Terminally Ill Adults (End of Life) Bill

Written evidence submitted by Dr Vicki Ibbett, MRCPsych, NHS Speciality Doctor in Psychiatry (TIAB434)

IMPACT ON SUICIDE PREVENTION

I am writing as an NHS specialty doctor in psychiatry with personal and professional experience of suicidality. I have significant concerns about the impact of the Bill of suicide prevention efforts. I am also extremely concerned that neither the voice of people with lived experience of suicidal ideation, nor the adverse impact of suicide, was heard during the oral evidence sessions. The insights of experts in the field of suicide prevention have also not been adequately heard due to their concerns about the adverse impact on people currently experiencing suicidal thoughts (see Annex 1).

I am presenting a conceptual narrative aiming to bring to light the potential consequences of undermining suicide prevention efforts through the legalisation of assisted suicide. Given the anticipated fatal consequences of the Bill, beyond that would become legal, a comprehensive research project should have been commissioned to explore the impact of the Bill on suicide prevention. In the absence of a comprehensive report exploring the impact of the Bill on suicide prevention, and without the resources or time to complete such a project, I invite you to briefly step into the lives of people who would be impacted by this Bill. Consider how it would affect their lives. As you consider how this Bill would affect them, remember that their voices would likely never be heard in public and or captured in a research study. And remember that unheard suffering is real and must not be forgotten.

As clause 24 of the Bill would amend the Suicide Act 1961 and thus legalise ‘assisted suicide’, I will use this legally correct phrase rather than the euphemistic ambiguous phrase ‘assisted dying’.

SUICIDE PREVENTION IS A DUTY TO ALL, INCLUDING THE TERMINALLY ILL - PASSING THIS BILL WOULD UNDERMINE SUICIDE PREVENTION.

1. The legalisation of assisted suicide would undermine suicide prevention strategies in England [1] and Wales [2] . Annex 2 provides further details on suicide prevention in the context of assisted suicide.

2. If the Bill passes into law, deaths by assisted suicide would increase total deaths by suicide in England and Wales. However, it is important to remember that while the legal criteria would have been met, it could not be said that all of the requests for assisted suicide that were granted would be free from coercion. Sadly we know that coercion is difficult to detect and no combination of safeguards would be sufficiently robust to always identify its presence. Every death by suicide is one death too many.

3. Legalisation of assisted suicide would also increase the risk of some individuals ending their life by unassisted suicide. This impact may not be captured through an increased rate of deaths by suicide, as this is influenced by many factors. Nevertheless, the impact on individuals must not be overlooked. How may individual people respond to the Bill? Even if you disagree with someone’s thought processes, could the legalisation of assisted suicide lead to some people thinking that there life is no longer worth living, and ending their life by suicide?

SUICIDE PRVENTION UNDERMINED: IMPACT ON INDIVIDUALS

4. Below are a range of hypothetical though plausible examples of how suicidality, and the risk of a person ending their life by suicide, may increase for different groups of individuals. These examples are not exhaustive and the suffering experienced is not limited to an greater risk of suicidal ideation and suicide. A more extensive review of available research and grey literature would likely provide further weight to these scenarios, though given the sensitivity and complexity of suicidal ideation and acts in the real lives of individuals, many stories and examples will remain hidden.

People with thoughts of not wanting to be alive who are terminally ill

5. Thoughts of wanting to die have a known association with being given a cancer diagnose and learning of being terminally ill [3] [4] . Analysis of data for England has shown that the risk of death by suicide increases after a diagnosis of a ‘low survival’ severe physical health problem compared to matched controls, with a higher risk in the first 6 months after diagnosis [5] . Usually on identification of a group at higher risk of suicide, a suicide prevention approach would be taken and the phenomenon explored further [6] . However through euphemistic distancing from the term suicidal ideation, rather than acting to prevent death doctors could assist people to die by suicide under the proposed Bill. While the euphemistic term ‘assisted dying’ is understandably preferred by proponents of the Bill, it is, nevertheless, assisted suicide which would be legalised.

6. Suicidal ideation may have arisen as part of the response to a new diagnosis with a terminal prognosis. It may, therefore, be part of an ‘adjustment reaction’. Adjustment Disorder often settles without professional intervention. If it persists additional support may be beneficial. Assisted suicide should not be facilitated.

7. Suicidal ideation may be intermittent or present for a distinct period due to a specific psychosocial challenge or unaddressed physical symptom. While the person may ‘wish everything were over’ they may not want to actively end their life. In such cases where a resolution of the precipitating factor is anticipated, it would be inappropriate to state their intention to die as "settled". However, if expressions of such feelings result in discussions around assisted suicide they may be unduly influenced.

8. Suicidal ideation may occur in the context of a pre-existing mental health disorder with such thoughts preceding the terminal prognosis. Many factors may impact on suicidal intent and planning, and skilled holistic support from mental health professionals will hopefully dissipate such thoughts. If their wish to die remains settled and they are informed about their options as per the Bill, how would it be decided whether to detain them under the Mental Health Act to prevent (unassisted) suicide, or to proceed to facilitate assisted suicide?

9. When someone describes suicidal ideation and intent, expressed as a wish to end life as "it’s my choice" (due to ‘bodily autonomy’), the reason for wanting this choice and control must be explored further. This should include exploring any fear around dying, any sense of pressure or coercion from others, the presence of domestic abuse and their understanding of alternatives such as palliative care. While under the Mental Capacity Act capacity should be assumed, given that the Bill would allow people to make the decision to end their life by suicide, it should be necessary for someone to demonstrate that they could understand, retain and weigh up all relevant information. If all the relevant information is not shared in an accessible way to inform decision making, informed consent could never be ascertained.

10. When in the position of having a terminal illness themselves, the most vocal, powerful proponents of assisted suicide still need to be protected by suicide prevention principles. Previous vehement rejection of the term 'suicide' in relation to this Bill, must not exclude people from changing their mind to opt for a natural death or talking about their fears and concerns of death etc.

Close family members and friends of a person who requests assisted suicide

11. The impact on those close to the person requesting assisted suicide is not considered in the Bill.

12. When a close family member or friend is given a terminal prognosis and approaches the end of life, it can result in pre-loss grief and also prompt preparation for death [7] . It can also offer a time for reconnection and reconciliation. Every experience of bereavement will be different, though a sudden or unexpected death will generally be more traumatic than a death where close family and friends have time to adjust to their loved one being at the end of their life. While bereavement has been associated with an increased rate of suicidal ideation generally, studies have shown a higher risk where the cause of the death was by suicide [8] . Research in this area is limited, though a 2023 scoping review highlighted several distinct challenges of medical assistance in dying on family and friends. These ‘burdens’ include fear of societal stigma and the sense of a heavy burden. Lived experience has also been submitted as written evidence [9] .

13. If a family member or friend is aware of their loved ones request for assisted suicide but disagrees, this is likely to result in a tension that will adversely impact on both parties. If the assisted suicide proceeds, this may cause ongoing significant distress for the family member and could result in suicidal ideation. Powerful written evidence has been submitted by Alicia Duncan [10] and Christopher Lyon [11] , both bereaved by the suicide of a parent.

14. Currently the Bill would not require any consultation with those close to a patient prior to assisted suicide. This means that a family member may be unaware of the assisted suicide until after they have died. Such news would cause significant psychological distress to some people and may result in suicidality and/or Prolonged Grief Disorder. Particularly as such distress would be anticipated, this is in conflict with being "considerate and compassionate to those close to a patient" as per GMC guidance [12] [13] .

Family and friends of people who are terminally ill

15. If this Bill were introduced, the lack of necessity for a person requesting assisted suicide to inform someone close to them may adversely impact close friends and relatives. Some family and friends may become hypervigilant in their communication with their loved one, anxious that their words and interactions may prompt thoughts of requesting assisted suicide. Furthermore, they may have significant fear that their loved on may request assisted suicide without them being aware. Such anxiety and stress could exacerbate existing mental health problems. While hopefully unlikely, it is plausible that with the high levels of stress someone may consider ending their life by suicide.

16. While caring for a relative can be rewarding, it can also be very difficult. It is important that carers can access support and be honest about their struggles. Carers of people who are terminally ill must feel able to access people who they can speak with openly about how they are feeling. Some may feel like caring is a burden, but if the law is passed, may feel reluctant to speak about this for fear of their relative finding out and potentially seeking to end their life due to feeling like a burden. If the carer does not feel able to speak out, this could adversely impact on their mental health and result in suicidality.

Professionals connected with a person who requests assisted suicide

17. Professionals directly involved in the assisted suicide process will mostly be those who are supportive of the principle of assisted suicide. This, however, does not make them immune from experiencing thoughts of ending their own life by suicide, and acting on these thoughts, as a result of their involvement in assisting a person to kill themselves. While they may be 100% confident that the individual requesting assisted suicide meets criteria and have no moral concerns about their own involvement, this may change later.

18. New information may come to light following a person’s assisted suicide. Maybe they were seeking to escape domestic abuse or overwhelming debt. Maybe a test result is found which would have changed the prognosis or diagnosis. Maybe their perception of having no family members who loved them and would support them as they faced the reality of their natural death, was actually a delusional belief.

19. Seeing and reading of the devastating impact of that individuals’, or someone else’s, assisted suicide on those close to them, or putting yourself in their shoes when someone close to you is told they have less than 6 months to live, may be emotionally crushing.

20. For professionals in this situation it is not hard to imagine the shame they may feel and the thoughts of guilt that may plague them. While they should be met with compassion if they seek help, their feelings of shame may drive them to silence with suicide (wrongly) appearing the only way out of their mental torment.

21. Professionals directly involved in the care of someone who requests assisted suicide but not involved in the process of assisting with their self-killing may also experience distressing thoughts and emotions in response to the person’s request for assisted suicide and subsequent death. Professionals may experience a sense of hopelessness and despair following rejected attempts to provide their professional opinion to the assessing doctors or assisted suicide decision panel. For GPs, despite helping the person live well for 30+ years of their professional life, they may only hear of the persons request for assisted suicide on being notified of their death. They may be left with a sense of anger and despair, feeling that the person had been let down by the ‘system’. Perhaps they knew the person had become despondent following a prolonged wait for more appropriate housing or other psychosocial support outside of the GP’s control. This distress could be the ‘final straw’ on top of many other stressors in their work and personal life, that leads them to take that fatal decision to end their life.

People with thoughts of not wanting to be alive who are not terminally ill

22. The potential impact on people who are not terminally ill, or close to those who are, must be acknowledged and addressed, not conveniently ignored. It could result in new or exacerbated suicidal ideation and even death by suicide.

23. Legalising assisted suicide would fundamentally change society in England and Wales. It would imply that some lives are no longer worth living. The moment we cross this Rubicon – where people no longer have an inherent right to be protected in order to live – we put many lives in danger.

24. Legalisation of assisted suicide will complicate perceptions of society and individuals towards unassisted suicide. For some, unassisted suicide will appear more ‘acceptable’ as suicide becomes more normalised. Such ‘normalisation’ was evidenced in part by the Dignity in Dying’s promotional campaign on the London Underground using emotive euphemistic language to promote assisted suicide as a compassionate choice. Such advertising is not restricted in the proposed Bill. At the same time the stigma associated with unassisted suicide may increase, particularly as proponents of ‘assisted dying’ seek to distance it from suicide. This stigma may make it harder for some people experiencing suicidal ideation to seek help, with fears associated with doctors having the potential power to end life proving a further barrier.

25. It is inevitable that proponents of ‘assisted dying’ will continue to advocate for greater autonomy through expansion of the eligibility criteria. For those seeking autonomy in how and when their life ends, it is illogical why they would be willing to restrict their autonomy to only the 6 months prior to reasonably expected death. This 6 month limit could provide an opportunity to advocate for expansion of the eligibility criteria on the basis on inequality. It is foreseeable that some people whose risk of unassisted suicide would increase if this Bill passes, would also be at increased risk of ending their life by assisted suicide if the eligibility criteria expand.

26. For people with suicidal ideation in the context of a mental health disorder, they may be more likely to end their life by suicide due to it appearing more acceptable. Alternatively they may feel angry that the state has let those with suffering expected to end within 6 months end their life, while mental health professionals continue to seek to improve their life.

27. People with a disability who are already struggling with discrimination may feel that this Bill further undermines their inherent worth, which may increase their risk of suicide. However, as they adjust to their new situation, for many they will feel less like life is no longer worth living. For people who are unable to access adequate social and mental health support in the community, again this Bill could further strengthen their internalised ‘justification’ of suicide. Furthermore, knowing that ‘feeling you’re a burden’ could be considered sufficient justification for assisted suicide, may add to their self-justification of suicide to ‘alleviate’ a loved one of the practical and financial responsibility of supporting their care.

28. People with minimal English who are experiencing suicidal ideation may be less likely to seek help from doctors as they may have a particularly heightened fear of doctors if they hear, but don’t fully understand why, some doctors are allowed to help people kill themselves. As their isolation and despair increases, they may end their life by suicide.

29. Isolation and despair may already be too familiar to people living as victims of domestic abuse. With seeking help or leaving their situation already feeling so hard and plus a perceived greater acceptability of suicide, sadly some people may view suicide as an ‘easier’ way to end their suffering than alternative options. It has been extrapolated that there are over 1800 domestic abuse related deaths in England each year (includes perpetrators and ‘involved parties’) [14] .

30. Finally, men with suicidal ideation who may perceive an increased stigma towards suicide by society if assisted suicide is legalised, could see this as the final straw in their fight against suicide. We already know that males with suicidality experience many barriers to help seeking including internal and external stigma [15] . Such barriers must be broken down not increased.

LEGALISING ASSISTED SUICIDE WILL PUT MANY INDIVIDUALS AT INCREASED RISK OF ENDING THEIR LIVES BY SUICIDE, INCLUDING UNASSISTED SUICIDE

Recommendations:

31. As this Bill is incompatible with suicide prevention I implore all MPs to vote against the Bill at its third reading. However, to partially limit harm if the Bill were passed, amendments are needed to uphold suicide prevention strategies and principles as far as possible. Amendments should include the need to regularly collect, analyse and publish qualitative and quantitative data on the impact of the Bill on unassisted suicide. Furthermore, there should be an amendment requiring the body overseeing the implementation of the Bill to actively engage with national suicide prevention leads. There must be a commitment to minimise any potential or actual harm to unassisted suicide prevention efforts identified by the suicide prevention strategies of both England and Wales. We must not create a society where, for some people, it is easier to die than live. We must continue to commit to suicide prevention.

Annex 1: Given the link between legalising assisted suicide and efforts to prevent unassisted suicide, why has the suicide prevention ‘community’ been so quiet?

Without an impact assessment covering suicide prevention, as a Committee you have received minimal oral or written evidence on how the proposed Bill may impact on suicide prevention. This contrasts with groups focused on disability rights, who have made their opposition to assisted suicide known ‘loudly’ through the opportunities to provide evidence and on social media. The relative silence of the suicide prevention ‘community’ must NOT be taken as an endorsement of assisted suicide or of the proposed Bill.

The National Suicide Prevention Alliance for England, with a membership of over 2000 organisations, including frontline charities Samaritans and Papyrus, makes no mention of the Bill on its website [16] . At first this appears contradictory to its vision for fewer lives to be lost to suicide. However, it is precisely because of the potential impact of assisted suicide – even just its discussion – on people’s likelihood of engaging with suicide prevention initiatives that has led to their silence. Samaritans’ have helpfully explained their rationale:

"Samaritans does not take a position on whether assisted dying is right or wrong, or on what the law should be on this matter. This would involve making a range of judgements which could compromise people’s perception of our ability to provide non-judgemental emotional support… We cannot take the risk that someone who is in distress will not use our service because of a position we have taken on the issue of assisted dying, which is so strongly related to ethical and moral beliefs and personal experience." [17]

The full statement can be read here: https://www.samaritans.org/news/samaritans-does-not-take-a-view-on-assisted-dying/

Annex 2: Suicide prevention in the context of assisted suicide

Suicide prevention: why it matters

Each year over 300 people die from suicide in Wales (about three times the number killed in road accidents) and over 5000 people die from suicide in England. But this is not about statistics. We are talking about people with inherent worth. Sons. Daughters. Sisters. Brothers. Fathers. Mothers. Friends. Colleagues.

Some people will not have faced the grief of a close friend or family member dying by suicide. But the chances are that you will know people who have experienced suicidality personally. The last Adult Psychiatric Morbidity Survey showed that one in five people in England experience suicidal ideation during their lifetime [18] .

From 2001 to 2023, suicide and self injury or poisoning of undetermined intent has been the leading cause of death for both males and females aged 20 to 34 years in England and Wales [19] [20] . Suicidality is also linked with care giving with such responsibilities usually beginning later in adulthood [21] .

Importance of upholding current commitment to suicide prevention

Both England [22] and Wales [23] have suicide prevention strategies, with the new strategy for Wales currently under consultation [24] . The strategies recognise suicide prevention as a major public health challenge that demands "collective action by individuals, communities, services, organisations, government and society" [25] and is "everybody’s business" [26] .

Legalising assisted suicide directly opposes suicide prevention

Assisted suicide is a form of suicide. Currently anyone who assists the suicide, or attempted suicide, of another person commits an offence under the Suicide Act 1961 and is liable to an imprisonment for up to 14 years [27] . The proposed Bill, if passed, would legalise assisted suicide. It would provide access to a means of suicide – a lethal substance – through the assistance of a medical professional. It would enable people to end their life by suicide without the need for secrecy to prevent someone intervening to save life or not intervening and thus being liable to prosecution. Even when euphemistic language is used, assisted suicide remains suicide and therefore it’s legalisation would directly oppose suicide prevention.

The decriminalisation of suicide and suicide prevention

The 1961 Suicide Act decriminalised (unassisted) suicide. Prior to this, people in distress who attempted to end their life by suicide could be imprisoned. The decision to decriminalise (unassisted) suicide was not an endorsement of suicide. Instead it indicated a change in attitude towards people who considered or acted to end their life by suicide, and to those close to them. They should be supported with dignity and compassion.

The legacy of unassisted suicide having once been considered a crime lives on. Despite its decriminalisation the word "commit" is still wrongly used in association with suicide (I am guilty of this myself). There is still lingering stigma and shame associated with suicide (as sadly evidenced by recent comments from proponents of assisted suicide). this ongoing societal stigma dampens suicide prevention efforts For some people experiencing suicidal thoughts it , will make it harder to access support and thus may dampen.

Suicide prevention: societal consensus

For many years there has been consensus that trying to prevent all suicides is right.

Prof Louis Appleby, chair of the government’s national suicide prevention strategy advisory group, has expressed concerns about the impact of allowing suicide in some circumstances and has stated:

"As society, we are signed up to the idea that we should do all we can to help [suicidal people] get through. It’s very rarely questioned. Society accepts that it has a role in protecting people who are vulnerable and at risk." [28]

He highlighted that legalising assisted suicide would say "some suicides are acceptable" and it would "open up the possibility of a validated suicide":

"you start saying certain kinds of suffering are so terrible and so irremediable that we have to support people in this action to take their lives – which in every other sense we would try to prevent" [29] .

‘Assisted dying’ is NOT a form of suicide prevention

Shockingly it has been asserted by some that voluntary assisted dying is a form of suicide prevention [30] . This is false and highly misleading. It is based on the premise that if a person knows they have the option of ending their life by assisted suicide rather than unassisted suicide, they are more likely to live until their natural death. During the debate that led to the Voluntary Assisted Dying Act 2017, in the neighbouring state of Victoria, evidence was presented that implied legalisation of assisted suicide could prevent "at least 1 suicide per week" [31] . However, analysis of data following the implementation of the Bill has not supported this proposition [32] . Moreover, neither a systematic review of studies published by late 2021 nor further data analysis have shown a reduction in unassisted suicide in states where assisted suicide had been legalised [33] [34] .

19 March 2025

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[1] Suicide prevention strategy for England: 2023 to 2028. UK Government. https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england-2023-to-2028

[2] Suicide and self harm prevention strategy 2015 to 2022. Welsh Government.

[2] https://www.gov.wales/suicide-and-self-harm-prevention-strategy-2015-2020

[3] Cheung, G., Martinez-Ruiz, A., Knell, R., O'Callaghan, A., & Guthrie, D. M. (2020). Factors Associated With Terminally Ill People Who Want to Die. Journal of pain and symptom management, 60(3), 539–548.e1. https://doi.org/10.1016/j.jpainsymman.2020.04.003

[4] Kolva, E., Hoffecker, L., & Cox-Martin, E. (2020). Suicidal ideation in patients with cancer: A systematic review of prevalence, risk factors, intervention and assessment. Palliative and Supportive Care, 18(2), 206–219. https://doi.org/10.1017/S1478951519000610

[5] Nafilyan, V., Morgan, J., Mais, D., Sleeman, K. E., Butt, A., Ward, I., Tucker, J., Appleby, L., & Glickman, M. (2022). Risk of suicide after diagnosis of severe physical health conditions: A retrospective cohort study of 47 million people. The Lancet regional health. Europe, 25, 100562. https://doi.org/10.1016/j.lanepe.2022.100562

[6] Spencer, R. J., Ray, A., Pirl, W. F., & Prigerson, H. G. (2012). Clinical correlates of suicidal thoughts in patients with advanced cancer. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 20(4), 327–336. https://doi.org/10.1097/JGP.0b013e318233171a

[7] Treml, J., Schmidt, V., Nagl, M., & Kersting, A. (2021). Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Social science & medicine (1982), 284, 114240. https://doi.org/10.1016/j.socscimed.2021.114240

[8] Molina, N., Viola, M., Rogers, M., Ouyang, D., Gang, J., Derry, H., & Prigerson, H. G. (2019). Suicidal Ideation in Bereavement: A Systematic Review. Behavioral sciences (Basel, Switzerland), 9(5), 53. https://doi.org/10.3390/bs9050053

[9] Yan H, Bytautas J, Isenberg SR, et al. Grief and bereavement of family and friends around medical assistance in dying: scoping review. BMJ Supportive & Palliative Care 2023;13:414-428. https://doi.org/10.1136/spcare-2022-003715

[10] Written evidence by Alicia Duncan (TIAB220). https://publications.parliament.uk/pa/cm5901/cmpublic/TerminallyIllAdults/memo/TIAB220.htm

[11] Written evidence by Dr Christopher Lyon (TIAB165). https://publications.parliament.uk/pa/cm5901/cmpublic/TerminallyIllAdults/memo/TIAB165.htm

[12] Paragraph 37. Good Medical Practice.

[13] Paragraphs 17-19. Treatment and care towards the end of life.

[14] Woodhouse, Tim (2023). The person most likely to kill a victim of domestic abuse… … is themselves: 66 ways to reduce domestic abuse related suicides. https://media.churchillfellowship.org/documents/Woodhouse_T_Report_2023_Final.pdf

[15] Jones et al. (2019). Barriers to Help-Seeking in Suicidal Men: A Systematic Literature Review. International Journal of Psychiatry, 4(2). DOI:10.33140/IJP.04.02.06

[16] National Suicide Prevention Alliance https://nspa.org.uk/members/

[17] Samaritans does not take a view on assisted dying. https://www.samaritans.org/news/samaritans-does-not-take-a-view-on-assisted-dying/

[18] Suicidal thoughts, suicide attempts, and self-harm (Chapter 12). Adult Psychiatric Morbidity Survey 2014. https://assets.publishing.service.gov.uk/media/5a802e2fe5274a2e8ab4ea71/apms-2014-full-rpt.pdf

[19] 2023 dataset. Deaths registered in England and Wales. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsregisteredinenglandandwalesseriesdrreferencetables

[20] Leading causes of death, UK: 2001 to 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/leadingcausesofdeathuk/2001to2018

[21] O’Dwyer et al. (2021). Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review. Comprehensive Psychiatry, 152261. https://doi.org/10.1016/j.comppsych.2021.152261.

[22] Suicide prevention strategy for England: 2023 to 2028. UK Government. https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england-2023-to-2028

[23] Suicide and self harm prevention strategy 2015 to 2022. Welsh Government.

[23] https://www.gov.wales/suicide-and-self-harm-prevention-strategy-2015-2020

[24] Draft suicide and self-harm prevention strategy. Welsh Government. https://www.gov.wales/draft-suicide-and-self-harm-prevention-strategy

[25] Suicide prevention strategy for Wales.

[26] Suicide prevention strategy for England.

[27] Suicide Act 1961. https://www.legislation.gov.uk/ukpga/Eliz2/9-10/60

[28] Legalising assisted dying in England and Wales ‘may hamper suicide prevention work’ https://www.theguardian.com/society/2025/feb/21/legalising-assisted-dying-england-and-wales-may-hamper-suicide-prevention-work-says-adviser?CMP=share_btn_url

[29] Ibid.

[30] "Voluntary assisted dying in New South Wales is an important form of suicide prevention." New South Wales MP Alex Greenwich. Column 212. https://hansard.parliament.uk/commons/2025-01-30/debates/895ba091-38d0-4162-8f79-40df9fae7e38/TerminallyIllAdults(EndOfLife)Bill(SixthSitting)

[31] DA Jones (2023). Did the Voluntary Assisted Dying Act 2017 Prevent "at least one suicide every week"? Journal of Ethics in Mental Health, 11 (1). https://irp.cdn-website.com/c0d44f22/files/uploaded/Did_the_Voluntary_Assisted_Dying_Act_2017.pdf

[32] Ibid.

[33] Doherty, A. M., Axe, C. J., & Jones, D. A. (2022). Investigating the relationship between euthanasia and/or assisted suicide and rates of non-assisted suicide: systematic review. BJPsych open, 8(4), e108. https://doi.org/10.1192/bjo.2022.71

[34] Professor David Albert Jones (2022). Suicide prevention: does legalising assisted suicide make things better or worse? Anscombe Bioethics https://www.bioethics.org.uk/research/euthanasia-assisted-suicide-papers/suicide-prevention-does-legalising-assisted-suicide-make-things-better-or-worse-professor-david-albert-jones/