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Psychiatric Services, VOL. 51, No. 10

Book Review | October 01, 2000

Contemporary Perspectives on Rational Suicide

Andrew Edmund Slaby, M.D., Ph.D.

Psychiatric Services 2000; doi: 10.1176/appi.ps.51.10.1323

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edited by James L. Werth, Jr.; Philadelphia, Brunner/Mazel, 1999, 236 pages, $64.95 hardcover, $29.95 softcover

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Freud is reputed to have said that the most difficult adult task is tolerating ambiguity. Toleration of ambiguity is demanded in the extreme for wrestling with issues at the borders of rationale suicide, physician-assisted suicide, and humane care. Where does compassionate management of individuals with terminal or severely life-restricting illness become assisting in suicide? James L. Werth, a research associate in the law and psychology program at the University of Nebraska, has created an interesting forum for experts from many disciplines with views pro and con on issues surrounding rational suicide.

The presentation of opposing views begins with the book's two forewords. The first is by Derek Humphry, founder of the Hemlock Society, and the second is by Rita L. Marker, executive director of the International Anti-Euthanasia Task Force. These discussions set the pace and establish the format of subsequent chapters written from varying professional perspectives and by special-interest advocates.

The first two chapters are contributed by philosopher-ethicists with opposing views: Margaret P. Battin, professor of philosophy at the University of Utah (pro), and Daniel Callahan, former president of the Hastings Center (con). Subsequent chapters juxtapose pro and con views of individuals of comparable stature and experience in the fields of religion, sociology, law, medicine, nursing, psychiatry, psychology, social work, gerontology, grief counseling, death education, and disability rights advocacy.

The final two chapters are written by survivors with opposing views: Patty Rosen, a primary spokesperson for Oregon's Death With Dignity ballot measure (pro), and Adina Wrobleski, a recognized expert on suicide grief (con). Charlotte P. Ross, past executive director of the suicide prevention center of San Mateo County, California, and current executive director of the Death With Dignity National Center, supplies the concluding remarks. It is hard to conceive of a more illustrious group of contributors to provide material for meaningful consideration of the subject.

Werth specifically distinguishes rational suicide from aid in dying, and he offers several different definitions of rational suicide. In essence, they seem to reflect Jerome Motto's criteria for a rational suicide: the act must be based on a realistic assessment of the person's life situation, and the degree of ambivalence about it must be minimal. Rational suicide could occur with or without the assistance of a physician.

The ability to prolong life in the face of many terminal illnesses has led to public concern about the process of dying, the method of dying, and the degree to which a person may have control over how he or she lives and dies. Contemporary Perspectives on Rational Suicide raises many questions and provides some answers. In the end, however, any of us who have worked with patients know that the answers are never simple. We live and we die with personal histories and values, in a social context, amid political and economic realities. Intensity of pain and severity of disability alone do not determine the decision to live or to die. This book provides a vehicle for compassionate clarification of some of the often not so readily apparent factors that affect that decision.

Dr. Slaby is clinical professor of psychiatry at New York University and New York Medical College and past-president of the American Association of Suicidology.

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Andrew Edmund Slaby; Contemporary Perspectives on Rational Suicide. Psychiatric Services. 2000 Oct;51(10):1323-1323.

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