The Regulation of Suicide: Ethics, Policy, and Public Health

Jurgen De Wispelaere, Trinity College Dublin

Abstract

Suicide is a major cause of medical, social and political concern in most countries. According to the WHO, “suicide is a huge but largely preventable public health problem, causing almost half of all violent deaths and resulting in almost one million fatalities every year, as well as economic costs in the billions of dollars”. There is widespread agreement that suicide prevention ought to take centre stage in public health policy, yet debates about suicide are still largely informed by medical or religious doctrines that are only partially suitable for informing a robust policy. Against this background the purpose of this paper is threefold. First I want to make a general case for a broader public policy perspective on the regulation of suicide and attempted suicide. The reference to “regulation” explicitly denies that prevention is the optimal strategy in all cases, and that policy should cater for such complexity. Second, I want to engage with the main ethical arguments for and against suicide and assess how they might inform a policy perspective. Where traditional debates focus on the stalemate between “sanctity of life” vs. “right to die” arguments, I propose that a genuine policy perspective has to appreciate the salience of various types of negative externalities when considering its preferred strategy. Third, the paper briefly assesses existing strategies – such as the WHO worldwide initiative for the prevention of suicide (SUPRE) – from this revised policy perspective. In particular I focus on the drawbacks of a recommendation almost universally accepted – to wit, that action against suicide requires restricting access to the means for committing suicide – and suggest an alternative approach.