Euthanasia and Assisted Suicide - Suicide

Different Cultures and Religions

Different religions and cultures have viewed suicide in different ways. Ancient Romans who dishonored themselves or their families were expected to commit suicide in order to maintain their dignity and, frequently, the family property. Early Christians were quick to embrace martyrdom as a guarantee of eternal salvation, but during the fourth century, St. Augustine discouraged the practice. He and later theologians were concerned that many Christians who were suffering in the world would see suicide as a reasonable and legitimate way to depart to a better place in the hereafter. The view of the Christian theologian St. Thomas Aquinas (circa 1225–74) is reflected in the contemporary Roman Catholic teaching that "suicide contradicts the natural inclination of the human being to preserve and perpetuate his life … and is contrary to love for the living God."

While Islam and Judaism also condemn the taking of one's own life, Buddhist monks and nuns have been known to commit suicide by self-immolation (burning themselves alive) as a form of social protest. In a ritual called suttee, which is now outlawed, widows in India showed devotion to their deceased husbands by being cremated with them, sometimes throwing themselves on the funeral pyres, although it was not always voluntary. Widowers (men whose wives had died), however, did not follow this custom.

Quasi-religious reasons sometimes motivate mass suicide. In 1978 more than 900 members of a group known as The People's Temple killed themselves in Jonestown, Guyana. In 1997 a group called Heaven's Gate also committed mass suicide in California. The devastating terrorist attacks of September 11, 2001, were the result of a suicidal plot enacted by religious extremist groups. The rash of suicide bombers in the Middle East has also been attributed to extremist groups that have twisted or misinterpreted the fundamental tenets of Islam to further their political objectives.

The Japanese people have traditionally associated a certain idealism with suicide. During the twelfth century, samurai warriors practiced voluntary seppuku (more commonly known as hara-kiri,) or ritual self-disembowelment, to avoid dishonor at the hands of their enemies. Some samurai committed this form of slow suicide to atone for wrongdoing or to express devotion to a superior who had died. Even as recently as 1970, famed author Yukio Mishima publicly committed seppuku. During World War II, Japanese kamikaze pilots inflicted serious casualties with suicidal assaults in which they would purposely crash their planes into enemy ships, killing themselves.

Suicide is still commonly practiced in modern Japan. In early 1998 several government officials and businessmen hanged themselves in separate incidents involving scandals that attracted public attention. The reasons given for the suicides ranged from proclaiming innocence to assuming responsibility for wrongdoing.

Suicide in America

With the exception of certain desperate medical situations, suicide in the United States is generally considered an unacceptable act, the product of irrationality or severe depression. It is often referred to as a permanent solution to a short-term problem.

In spite of this generally held belief, in 2001 suicide was the eleventh leading cause of death in America. Suicides outnumbered homicides 3 to 2, and there were twice as many deaths from suicide than deaths from HIV/AIDS. Nevertheless, since 1950, the national suicide rate has dropped from 13.2 suicides per 100,000 people to 10.7 per 100,000 in 2001. (See Table 6.1.)

The Centers for Disease Control and Prevention (CDC) did a five-year study of suicide patterns in different geographic regions across the country ("Regional Variations in Suicide Rates—United States, 1990–1994,"

TABLE 6.2
Number of suicides and rate of suicides per 100,000 population, by region and state, 1990–94

Morbidity and Mortality Weekly Report, vol. 46, no. 34, August 29, 1997). The CDC found that the suicide rate in the United States was the highest in the West, at 14.7 suicides FIGURE 6.1
Rate of suicide per 100,000 population, by state, 1990–94 per 100,000 people. (See Table 6.2 and Figure 6.1.) No reason for this finding has yet been determined.

Gopal K. Singh and Mohammad Siahpush, both of the National Cancer Institute, compared the suicide rates in rural and urban populations in the United States. In "Increasing Rural–Urban Gradients in U.S. Suicide Mortality, 1970–1997," American Journal of Public Health, vol. 92, no. 7, July 2002, Singh and Siahpush reported significant rural–urban gradients in male suicide mortality rates over this time period, and noted that the rural–urban gap is widening. Male suicide mortality rates in rural areas increased over the time period, while rates in urban areas declined. Conversely, the rural–urban gap in suicide mortalities among females has closed. Suicide mortality rates for females in urban areas has decreased but has remained somewhat stable in rural areas. (See Figure 6.2.)

In explaining these differences, Singh and Siahpush suggest that both rural and urban areas have experienced profound social and demographic changes during the past three decades. They contend, however, that change has affected life in rural areas more than in urban areas. They note that high levels of social isolation are correlated with high suicide rates. Thus,

declines in traditional farm activity, the change from an agriculture-based economy to a more service- and manufacturing-oriented economy, and the substantial population loss due to birth deficits and out-migration in most rural communities can lead to a deemphasizing of traditional institutions such as the family and religion, a progressive weakening of social and community ties, and a loss of people's sense of community.

Suicide among Young People

According to the American Association of Suicidology, the rate of suicide among young people increased 200 percent between the 1950s and 1990s. During the 1990s death rates for suicide declined, but in some age groups the rate of suicide attempts actually rose. In 2001 suicide was the third leading cause of death among people ages 15 to 24 years, and more teens and young adults died from suicide than from AIDS, birth defects, cancer, chronic lung disease, heart disease, pneumonia and influenza, and stroke combined. While females are more likely to attempt suicides, males are more likely to die from their attempts.

In recent years clusters of suicides among young people have occurred in different areas of the country including Westchester County, New York; Bergenfield, New Jersey; Pierre, South Dakota; and Plano, Texas. Experts have found no significant pattern in any of these strings of suicides. They happened in rich and poor communities, and in urban, suburban, and rural areas.

While the overall suicide rate among black youths has been relatively low in comparison to white males, the rate rose among black males from 1950 through 1990. (See Table 6.1.) By 1990 the death rate for suicide among black males ages 25 to 44 years had risen to a high of 19.6 suicides per 100,000. After 1990 the suicide rate for young black males steadily declined and by 2001 it had dropped to 14.4 per 100,000. This rate remained relatively steady through 2001.

Death rates for suicide declined for white males ages 25 to 44 years from a 1995 high of 25.8 suicides per 100,000 to 22.9 per 100,000 in 2000. The rate rose slightly in 2001 to 24.0 per 100,000. In 1990 the highest suicide death rate among youth 15 to 24 years of age was 49.1 suicides per 100,000 people among male American Indian or Alaska Natives. (See Table 6.1.) By 2001 this rate fell to 24.7 per 100,000.

While death rates from suicide have declined among young adults aged 15 to 19 years from 1990 to 2001 (see Table 6.1), the percentage of high school students who attempted suicide increased from 7.3 percent in 1991 to 8.8 percent in 2001, and the percentage of students injured during a suicide attempt also rose from 1.7 percent to 2.6 percent during those same years). (See Table 6.3.) These statistics underscore the urgent need for prevention,

TABLE 6.3
Suicide ideation, attempts, and injuries among students in grades 9–12, by sex, grade level, race, and Hispanic origin, selected years 1991–2001
[Data are based on a national sample of high school students, grades 9–12]

education, and support programs to help teens and young adults at risk.

The National Center for Injury Prevention and Control (NCIPC) sponsors initiatives to raise public awareness of suicide and institutes strategies to reduce suicide deaths. Along with support for research about risk factors for suicide in the general population, NCIPC also addresses high-risk populations with programs such as the American Indian/Alaska Native Community Suicide Prevention and Network Conference held in San Diego, California, in November 1998.

GAY AND LESBIAN ADOLESCENTS.

Gay and lesbian adolescents are two to three times more likely than heterosexual adolescents to attempt suicide, making suicide the leading cause of death among this group of young people. Adolescence (the transition to adulthood) is often a difficult period. For gay and lesbian adolescents, this transition is compounded by having to come to terms with their sexuality in a society generally unaccepting of homosexuality.

At this period in their lives, when the need to confide in and gain acceptance from friends and family may be crucial, gay and lesbian adolescents are often torn between choices that do not necessarily meet either of these needs. Those who are open about their sexual orientation risk disappointing or even alienating their families and facing the hostility of their peers. Teens who choose

TABLE 6.3
Suicide ideation, attempts, and injuries among students in grades 9–12, by sex, grade level, race, and Hispanic origin, selected years 1991–2001
[Data are based on a national sample of high school students, grades 9–12]

not to disclose their homosexuality may suffer emotional distress because they have nowhere to turn for emotional support. In either scenario, despair, isolation, anger, guilt, and overwhelming depression may promote suicidal thoughts or actual suicide attempts.