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Book Review   |    
Contemporary Perspectives on Rational Suicide
Andrew Edmund Slaby, M.D., Ph.D.
Psychiatric Services 1999; doi:
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edited by James L. Werth, Jr.; Philadelphia, Brunner/Mazel, 1999, 236 pages, $64.95

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The recent conviction of Dr. Jack Kevorkian for second-degree murder has brought into bold relief the continuing controversy surrounding physician-assisted suicide. However, the controversy seems less related to prevention of suicide, despite the unfortunate term "physician-assisted suicide," than it is to ethical, religious, and philosophical issues about what is humane care for dying patients. Only a very small percentage of those who die by what may be construed by some as suicide die with a terminal illness. Most of those who kill themselves suffer from treatable psychiatric disorders that if recognized early and managed, would obviate the desire to die by self-inflicted means.

People who die by suicide do not want to die. They merely wish to end the pain. Hopelessness, more than depression, predicts who dies by suicide. If there were other means to end the pain, those who commit suicide would seek the other means. Only a few of those who commit suicide are free of the veil of depression that distorts and dictates choices that would not be elected if they truly acted rationally.

Rational suicide is not synonymous with physician-assisted suicide, as this interesting book edited by James L. Werth explains. It is quite separate, and issues surrounding it should not be confused with those devolving on humane care of the terminally ill.

The book consists of 30 chapters, 28 of which are creatively paired presentations by major figures in various academic and professional disciplines discussing arguments for and against rational suicide. The book cleverly seduces the reader by two forewords, one by Derek Humphry, founder of the Hemlock Society, juxtaposed with one by one by Rita L. Marker, executive director of the International Anti-Euthanasia Task Force. Subsequent chapters pair philosophers of the stature of Margaret Battin and Daniel Callahan, religious leaders, sociologists, attorneys, death or grief counselors, nurses, physicians, psychiatrists, psychologists, social workers, death educators, disability-rights advocates, gerontologists, and survivors. Chapters vary in quality and content, but each raises issues that help to clarify distinctions between humane caring for the terminally ill and rational suicide.

The power of the book for those with an academic, personal, legal, ethical, or clinical interest in the subject is its demonstration that resolution of the controversy is not simple and will never be without some ambiguity. This sentiment is summed up by Richard R. Ellis, founding board member of the Association for Death Education and Counseling, who wrote the chapter entitled "Counselors and Rational Suicide: Voices From the Opposition." In the words of Oscar Wilde quoted at the beginning and the end of his chapter, "Truth is rarely pure, and never simple," and "For every complex problem there is a simple, direct solution—and it is wrong." Amen.

Dr. Slaby is professor of psychiatry at New York University and New York Medical College in New York City.

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