Appeals Court Upholds South Dakota Suicide Advisory

Suicide is entirely horrible. For someone who is profoundly depressed, suicidal thoughts are as intrusive and all-encompassing as violent nausea. A nauseated person has to concentrate very hard to avoid doing something that healthy people avoid doing effortlessly. So too with the suicidal person: s/he must, every moment, dredge up focused effort and self-talk about how the promised relief wouldn’t really be worth it.

And losing someone you love to suicide (to continue with bowel metaphors) is like having your guts scooped out, without benefit of anesthesia; and the only relief offered you is a smelly pillow to bite on, on which is cross-stitched, “Evidently you weren’t enough.” There is nothing about suicide that isn’t awful.

That said, it’s entirely possible to believe that suicide is really serious and really horrible, and—for that very reason, no less—to think that one ought not play fast and loose with actual data about suicide. Which is why I was dismayed to read that the Eighth Circuit Court of Appeals upheld the suicide advisory provision in South Dakota’s abortion law, which requires doctors to tell patients that there is a link between abortion and suicide. 

Because in fact there may be no such thing. A 2009 systematic review concluded that the most well-designed study of mental health outcomes and abortion suggested that abortion made little, if any, difference in overall mental health of women. Moreover, if there were a weak link, then it still may not be causal, let alone prescriptive. Women generally live longer than men, but that doesn’t mean that maleness is a morbid condition, or that cisgender men should be urged toward sex reassignment surgery. People whose parents earn more money generally do better on standardized tests, but that doesn’t mean that you should give your mom $100 on the eve of your PSATs in the hopes of increasing your score.

Mental health is really important. In an ideal world, doctors would be attentive to the mental health of all patients: prenatal care patients, cosmetic surgery patients, patients who come in with the sniffles, and so forth. (And God bless the compassionate family doctors, pediatricians, and other primary care physicians who do so attend!) At the same time, it’s worth noticing who does, and does not, get warned about their behaviors on the basis of weak evidence.

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