It used to be that only rich people could afford to be fat. Now only rich people can afford to be thin.

And there's even a growing income gap when it comes to suicide.

Assisted suicide is legal in Switzerland but that doesn't make it equal, and the authors of a paper in the International Journal of Epidemiology have found that assisted suicide is more common in wealthier areas.

To be clear, euthanasia is not legal, just assisted suicide is. It's a subtle distinction, courtesy of the country that says you can't hang clothes out to dry on a Sunday.

Doctors don't need to be involved in assisted suicides, they just need to sign off on the decisional capacity of the intended suicidee. Instead of doctors, assisted suicides in Switzerland are performed with volunteers working for "right-to-die" associations.


You don't need a terminal illness, you just need to be capable of making an informed decision.

Professor Matthias Egger and colleagues at the University of Bern gathered data from three right-to-die organizations to the Swiss national Cohort, a longitudinal study of mortality based on linkage of census and mortality records. The study followed those aged 25 to 94 from 1 January 2003 until their death, emigration, or the end of the study: a total of 5,004,403 people. Anonymous data on 1,301 cases of assisted suicide between 2003 and 2008 were provided.

Who kills themselves the most? Women. And those with college degrees. People who live alone. And atheists. And city people. And the French-speaking Swiss.

Oh, and the wealthy. You'd think wealthier people have more to live for - they didn't even get to purchase a Playstation 4. But no, they gave up. Some for decent enough reasons. 84% of cases listed at least one cause of suicide. In the age group 25-64 years , 57% had cancer and 21% had diseases of the nervous system (21%). 11 had a mood disorder listed as the first underlying cause, and 3 had another mental or behavioral disorder.

In all cases except Parkinson's disease, more women than men committed suicide. In the 65-94 years age group, cancer was again the most common underlying cause (41%), followed by circulatory (15%) and diseases of the nervous system (11%). Thirty people had a mood disorder, and six had another mental or behavioral disorder. 

Egger said in their statement, "Our study is relevant to the debate on a possibly disproportionate number of assisted suicides among vulnerable groups. The higher rates among the better educated and those living in neighborhoods of higher socio-economic standing does not support the 'slippery slope' argument but might reflect inequities in access to assisted suicide. On the other hand, we found a higher rate among people living alone and the divorced. Social isolation and loneliness are well known risk factors for non-assisted suicides and our results suggest that they may also play a role in assisted suicide. Also, the observation that women die more frequently by assisted suicide than men is potentially of concern. Interestingly, though, studies from the Netherlands and Oregon in the USA reported more men than women among assisted deaths."

16% of death certificates did not register an underlying cause. A previous analysis of suicides by two right-to-die organizations showed that 25% of those assisted had no fatal illness, instead citing "weariness of life" as a factor. In 2013 the European Court of Human Rights asked Switzerland to clarify whether and under what conditions individuals not suffering from terminal illnesses should have access to help in ending their lives, suggesting that Switzerland should more precisely regulate assisted dying. 

Egger says, "We believe that such new regulation should mandate the anonymous registration of assisted suicides in a dedicated database, including data on patient characteristics and underlying causes, so that suicides assisted by right-to-die associations can be monitored."