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Do states have an obligation to prevent pesticide suicide?

(Based on the paper “”)

Leah Utyasheva

Michael Eddleston

September 3, 2021

1,337

What is the extent of states’ obligation to protect its residents from self-inflicted harm and suicide? In the question of suicide prevention, the burden is usually placed on health care and mental health professionals, police, and school councilors to ensure mental health support and protection of life of suicidal individuals [1, 2]. Domestic laws of the right to life concentrate on the general criminal law prohibition of the “arbitrary” deprivation of human life.

Suicide by pesticide ingestion

However, in the situation involving vulnerable communities and individuals, the scope of the states’ obligation to protect life is higher. In case of suicide with ingestion of highly hazardous pesticides (HHPs) – one of the three most important global means of suicide [3] – the wide availability and accessibility of HHPs is to blame for the high number of deaths. In rural areas, small-scale farmers store pesticides in, or in close proximity to, their homes and common use areas. High concentration, agricultural pesticide formulations are readily available for purchase in pesticide shops or in convenience stores where they may be sold next to food and other everyday items [4, 5].

A large proportion of pesticide suicides are impulsive with little planning [6, 7]. Most persons who engage in suicidal behaviour are ambivalent about wanting to die, with self-harm serving as a response to often transient psychosocial stressors [8]. Surviving a suicidal action usually allows the person to find the support they require from family, community or social and mental health services, and a different way to deal with the crisis.

The link between suicide and mental illness is not as prominent in the low and middle income countries (LMIC) as in the high-income countries, although researchers have proposed a link between pesticide use, depression and suicide [9, 10]. This link with mental illness is weak because individuals with little suicidality die when they ingest highly hazardous pesticides with little thought, after just minutes of contemplation, with no ability to change the outcome after the ingestion. Awareness is rising of the more appropriate view of suicide as a social and a public health issue that is best addressed by social and public health programs, rather than solely within the mental health framework [11].

The right to life

The value of life has been the object of considerable philosophical debate for over two millennia [12]. The discourse has evolved from Judea-Christian religious beliefs in the sanctity of life determined by God to philosophical ideas about the inherent dignity and worth of an individual in the human rights system. The initial prohibition on intentional killing as the primary obligation of the State (a negative obligation) has grown into a positive obligation to preserve life of individuals if the State has jurisdiction and physical control over the person [2, 13].

The right to life is entrenched in the constitutions and other legislation of the majority of common and civil law countries. The States affirm their interest in preserving the lives of their residents by adopting suicide prevention and mental health strategies, by placing restrictions on access to suicide means such as barriers on bridges, railway and train platforms, prescription medicine sale and gun control rules. It is also confirmed by the fact that in the jurisdictions that allow it, physician assisted suicide or euthanasia is allowed only in certain strictly limited circumstances. Some countries criminalise suicide by imposing fines or prison sentences on suicide survivors, although evidence shows that criminalization of suicide attempt does more harm than good in suicide prevention [14].

The right to life is entrenched in the Universal Declaration of Human Rights (UDHR) and the International Covenant on Civil and Political Rights (ICCPR)[15, 16]. The General Comment No 36 [17] that helps states understand their obligations under the ICCPR affirms that “the right to life has crucial importance both for individuals and for society as a whole.” State parties are obliged to adopt special measures of protection towards persons in situation of vulnerability whose lives have been placed at particular risk because of specific threats. Particularly on the subject of suicide, the General Comment states that “[w]hile acknowledging the central importance to human dignity of personal autonomy, States should take adequate measures, without violating their other Covenant obligations, to prevent suicides, especially among individuals in particularly vulnerable situations…”[17].

It follows that in certain circumstances States are under an obligation to take positive measures to protect life, even against actions by which individuals endanger themselves, particularly if they are in the jurisdiction and physical control of the state or in the situation of vulnerability. Usually, UN agencies identify rural workers and peasants as such a group, including the most vulnerable people working in rural areas, smallholder farmers, and landless workers [18].

Protection of vulnerable communities

Several factors make it difficult for peasants and other people working in rural areas to make their voices heard, to defend their human rights and land ownership rights, and to secure the sustainable use of the natural resources on which they depend. Poverty, lack of education and information about harms associated with pesticides use, lack of social, health care and community services, gender inequality, domestic violence, dowry issues, long distance to urban areas with where more services are available – all these factors put farmers and agricultural/ rural communities in the situation of vulnerability [19]. Rural women carry out a disproportionate share of unpaid work, are often heavily discriminated against in the access to natural and productive resources, financial services, information, employment and social protection, and face violence in manifold forms [18].

The UN Declaration on Peasants affirms that small-holder farmers and people living and working in rural areas, being specially affected by climate change, poverty, and the changing dynamics in agriculture, input and food markets that all are placing pressure on their traditional lifestyles, food security and modes of livelihood are amongst the most vulnerable groups in the world [20]. The recognition that smallholder farmers and other rural populations are among the most discriminated and vulnerable people in many parts of the world underlines that special measures need to be taken to lessen the impact of HHPs on rights and lives.

Highly hazardous pesticide bans as a suicide prevention strategy

In the case of pesticide suicides, the wide availability of highly hazardous substances in agricultural communities puts people who are poorly equipped to understand dangers associated with these hazardous substances into direct risk to their lives. The ICCPR’s duty to take positive measures to protect the right to life of vulnerable individuals means that States need to take action to restrict the wide availability of these substances in rural communities thus protecting peoples’ right to life.

A clear distinction needs to be drawn between people wishing to die to avoid suffering or debilitating and painful illness, and vulnerable individuals resorting to self-harm with lethal means in a moment of short-lived crisis. For the impulsive suicides in LMICs in the situation of vulnerability, absence of counselling and mental health services as well as coping means in a case of personal conflict, the State has an obligation to prevent suicide. State approved physician assisted suicides in clearly defined circumstances and strictly implemented safeguards, allows terminally ill people, who experience severe physical or mental pain and suffering, die with dignity. These measures exist usually in high income countries (HIC) due to

careful balancing of the interests of the state in protecting “sanctity” of life and competing interests such as personal autonomy, dignity and respect for private and family life [1, 21].

States’ heightened obligation to protect the right to life of vulnerable individuals, such as people working and living in rural communities, encompasses the duty to adopt positive measures to protect people’s right to life. This is done by severely restricting or banning means of suicide such as HHPs to protect vulnerable individuals without the long-standing predetermination to end their life – as is normally the case with pesticide suicides. Needless to say, such measures will also help to mitigate environmental, public health and other harmful impact of HHPs use.

1.         Wicks, E., The right to life and conflicting interests. 2010, Oxford ; New York: Oxford University Press. xiv, 260 p.

2.         Ho, A.O., Suicide: Rationality and Responsibility for Life. The Canadian Journal of Psychiatry, 2014. 59(3): p. 141-147.

3.         World Health Organisation. Fact Sheet on Suicide. 2019 2 September 2019 [cited 2020 11 June]; Available from: https://www.who.int/news-room/fact-sheets/detail/suicide.

4.         Vethanayagam, A.V., Folidol Poisoning. Ceylon Medical Journal, 1962. 7: p. 209-11.

5.         Gunnell, D., et al., The global distribution of fatal pesticide self-poisoning: Systematic review. BMC Public Health, 2007. 7(1): p. 357.

6.         Eddleston, M., et al., Choice of poison for intentional self-poisoning in rural Sri Lanka. Clinical Toxicology (Philadelphia, Pa.), 2006. 44(3): p. 283-286.

7.         Conner, K.R., et al., Low-planned suicides in China. Psychological Medicine, 2005. 35(8): p. 1197-1204.

8.         World Health Organization. Restricting Access to the Means for Suicide. Mental Health 2018  [cited 2020 June 18]; Available from: http://www.who.int/mental_health/prevention/suicide/pesticides/en.

9.         Meyer, A., et al., Mood Disorders Hospitalizations, Suicide Attempts, and Suicide Mortality Among Agricultural Workers and Residents in an Area With Intensive Use of Pesticides in Brazil. Journal of Toxicology and Environmental Health, Part A, 2010. 73(13-14): p. 866-877.

10.      London, L., et al., Suicide and exposure to organophosphate insecticides: cause or effect? American Journal of Industrial Medicine, 2005. 47(4): p. 308-21.

11.      Vijaykumar, L., Suicide and its prevention: The urgent need in India. Indian Journal of Psychiatry, 2007. 49(2): p. 81-4.

12.      Mishara, B. and D. Weisstub, Ethical and legal issues in suicide research. International Journal of Law and Psychiatry, 2005. 28(1): p. 23-41.

13.      Allen, N., The right to life in a suicidal state. International Journal of Law and Psychiatry, 2013. 36(5): p. 350-357.

14.      Mishara, B. and D. Weisstub, The legal status of suicide: A global review. International Journal of Law and Psychiatry, 2016. 44: p. 54-74.

15.      United Nations General Assembly, Universal Declaration of Human Rights, in 217 A (III), United Nations, Editor. 1948.

16.      United Nations General Assembly, International Covenant on Civil and Political Rights, in Treaty Series, Vol 999, United Nations General Assembly, Editor. 1966: United Nations.

17.      United Nations Human Rights Committee, ICCPR General Comment No. 36 on Article 6 of the International Covenant on Civil and Political Rights, on the Right to Life, in CCPR/C/GC/36. 2018, Human Rights Committee: Geneva.

18.      United Nations General Assembly, Final Study of the Human Rights Council Advisory Committee on the advamcement of the rights of peasants and other people working in rural areas, in A/HRC/AC/8/6. 2012, Human Rights Council: Geneva.

19.      Chapman, A. and B. Carbonetti, Human Rights Protections for Vulnerable and Disadvantaged Groups: The Contributions of the UN Committee on Economic, Social and Cultural Rights. Human Rights Quarterly, 2011. 33(3): p. 682-732.

20.      United Nations Human Rights Council, Declaration on the Rights of Peasants and Other People Working in Rural Areas, in 39th session. 2018, UN Human Rights Council: Geneva.

21.      Tiensuu, P., Whose Right to What Life: Assisted Suicide and the Right to Life as a Fundamental Right. Human Rights Law Review 2015. 15(2): p. 251-281.