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Experts on suicide have long known about the “copycat” phenomenon: One widely publicized suicide may touch off similar acts among other impressionable people. Recently four researchers at the University of California tried to answer the question: Does the same phenomenon exist when favorable publicity is given to assisted suicide and other involvement by physicians in hastening patients’ deaths?
In the Spring 1999 issue of the American Association of Suicidology’s journal, the researchers explain how they studied the aftermath of two nationally publicized events: the publication of Dr. Timothy Quill’s landmark editorial about his personal involvement in an assisted suicide in the March 7, 1991 issue of the New England Journal of Medicine; and the Missouri Supreme Court’s decision allowing the removal of artificially assisted feeding and fluids from Nancy Cruzan in December 1990. Noting that the extent to which physicians may be seen as hastening death is strikingly different in the two cases, the authors nonetheless wished to study cases in which a medical authority (Quill) and a legal authority (the Missouri court) advanced the idea of a “right to die” for a certain class of patients.

The results of the study are startling. In the month of March 1991, following Dr. Quill’s public account of assisting the suicide of a female leukemia patient, deaths among female leukemia patients nationwide showed a peak of 11.3% that could not be explained by any other known factor. This peak was larger the more similar the patient’s situation was to that of Quill’s patient. For example, the increase was almost entirely found among long-term residents of small communities — those most likely to have a long-term relationship with their physician, as Quill’s patient did. The increase in deaths was 34% among “female leukemia patients in their 40s who were long-term residents of smaller communities.” The authors believe the peak in deaths was due to an increase in privately arranged assisted suicides, emboldened by Quill’s nationally reported account in a prestigious medical journal. Similarly, in the weeks following the Cruzan ruling, deaths among patients who were comatose following an accident were 57% higher than in surrounding months.

“Both legal and medical authorities appear to have played significant permission-giving roles in conditions of ethical uncertainty,” conclude the authors. “The best available explanation for the mortality peaks is that they were elicited by two major opinion-shaping mechanisms in our society: courts and editorials.” They add: “If the publication of a single medical editorial did in fact change the short-term behaviors of physicians and their patients to the extent observed, then legalization of assisted suicide might well have even larger and more widespread effects.”

[See: D. Phillips, N. Christenfeld, L. Glynn, and A. Steinberg, The Influence of Medical and Legal Authorities on Deaths Facilitated by Physicians, 29 Suicide and Life-Threatening Behavior 49-57 (Spring 1999)]

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