Assisted suicide storyline on Coronation Street – Five myths about death and dying

This morning I took part in a debate on the Radio Four Today programme (listen here) about the assisted suicide story to be screened next Monday in a British television drama (see my previous blog on this here).

The ITV Soap ‘Coronation Street’ is running a story centred on Hayley Cropper, a transgender character who has been diagnosed with inoperable pancreatic cancer.

According to media reports she declines pain relief out of fear that it might confuse her sexual identity and dies after drinking a lethal cocktail, the contents of which are not specified. 

I am not opposed in principle to drama programmes dealing with this issue but as a doctor who has managed many dying patients I expressed concern this morning that all media portrayal of suicide or assisted suicide has to be done with the utmost care and sensitivity so as not inadvertently to steer vulnerable people toward suicide.

On the basis of the reports I have heard the programme runs the real risk of giving credence to five dangerous myths about death and dying.

First there is the myth that people dying of cancer want to die. The overwhelming majority don’t – they want good care and support. Over 7,000 people die from pancreatic cancer every year in England and Wales and it is never more than a handful who choose or desire to go down the suicide route.

Next is the myth that cancer pain cannot be controlled – in good hands it almost invariably can. This is why the pro-euthanasia lobby have essentially stopped using pain as an argument for changing the law.

Third is the myth that that effective pain relief produces confusion and is therefore to be avoided. Although sedation is sometimes necessary in order to help control severe pain in a dying patient this is in practice very rarely the case. Patients with cancer pain can tolerate much larger doses of pain medication than you or I and remain mentally alert.

More serious is the myth that that the lives of some sick and disabled people are not worth living and that it is therefore reasonable for people with these conditions to kill themselves. This is profoundly discriminatory and demeaning and simply panders to ignorant prejudice. This is why disability rights activists are so strongly opposed to any change in the law. They know they will be in danger from people who have made judgments about their lives.

Finally, there is the myth that suicidal thoughts in sick and disabled people should be managed differently from similar thoughts in people who are not sick and disabled. People who choose to end their lives usually do so because of a perception that they are alone and that no one cares about them, because of a loss of meaning and purpose or because they perceive their lives to be a burden on others. It is much more about the person than the disease. People who are suicidal need love, support, care and professional help, not for us to accede to their requests. It is utterly illogical to offer a glass of barbiturate to someone who is terminally ill whilst offering protection and care to a person equally suicidal with a mental illness.

The WHO’s international guidelines on suicide portrayal in the media refer to over 50 published studies, systematic reviews of which have consistently drawn the same conclusion, that media reporting of suicide can lead to imitative suicidal behaviours.

Bad media portrayals of suicide run the very real risk of putting the lives of very vulnerable people in danger.This phenomenon is variably termed suicide contagion, copycat suicide or the Werther effect. 

Werther was the subject of an 18^th century quasi-autobiographical novel by Goethe who killed himself after losing his lover. The book led to a spate of suicides amongst young people at the time, showing that fictional portrayals of suicide can be as dangerous as real stories.

The WHO guidelines specifically include the following:

·         Avoid language which sensationalises or normalises suicide, or presents it as a solution to problems

·         Avoid prominent placement of stories about suicide

·         Avoid explicit description of the method used

·         Take particular care in reporting celebrity suicides

Conversely, the Papageno effect refers to suicide portrayal which reduces suicide, usually by showing its detrimental effects on relationships and communities or by demonstrating how to overcome suicidal thoughts. The term comes from Mozart’s magic flute and has been popularised in a recent article in the British Medical Journal.

So in short, Werther effect bad, Papageno effect good.

The producer of the Coronation Street defended his depiction this morning on Radio Four. We will see how his programme actually measures up next week.

.

Coronation Street must handle assisted suicide story with great sensitivity and care

The BBC has reported this week that the ITV Soap ‘Coronation Street’ is to run a story on assisted suicide centred on the character Hayley Cropper (pictured).

Hayley, the first transgender character in a British soap, has been diagnosed with inoperable pancreatic cancer and the show has revealed that as her health deteriorates she will decide she wants to take her own life.

Cancer of the pancreas is not uncommon:  7,065 people in England and Wales died from the disease in 2010.

However, the overwhelming majority of those with pancreatic cancer, or in fact any other physical disease or disability for that matter, do not want assisted suicide or euthanasia but rather good care and support.

So this in itself means that Coronation Street is in great danger of normalising an occurrence that is actually very rare indeed.

It is a widely held misconception that people with terminal illnesses or disabilities are more likely than those in the general population to want to end their lives.

In fact suicidal thinking is far more likely related to feelings of hopelessness or worthlessness - existential or spiritual factors that may accompany illness - rather than physical symptoms which can in the main be effectively controlled.

90% of those who commit suicide suffer from some form of mental illness including depression, bipolar disorder, borderline personality disorder and alcohol or drug misuse.

American psychologist Thomas Joiner, has said that the three main factors causing someone to turn to suicide are:

• a perception (usually mistaken) that they are alone in the world and that no one really cares about them
• a feeling (again, usually mistaken) that they are a burden on others and that people would be better off if they were dead
• fearlessness towards pain and death

It is when these factors accompany illness that people might begin to find the prospect of euthanasia or assisted suicide appealing. But then our response, as with any suicidal person, should be to address these issues, not to reach for the euthanasia needle.

It was for these reasons that when Emmerdale, another TV Soap, ran an assisted suicide plot in 2011, the programme was not surprisingly criticised by disability rights groups for misrepresenting the lives and attitudes of sick and disabled people. 

As I have previously commented however, Emmerdale did eventually take a realistic view about the huge ramifications for the lives and relationships of those left behind after an assisted suicide and showed something of the huge emotional and spiritual fall out for those involved.

The way the media handles suicide is incredibly important – as it may have the effect of either increasing suicides or preventing them – the Werther and Papageno effects respectively.

The ‘Werther effect’ refers to ‘suicide contagion’ or ‘copycat suicides’ resulting from inappropriate media coverage of suicide.

However a recent paper in the British Medical Journal, ‘Papageno vs Werther Effect’, has demonstrated that some media coverage of suicide actually leads to a decrease rather than an increase in suicide rates.

‘Newspaper items accounting for (a decrease) form a distinct non-sensationalist class of suicide reporting. They follow the recommendations of the World Health Organization in reporting suicide—for example, avoiding terms such as suicide epidemic. Our findings suggest that media reports on individual mastery of suicidal crises are highly relevant in preventing suicide.’

In other words, media stories about how people coped positively with suicidal feelings actually lead to a decrease in levels of suicide in the general population – the ‘Papageno effect’.

The BBC, which has been justifiably called a ‘cheerleader for assisted suicide’ for portraying assisted suicide in a positive light, could learn some lessons from Emmerdale.

Let’s hope that ITV will too and that this new story in Coronation Street will not act as a propaganda vehicle for the pro-euthanasia movement and in the process push more vulnerable people over the edge by making suicide seem like an attractive answer to life’s problems. 

While soaps should not avoid controversial subject matters, it is crucially important that this particular issue is presented in a sensitive way and handled with great care.

Irresponsible portrayal of suicide risks being a recipe for elder abuse and a threat to vulnerable people, many of whom already feel under pressure at a time of austerity and who are worried about being a financial or emotional burden on others.

Jonathan Agnew should stick to cricket rather than pontificating about serious matters of public policy

I am passionate about cricket. I am not that good at it (I once played for the Lynfield College social team which was bowled out for 5!) but since I was a teenager I have loved listening to radio cricket commentaries and from a good description can picture exactly what is happening on the field.

For this reason I have always appreciated Jonathan Agnew (‘Aggers’) (pictured). Not only is he an excellent radio commentator but he also played personally to a high level in county cricket and knows what he is talking about.

Being an expert on cricket, however, does not make him an expert on important issues of public policy like assisted suicide.

It was deeply disappointed today to see him jumping on the pro-euthanasia bandwagon in comments carried by the Telegraph, Times, Daily Mail and a host of other media outlets.

Apparently he previously offered to accompany Brian Dodds, his second wife’s ex-husband, to the Dignitas assisted suicide facility in Zurich after he had Motor Neurone Disease diagnosed.

Mr Dodds didn’t take him up on his offer and subsequently died in England from the disease in 2005.

In a quite bizarre twist Agnew says he is unable to remember whether he ever mentioned the conversation to Dodds’ former wife, to whom he is now married.

Agnew advances the usual tired superficial arguments to advance his position (‘I had my dog put down’ and ‘the choice should be left up to the individual’) without displaying any appreciation of the complex issues involved, not least the fact that his dog’s death (since there was no consent given) was a case of euthanasia rather than assisted suicide.

Legalizing euthanasia and/or assisted suicide create a right to be killed or allow a physician to be involved with causing your death, it is not simply about a right to die. It is primarily one of public safety. This is why British parliaments have roundly rejected it on three occasions in the last seven years and why the medical profession and disability rights groups remain so strongly opposed to it.

That the media considers a sports commentator commenting on assisted suicide to be newsworthy reveals how superficial this debate has become.

But there is another more serious issue with Agnew seeking media support to promote euthanasia and assisted suicide.  The reality of the copy-cat suicide effect is well known and that is why the World Health Organization established a set of guidelines for the media to help prevent suicide.

The WHO report (World Health Organization’s Preventing Suicide: A Resource for Media Professionals) makes the point that ‘the degree of publicity given to a suicide story is directly correlated with the number of subsequent suicides. Cases of suicide involving celebrities have had a particularly strong impact’.

This is backed up by a major review of 42 studies on the impact of publicized suicide stories in the media on the incidence of suicide in the real world published in the Journal of Epidemiology and Community Health in 2003.

This found that ‘studies measuring the effect of either an entertainment or political celebrity suicide story were 14.3 times more likely to find a copycat effect than studies that did not. Studies based on a real as opposed to fictional story were 4.03 times more likely to uncover a copycat effect.’

In other words, celebrities like Agnew, who throw their weight behind promoting suicide as a solution to health problems, may unwittingly be contributing to vulnerable people being pushed over the edge into taking their own lives.

It was good to see Agnew last month encouraging his 240,000 Twitter followers to donate to the fundraising web page set up by his stepson, who climbed Mount Kilimanjaro in Tanzania to raise money for the Motor Neurone Disease Association.

He must surely then  be aware that the overwhelming vast majority of people suffering from motor neurone disease (MND), presumably like his wife’s former husband, do not actually want ‘assisted dying’ but ‘assisted living’, help to die naturally in as much comfort as possible. Our focus should be on care, not killing. 

It would therefore be a far better use of his time to draw attention to the stories of good role models like South African rugby hero Joost var der Westhuizen, currently dying from MND, rather than using his celebrity status to shoot his mouth off on a subject he is not actually qualified to address.