Commentary on elger and hardingcan suicide be rational in persons who are not terminally ill?

Abstract

c c e a l M The accompanying article by Elger and Harding [1] bout whether a nonterminally ill suicidal patient should be ospitalized against her will is relevant to the ongoing ebate about the morality of physician acquiescence in uicide and of physician-assisted suicide (PAS). Whether AS ever is ethically justified, and under what conditions, if ny, it should be legal, depend upon several considerations. or example, some persons believe that assistance in hasening death, under any circumstances, represents a perverion of the doctor’s role, and should be prohibited on that round alone [2]. Others acknowledge that hastening death ay be ethical under certain conditions, but fear that legalzation would open the door to unpreventable abuse [3,4]. I hink that there are convincing reasons to reject both of hese arguments [5]. These objections to legalization are not onsidered by Elger and Harding, however, and will not be iscussed further here. A central concern with regard to the ethics of PAS is hether and, if so, when, suicide can be a rational act. sychiatrists are well aware of the strong association beween suicide and mental illness, including depression, subtance abuse and psychosis [6–8]. This association supports uch contemporary psychiatric practice; i.e., active interention, even to the point of involuntary hospitalization, to ave the lives of acutely suicidal persons. Yet a facile onclusion that every suicidal person is mentally ill is unarranted. Indeed, a major textbook of psychiatric ethics efers confidently to “rational suicide”, and states (perhaps vercategorically) that “no psychiatrist would consider orced hospitalization” for a terminally ill patient who has ade a “decision to die [which] is deliberate, authentic, and, n all likelihood, irreversible,” as well as consistent with the atient’s long-held values [9]. It is for patients such as hese that PAS has been legalized in Oregon [10]. In spite of