Book linked to more suicides by asphyxiation

November 07, 1993|By New York Times News Service

A popular suicide manual has had a noticeable effect on the methods people use to kill themselves, research has shown.

The book, "Final Exit," recommends that terminally ill people wishing to end their lives rely on asphyxiation, which the book calls "self-deliverance via the plastic bag," combined with drugs for sedation.

In the year after the book's publication in March 1991, the number of suicides by asphyxiation rose to 33 in New York City, a new study has shown, compared with eight in the year before the manual came out.

The study will appear in the New England Journal of Medicine.

Although the researchers could not establish a direct link between the book and each death, they found strong evidence that the book had influenced almost a third of these people. In nine cases, the City Medical Examiner's office found "Final Exit" at the scene of the suicide, and in another case, a suicide note mirrored verbatim a note suggested in the book.

Although no one has studied the influence of the book on a national level, the National Center for Health Statistics reports that suicides by plastic bag asphyxiation rose from 334 in 1990 to 437 in 1991, for an increase of 30.8 percent.

The average number of suicides by asphyxiation in the seven years preceding the book's publication was 271.

Both New York City and national data show no overall increase in the number of suicides since the publication of the book, written by Derek Humphry, a former president of the Hemlock Society, which advocates the right of terminally ill patients to kill themselves.

Nonetheless, some psychiatrists said the increasing popularity of the plastic bag method represents a frightening trend, because the method is so effective.

"The bad news was that we found an increase in the methods the book recommends, namely asphyxia by plastic bag, and this is a very lethal means of suicide," said Dr. Peter M. Marzuk, a psychiatrist at Cornell University Medical College. Dr. Marzuk conducted the New York research in collaboration with the medical examiner's office.

"Most suicide attempts are half-hearted, impulsive and later regretted," he said. "So whenever there's a shift to more lethal means, that's very concerning."

But Sidney D. Rosoff, president of the Hemlock Society, said that since the overall number of suicides had not increased, "Final Exit" had merely performed a service for those already intent upon death.

"I'd have been disturbed if there had been an increase in $H suicides, but all the study shows is that people instead of doing it one way did it another, that the book showed them an easier way," Mr. Rosoff said. He said that the book was intended to help terminally ill patients kill themselves using the quickest, most painless, most reliable methods.

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