observes that “some people with a medium-term life expectancy suffer from serious and incurable diseases with unbearable pain and are unable to find relief for their distress“. On this particular point, no documents or studies have been provided by the CCNE to describe or quantify these cases, to better understand the situation. It is essential to provide in-depth information since these cases are mentioned as an important justification for the volte-face.

  • The right to life threatened by other rights

The CCNE acknowledges that the right to life is enshrined in Article 2 of the European Convention on Human Rights (ECHR; formally the Convention for the Protection of Human Rights and Fundamental Freedoms). Nonetheless, the CCNE declares

that Article 8, which recognizes the right to having one’s private life respected, allows the States to concede a right to autonomy and freedom for self-determination. Thus, the CCNE construes that there is no obligation to live and that if a person “considers that his condition is no longer compatible with his personal requirements for dignity”, he may request for “his right to self-determination to prevail over his right to life”. This reasoning on which the conclusions of the  recommendation is based, avoids answering the following issue: why should society accede to such a request by providing services for assisted suicide or euthanasia, especially when we are talking about such a fundamental precept for a society as the ban to kill? Even though there seems to be a social consensus according to opinion polls, the CCNE notes in page 14 that these opinion polls “do not always accurately reflect the characteristics and true intensity of societal requests“. Moreover, the CCNE itself advises against holding a referendum (page 37) “because of the extreme complexity of the issue “.

Dissenting Voices

Eight of the forty Ethics Committee members openly voiced their misgivings about this latest recommendation. They rationalized that developing palliative care is a prerequisite to any further discussions, to clarify the report’s ambiguity on this point. The three issues they have reservations about resemble those in the 2013 report and include:

  1. the limitation of one’s claim for individual autonomy, detached from any social and interpersonal impact,
  2. the protection of the most vulnerable and suicide prevention, and
  3. addressing the ethical dilemma for physicians whose Hippocratic oath forbids them to “distribute poison to anyone” or to “initiate such suggestions”.

The CCNE’s latest recommendations have forsaken ethics. They are propped up on stilts that cannot prevail in the face of economic pressure or the cultural demands arising from unappeasable individualism.

[Press Release] – The Ethics Committee’s Blatant Contradiction on Palliative Care, Assisted Suicide and Euthanasia

[Press Release] – The Ethics Committee’s Blatant Contradiction on Palliative Care, Assisted Suicide and Euthanasia

Alliance VITA denounces the disturbing and blatant contradictions in the end-of-life recommendation published today by the “CCNE” (French National Consultative Ethics Committee).

The authors rightly assert that every individual has inalienable dignity, and they claim they want to reconcile solidarity with the most vulnerable, all the while respecting individual autonomy. But it is erroneous to assert that “to respond to the liberty of self-determination, there is an ethical way to enact ‘active assistance in dying’ ” (meaning assisted suicide and euthanasia). If some French deplore the fact that various individuals have died a horrible death, it has mostly been caused by the lack of pain-relieving care and assistance, and generally because of lack of access to palliative care. Furthermore, the rare requests for euthanasia are often due to underlying social pressure, the fear of becoming a burden or financial worries.

Tugdual Derville, Alliance VITA’s spokesperson declares:

We can only wonder what motivation and pressure has led the authors to attempt this sleight of hand, to reconcile the irreconcilable. Palliative care is the antithesis of assisted suicide and euthanasia; the endorsement of one cannot be used to justify giving credit to the other. We believe that no matter how ambiguous the vocabulary is, lifting the ban on killing is not medically ethical, nor indeed is it ethical in any way at all. It is undeniable that the basis of trust between patients and caregivers is founded on the prohibition to kill, just as for life in society; no one should be excluded from suicide prevention. Besides, the CCNE subtly lists the inherent risks in this changeover. How can we fail to see that if a person’s autonomy is conceived as sacred, it can only lead to rejection and self-exclusion for those who are the most vulnerable? »

Consensus is still far off, even for the CCNE, where 8 members have publicly expressed their strong reservations in regard to this published recommendation.

In the upcoming days Alliance VITA will take the necessary steps to protect the French from the violence and discrimination of suicide and euthanasia. We firmly reject both unreasonable therapeutic obstinacy and euthanasia. And we will work to preserve the French perspective, one that is worthy of ethics and medicine: making palliative care accessible for everyone, while continuing to fight against the “social death” of those who are sick, dependent and/or alone.

Press Contact
contactpresse@alliancevita.org

Alliance VITA’s UN Contribution on Human Rights of Older Persons

Alliance VITA’s UN Contribution on Human Rights of Older Persons

In Geneva, on August 29 and 30, 2022, a UN meeting on the human rights of older persons was held to discuss the gaps and fragmentation in the protection of human rights of older persons in international laws.

 

This meeting was held in application of resolution 48/3 whereby the Human Rights Council requested the Office of the High Commissioner for Human Rights to convene a multi-stakeholder meeting to discuss the report on normative standards and obligations under international law in relation to the promotion and protection of human rights of older persons.

 

The conclusions of this meeting will be presented at the 51st session of the Human Rights Council to be held from September 12 to  October 7, 2022, in the form of recommendations.

 

For the past several years, the issue of how societies can adapt to ageing has been a concern. Already in 2002, at the Second World Assembly on Ageing an international agreement was adopted with the Madrid Plan of Action on Ageing. Furthermore, the Open-ended Working Group on Ageing was established by the UN General Assembly in 2011. This working group is in charge of evaluating the existing international framework in order to identify possible gaps, decide how to address them, and make proposals for elaborating legal measures to reinforce the protection of human rights of older persons, such as those already in force for children or disabled persons.

 

As an NGO accredited by the UN with a special consultative status with the Economic and Social Council, Alliance VITA took part to point out the need to develop intergenerational solidarity policies and called for increasing the protection of human rights for older persons especially in view of the attempts to legalize euthanasia and assisted suicide.

 

We are faced with new challenges due to the increasing number of older people. Two specific ones came to the forefront during the Covid-19 crisis. As highlighted by the UN Secretary-General in a Policy Brief on the impact of Covid-19, there is a notable risk for the elderly to experience “social death” through isolation. The second important challenge concerns medical support at the end-of-life.

 

To fight social exclusion and emotional loneliness, it is important to have wide-reaching programs to prevent isolation, and to fight discrimination based on age. To reach this goal, intergenerational solidarity could be developed by implementing programs for young people to support the elderly. Since the time and effort to take care of a loved one can become a real burden for those in the work force, each country should be encouraged to implement social policies which value and compensate family caregivers. For the challenge of taking care of individuals at the end-of-life, it is vital that palliative care be provided for those who need it. No elderly person should be deprived of the care to which he or she is entitled.

 

The public is increasingly worried about the attempts to legalize euthanasia and assisted suicide. Even within the UN these practices have been denounced. On January 25, 2021, a joint statement issued by the Special Rapporteur on the rights of persons with disabilities, the Special Rapporteur on extreme poverty and human rights, as well as the independent expert on the rights of older persons, disapproved these practices since they may incite persons with disabilities or older persons to end their lives prematurely. These highly controversial practices further amplify the discrimination against the aged and are even interiorized by the elderly themselves.

 

In order to maintain the effectiveness of the right to life, Alliance VITA calls for the legal framework to be reinforced at both national and international levels to guarantee older persons their just and rightful place with the needed support until the end of their lives.

[Press Release] – Calling for Insurance Companies, to Consider Their Duty of Discretion Rather than Pushing Euthanasia

[Press Release] – Calling for Insurance Companies, to Consider Their Duty of Discretion Rather than Pushing Euthanasia

Alliance VITA denounces the inappropriate endorsement of euthanasia by French complementary health insurance companies and calls upon their duty of discretion  in view of the potential conflict of interest. 

On September 7, 2022, the 43rd Congress of the “Mutualité Française” (French Complementary Health Insurance Companies) held a forum entitled “Choosing your end-of-life: the ultimate freedom?” Participants included Jean-Luc Romero, the honorary president of ADMD, a Right-To-Die association, François DAMAS, the head of ICU and member of the ethics committee of the Citadelle regional hospital in Liège, Belgium, and Matthias SAVIGNAC, the President of the national complementary insurance company for teachers, the “MGEN” (Mutuelle Générale de l’Éducation Nationale).

Previously in July, an IFOP survey entitled “Views on the End-of-life in France” was conducted for the MGEN which attested position advocating euthanasia in an End-of-Life Manifesto. This manifesto is similar to the appeal for “active assistance in dying” made by Thierry Beaudet, MGEN’s former President. Thierry Beaudet now President of the “EESC”, (Economic and Social and Environmental Council), is responsible for organizing the upcoming citizens’ debates on the end-of-life.

While these health insurance companies claim to have an essential role in healthcare, and in contributing to the management of old age and autonomy, questions are being raised by their open endorsement of euthanasia or assisted suicide, under the pretext of a “right to choose a dignified end-of-life”.

Members pay their healthcare insurance to be sure that their healthcare costs will be covered, and this becomes crucial when they are most vulnerable, whether they are elderly, sick or at the end-of-life. Even the title of this 43rd Congress which advocates aid in dying is incompatible with mutual aid and solidarity, and undermines the trust between caregivers and patients, which is founded on the ban to kill.

Isn’t it obvious that this so-called “freedom” to choose death, promoted by some public health authorities, inevitably becomes the “duty to die” for the most vulnerable, the poorest, and the most secluded individuals?

Alliance VITA spokesman’s Tugdual Derville declares:Beyond the standpoint in favor of dignity and individual freedom, we cannot help but wonder how much money insurance companies would save if euthanasia became legalized. The confusion and worry that such speeches cause for their members should not be underestimated. At a time when the healthcare system has undergone upheavals, coupled with an obvious conflict of interest, insurance companies should consider their  duty of discretion on the end-of-life issue as an obligation. »

This is why Alliance VITA is calling on the government to ensure that organizations involved in social protection maintain a neutral stance on this very sensitive issue and that the EESC, as organizer of the public debates on the end-of-life, remain impartial.

Press contact
contactpresse@alliancevita.org