Argument

The argument that legalization of assisted suicide changes

clinicians' perceptions of the problems of terminal illness is
addressed through several examples in which patients' clinical
presentation is evaluated differently if assisted suicide is
available. The point of this argument is that legalization is likely
to have an independent effect in shaping not only clinicians' and
societal views, but also on the expectations of patients. One
example of this effect on perceptions is on the assessment of
depression and suicidality, covered in a chapter by Harvey
Chochinov and Leonard Schwartz. This example is also discussed
by other contributors, who note a different standard applied to
depression and suicidality in terminally ill patients than to those in
the general population. In the terminally ill, they argue,
depression and suicidal thinking are seen as an inherent part of
terminal illness, not as problems to be treated. For that reason the
rate of referral for psychiatric treatment is much lower in the
terminally ill than in the general population. Suicidality is
effectively normalized, setting a different standard than that
otherwise applying in clinical practice. In some of this discussion
there is a suggestion that suicidality is not only an accurate
predictor of mental illness, but that it is also evidence of
incompetence. More than one contributor suggests that suicidality
in the absence of terminal illness would be grounds for a
determination of incompetence and therefore for civil
commitment. However the relationship between suicidality,
mental illness and incompetence is by no means clear cut. In
studies of emergency psychiatry, suicidality is a less reliable
predictor of civil commitment than danger to others. There is
certainly no ready acceptance by psychiatrists that suicidal
thinking equates to incompetence. Nevertheless, Chochinov and
Schwartz ask important questions regarding depression in the
terminally ill, and especially of the possible effect on the
evaluation of depression under conditions of legalized physician
assistance. Given the high rate of depression in severe and
terminal illness, a low rate of referral for psychiatric evaluation is

of concern. The evidence presented in the book is consistent with

the psychiatric literature in arguing that negative thoughts,
including the wish to die, diminish with treatment of an underlying
mood disorder. Depression and its relationship to suicidal ideas is
one of a number of examples of where the drive for assisted
suicide is strengthened by less than optimum health care.
Here is my rationale about suicide, in general. Some may agree,
some not.
1. Suicide prevention has nothing to do with saving or even
helping the suicidal. It is 100% geared toward helping the
survivors and preventing anyone from feeling anger, failure
guilt or remorse about not dealing with the suicidal persons
needs. So, call up a hotline. They read from a script, and try to
pawn you off onto a counselor after they try to guilt you about
how other people in your life will feel. And they try to do this in
25 minutes or less. If you call and are expecting someone to really
talk to, youll be (un)pleasantly surprised how quickly they try to
box you in and wrap up the call, but not before making a pact
not to hurt yourself. That eases their minds, not your pain.
2. Guilt about leaving family or friends. You wouldnt be feeling
suicidal now if they were there in the first place, would you?
Again, if they try to interfere, its because they are the ones who
have to live with your death and whatever feelings of inadequacy
and shame that they feel. Thats their problem. Once again, its all
about trying to protect the survivor from feeling bad, not taking
into account ending your pain permanently.
3. The selfishness argument. Oh, people who kill themselves are
selfish. Moreover, they are cowards. Classy move. Lets project
ones feelings about the death and place the blame on the person
who is no longer here. Yes, in a way it is selfish. The depressed
person is finally standing up and doing something 100% for their
best interests. They probably didnt do that in life, so its shocking
to others that that person finally stood up for themselves. As for

coward? To admit that your life is meaningless, non-productive,

empty, and, and only bringing you pain, and then choosing to do
something about it is quite the opposite of cowardly. It takes a
brave person to admit enough is enough and step away from a
life going nowhere. Cowards stick around, spend a lifetime
suffering trying to make others happy because they didnt die and
leave them with a guilty conscience.
4.People who kill themselves are going to hell. Listen, not
getting into a religious argument here. Your beliefs are your
beliefs. But, the plain fact of the matter is(no matter what we
dont know what is going to happen when we die. Besides some
people claiming to have seen ghosts, no one has come back to
tell us what happens. Who knows what and how we will be judged
in the afterlife, if there even is one. On a personal note, everyone
have their own religion, and I believe that if the tales of God being
a just God are accurate, then He or she cannot fault someone
escaping pain and inflicting misery on others. But thats my belief,
I know many others are there. But until I see proof, I dont think
its right to project a possibility of torture onto someone who is
suffering. For many people out there, if there is a hell, its better
than what life is here.
5. The theres a light at the end of the tunnel argument. If
things were always going to get better, depression would be nonexistent. Sometimes, life just put us in trouble and its not going
to get better. Same for the if you love me, you wouldnt leave
me argument. If someone really loved someone, they wouldnt
be depressed and they would want them to be at peace.