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Thoughtful and thought-provoking piece, Adam. Long ago, I handled the writing of obituaries for a small newspaper. It gave me a view into how important they were to the people involved.

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Or not...

We know that certain behaviors associated with mental illness, including suicide, tend to be contagious. Thus publicizing the fact that a recently deceased person sadly died by their own hand may increase the risk that others at risk will do the same.

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My sister died of bi-polar disease. This is what I usually say. People who know about bi-polar disease say, "she committed suicide?". Which is what happened.

I mention this because I find that if I say my sister committed suicide, people want to know what was wrong with her: was she jilted by her boyfriend, did she lose her job, etc.

But the reality is much simpler: she was dealt a bad hand that modern medicine can't treat and eventually she got to the point where she decided she would be better off dead. I can't imagine ever getting to this point myself, but I can easily understand how my sister ended up there. And it breaks my heart.

Thankfully most people don't have family members that have bi-polar disease and so don't understand what happens. And this makes it so important to let people know what actually happened, in case they experience this.

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Am I the only one who always thought "brief illness" meant PE or dissection, not OD?

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Link to the free Documentary "Road to Mercy" about their MAID law and assisted suicide.

https://tubitv.com/movies/498155/road-to-mercy?start=true

Article from Canada about adding Drug Addicts to the MAID law

https://dailycaller.com/2023/10/19/canada-maid-assisted-suicide-law-substance-abuse-drug-addiction/

Another article from Belguim

https://www.liveaction.org/news/belgian-teenager-euthanized-organs-donated/

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You might read Margalit Fox, former NYT obituary writer. Especially fascinating is “Riddle of the Labyrinth”

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A few months after I graduated medical school, COVID had just become widely known, and a mass email was sent out to my medical school class about mental health and reminding people to seek help if they needed it. Context suggested that someone had committed suicide, and detective work on my part suggested that one of my graduating classmates had indeed died that way. But I could only find one obscure indirect media reference to this fact. Neither the school’s official message or any obituary or other news story that I’m aware of specifically stated what happened. Given that my school is on the other side of the world and I was back home, I didn’t have a lot of firsthand opportunity to talk to people about it, but I did casually know the person who died, and it was upsetting.

I felt conflicted on how to handle disclosure of information in this circumstance, because one might fairly argue that the exact details of this individual’s death were private, and perhaps the family wanted it that way. There was also a certain salaciousness to the notion that beyond the general issue of physician suicide, this person’s death might have been directly related to overwork or other issues related to the early COVID era. There are also potential legal liabilities there.

But I continue to believe that at least some modicum of transparency would have been for the best.

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I'm opposed to assisted suicide. I think it's morally wrong. But aside from that, look at ramifications of making it legal. Do you think health insurance companies aren't eventually going to profit from pressuring sick people into doing themselves in? That they won't deny coverage of meds and treatment to someone whose doctor thinks suicide is a better option? This is Pandora's box we've opened. There's also the problem of oversight. What's been proposed in Maryland is basically like this: you go to a doctor, he prescribes you say, 200 Seconal, and you go home and he trusts that you take them and kill yourself. What keeps the drugs off the street?

It's a natural consequence of abortion on demand, that life is so devalued that it can look reasonable to kill a decrepit adult, maybe especially "useless eaters". Canada seems to be well down that path.

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Thank you for pointing out some of the "slippery slope" consequences of establishing a formal and legalistic system of assisted suicide. I still remember the abuse that was heaped upon those who argued against abortion being established as a right, subsidized, and encouraged because it would eventually lead to the acceptance of infanticide. But look where we are today.

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Abortion is the murder of a helpless victim for the convenience of the murderer. The acceptance of euthanasia/physician assisted suicide is a natural consequence. If one can applaud the right to murder a baby because it will be in the way, he'll accept the murder of helpless old or sick people. It's so much easier to view the elderly as useless and inconvenient. This is an inevitable development.

And medical doctors will be pressured into becoming killers instead of guardians of life and health. At some point a conscientious objection to murder may come at high cost.

The Dead Kennedys put out an album in the 80s entitled "Give Me Convenience or Give Me Death". How apt a motto for our age.

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Of course you are right on all points. My standard response to the claim of "My body, my choice" is to point out that the baby you are carrying in your womb is in no way a part of your body. It is a separate and unique human being who is totally dependent upon you for its existence just as he or she is for the first few years after birth. If you sanction killing before birth then you must think it is OK to let your child starve to death if something about them displeases you in those years of continued dependence after birth. That usually terminates the discussion.

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I wrote my wife’s bff’s daughter that I thought Nancy’s death contributed to her death. She replied she didn’t want to live anymore. She had stopped taking her blood pressure drug.

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Sigh. It was after the Huge joint memorial that I learned this. Just before she’d told me she had cried for a year when Nicolai died. The two was too much. Not in the obituary.

Note: A sin to commit suicide, hence not often reported.

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It’s not just legal in Canada, but encouraged. Poverty is now a valid reason there for assisted suicide.

I do believe that anyone (adults) has the right to say enough, but I don’t think the way it’s currently being done is right. And doctors who make a living doing that? No.

I didn’t think that charging someone who failed with the crime of trying was right, either. Don’t know if they still do that.

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I was impressed that Ms Rollin's obituary actually mentioned the Swiss assisted dying group she used, Pegasos. Going out to their website, one of the FAQs states: "And in Switzerland, the people who assist a person to die need not be medical physicians."

I don't have a problem if those assisting me are not doctors as long as they are well-motivated and competent. But it's a huge burden on people to not provide assistance at the end of life if they want it. (And, SOME doctors ARE willing to assist patients.)

A work friend once told me of her mother's death (who had advanced cancer). She would have liked apparently to have availed herself of the services of someone like Dr Kevorkian, but as that was not available to her she gassed herself in her garage and died alone. That bothered her daughter a LOT (she did not know her plans), and she so wished her mother had had a better option.

Similarly, I remember reading a piece in the BMJ years ago by a physician who hadn't been very friendly to the idea of assisted dying and who had refused a request by an elderly woman who was her patient to help her somehow (of course legally she would pretty much have had to do that anyway even if sympathetic). Subsequently the patient did manage to kill herself in some fashion that included stuffing her nose and mouth with kleenex I think and that gave the doctor pause that she had had to do all that alone and unassisted and to feel maybe there WAS a case for something different.

I like hospice, but even hospice-assisted deaths are often not that great as I have seen, and they are often very slow and prolonged. I know I don't want that for myself.

The best for me would be to die suddenly and unexpectedly and quickly, but since prolonged deaths are really common now, I want a method to avoid that. So grateful for Switzerland but wish there were an option without travel.

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I think an answer to this problem lies in a policy I suggested in a post on another subject on this web site. My solution would be to eliminate prescriptions and the laws and regulations that govern them. The only exception would be an age limit. Otherwise anyone should be able to purchase any drug they wish. They may choose to consult a doctor or not. No one should be denied the right to seek a smooth and painless exit if they choose to do so. Those who think the existing laws and regulations have had any effect on drug abuse are either naive or just plain fools.

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Thank you, Dr. Cifu, for sharing your position that you didn't go into medicine to participate in facilitating people's deaths. John Dolan, a philosophy professor at the University of Minnesota and co-founder of the Program in Human Rights and Medicine there, considered the push for physician-assisted suicide to be a corruption of medicine. If people not afflicted by mental illness choose to end their lives, there are many ways in which they can proceed. To demand that physicians approve and participate in their suicide is to demand that physicians violate the basic ethic of their profession, going back to Hippocrates: "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course." As a retired RN who is utterly dismayed at the crumbling of safeguards against the denial of care to vulnerable people, I'm so grateful for your statement. In Canada now the medical-assistance-in-dying (MAID) proponents are offering assisted suicide as the preferred solution to disability and homelessness. The slope can get very slippery.

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68. Sixty Eight people. That’s how many paper obits I saved of people with whom I’d touched physically (whether in passing or in treatment). Opiates were a large proportion of the obits; and I’m not sure how many I’ve had contact with since stopping print news 10 years ago or so. I’m sure the number has doubled. It’s sad to me that shame exists to this day regarding mental illness, including the mental illness of addictive disease.

I’ve made it clear to those around me to include my cause of death. If it’s due to CV, fine. If it is my addiction then that needs to be said too. If it’s a MVA fine. Kidney failure too. My point is that I have several NORMAL chronic illnesses and addiction is just one of them. I’d rather it not be my addiction, because living in active addiction is hell. But I know several ways out and always want those around me to know that.

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As someone who lives in Canada where medically assisted suicide is legal, I think there's a definite benefit to having this in the obituaries of people. Especially if it's being done through such a government program. We should have publicly available data on this type of thing. Places that you can gather this information outside of official sources.

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Depending on any given publication's policy on reporting suicides, the obituary may be the only space in a newspaper where people can write about a loved one's suicide free of censorship. That's because suicide prevention organizations such as SAVE (Suicide Awareness Voices of Education) actively seek to shape the media's reporting on suicides in order to reduce the risk that "unsafe" news coverage will cause others to take their own lives. https://save.org/

I do not know enough about suicide to give an informed opinion about the effectiveness of suicide prevention organizations, their ideology or the ethics of their approach to suicide.

What is remarkable about these organizations in a nation that reveres freedom of the press is their expectation that news outlets will voluntarily censor their reporting in accordance with their guidelines. It would be interesting to know the extent of the media's compliance with the organizations' guidelines and whether there is any significant disagreement within the media or elsewhere in society about them.

SAVE says its press guidelines are intended to prevent suicide "contagion" or "copycat" suicides. Are organizations that seek to prevent suicide also acting in accordance with religious teachings that treat suicide as a sin?

The following text comes from SAVE's "Best Practices and Recommendations for Reporting on Suicide."

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Best Practices and Recommendations for Reporting on Suicide

For more information and examples of best practices when reporting on suicide, visit ReportingonSuicide.org/Recommendations

Recommendations: Following these recommendations can assist in safe reporting on suicide.

1. Over 100 studies worldwide have found that risk

of contagion is real and responsible reporting can

reduce the risk of additional suicides.

2. Research indicates duration, frequency, and

prominence are the most influential factors that

increase risk of suicide contagion.

3. Covering suicide carefully can change perceptions,

dispel myths and inform the public on the

complexities of the issue.

4. Media reports can result in help-seeking when they

include helpful resources and messages of hope

and recovery.

AVOID… Describing or depicting the method and location of the suicide.

INSTEAD... Report the death as a suicide; keep information about the location general.

AVOID... Sharing the content of a suicide note.

INSTEAD... Report that a note was found and is under review.

AVOID... Describing personal details about the person who died.

INSTEAD... Keep information about the person general.

AVOID... Presenting suicide as a common or acceptable response to hardship.

INSTEAD... Report that coping skills, support, and treatment work for most people who have thoughts about suicide.

AVOID... Oversimplifying or speculating on the reason for the suicide.

INSTEAD... Describe suicide warning signs and risk factors (e.g. mental illness, relationship problems) that give suicide context.

AVOID... Sensationalizing details in the headline or story.

INSTEAD... Report on the death using facts and language that are sensitive to a grieving family.

AVOID... Glamorizing or romanticizing suicide.

INSTEAD... Provide context and facts to counter perceptions that the suicide was tied to heroism, honor, or loyalty to an individual or group.

AVOID... Overstating the problem of suicide by using descriptors like “epidemic” or “skyrocketing.”

INSTEAD... Research the best available data and use words like “increase” or “rise.”

AVOID... Prominent placement of stories related to a suicide death in print or in a newscast.

INSTEAD... Place a print article inside the paper or magazine and later in a newscast.

CHECKLIST FOR RESPONSIBLE REPORTING

‰ Report suicide as a public health issue. Including stories on hope, healing, and recovery may reduce the risk of contagion.

‰ Include Resources. Provide information on warning signs of suicide risk as well as hotline and treatment resources. At a minimum, include the National Suicide Prevention Lifeline and Crisis Text Line (listed below) or local crisis phone numbers.

‰ Use Appropriate Language. Certain phrases and words can further stigmatize suicide, spread myths, and undermine suicide prevention objectives such as “committed suicide” or referring to suicide as “successful,” “unsuccessful” or a “failed attempt.” Instead use, “died by suicide” or “killed him/herself.”

‰ Emphasize Help and Hope. Stories of recovery through help-seeking and positive coping skills are powerful, especially when they come from people who have experienced suicide risk.

‰ Ask an Expert. Interview suicide prevention or mental health experts to validate your facts on suicide risk and mental illness.

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The complete document is available at the "Reporting on Suicide" Quick Link at the following location: https://save.org/about-suicide/preventing-suicide/reporting-on-suicide/

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When I worked for a newspaper, several years ago, our policy in news stories was to downplay suicide. If it was committed in a public place or a public way, we'd cover it. Otherwise, not really. I'm not sure of the official policy regarding obituaries and suicide as a cause, but I suspect we'd have discouraged it. The reason, I was told, was fear of copycats—particularly if the suicide is a young person still in school. I'm told it's a fairly common practice at newspapers. This isn't me saying it's a good policy or not—I'm not sure. But that may be one reason suicide doesn't often appear in current equivalent of newspaper.

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