Opponents of Voluntary Assisted Dying (VAD), Assisted Dying (AD) or Medical Assistance in Dying (MAiD) often use the term ‘assisted suicide’ as an attempt to stigmatise VAD as immoral. The Irish Roman Catholic Bishops used the term more than thirty times in their 2020 submission to the Oireachtas Committee considering the Dying with Dignity Act.
The difference between suicide and Voluntary Assisted Dying is important. The American Association of Suicidology (AAS), an organisation ‘devoted to research, education, and practice in “suicidology,” and advancing suicide prevention’, considered the distinction between suicide and VAD and produced an Executive Summary of the findings. That summary was ‘retired’ in February 2023 and a new consideration may be reported in the near future. This document is based on the 2017 AAS summary which found 15 significant points of difference between suicide and VAD.
Alan Tuffery, End of Life Ireland
- Life cut short. In suicide an indefinite life-span is cut short. In VAD foreseeable death occurs a bit sooner, in accordance with patient’s values and decisions and the death is less painful.
- The wish to die. Suicidal thoughts arise from unrelenting psychological pain and despair with no hope for future. In VAD the patient does not wish to die; they have a disease which is killing them. (A study from the Netherlands showed that those seeking VAD ‘forego on average 3.3 weeks of life.’)
- Emotional response. Those who are suicidal often experience isolation, loneliness and loss of meaning. Those already facing death often experience intensified emotional bonds and a deepened meaning of life.
- Cultural view. Suicide may be seen as ‘self-destruction’ and disapprove in some traditions. In contrast, VAD is seen as ‘”self-preservation”, acting to die while one still retains a sense of self and personal dignity before sedation or the disease itself takes away meaningful interaction’ with others.
- Physical Self-Violence — is often involved in suicide. VAD aims toprovide the most peaceful form of death.
- Planning. Suicide is sometimes impulsive. VAD by law requires formal consultation and a considered application.
- Options. The suicidal individual often ‘sees no way out’, whereas in VAD the physician is required to inform the individual of all options, including palliative care and pain relief.
- Mental health. Suicide is commoner in those with mental health issues. In VAD mental health issues impairing decision-making are screened out. Sometimes additional scrutiny and safeguards are involved.
- Self-understanding. A suicidal individual may not be able to assess their own position clearly. Individuals seeking VAD typically can balance the choice of an early death as against increasing loss of control.
- Legal status. In VAD deaths are not reported as suicide. The cause of death is recorded as the underlying terminal condition.
- Effects on grieving. After suicide there is a higher rate of complications of the grieving process, including PTSD and risk of suicide, in family members. After VAD grieving tends to be less severe.
- Social effects. Suicide is often stigmatised and often creates a burden for families and healthcare professionals. VAD is typically well accepted with the community and society at large.
- Suicide Reduction Strategies. Many risk factors for suicide are recognised. These risk factors do not apply to VAD because the decision is planned in consultation with physicians and family.
- Forensic costs. Often substantial after suicides, especially of minors. (There are significant issues of publicity of suicides.) The forensic costs of VAD are minor, because the process is well-documented throughout.
- Dying alone. Unlike most suicides, most individual who choose VAD do not die ‘alone and in despair’; they die in accordance with wishes: at home, with family.