One of America’s leading bioethics journals features a strong argument for assisted suicide for the mentally ill in its latest issue. Jacob M. Appel, a short story writer and lawyer who writes on bioethics, contends in the Hastings Center Report that "the principles favouring legal assisted suicide lead logically to the extension of these rights to some mentally ill patients". In Switzerland this is already the case. In November last year the high tribunal in Lausanne set down guidelines for people with "incurable, permanent, severe psychological disorders" who want to terminate their own lives.

Mr Appel argues that that victims of depression or psychosis can make a rational choice about whether to end their lives, though given "the finality of a life-terminating decision", the bar for assessing competence should be set higher. "If the values championed by assisted suicide advocates are maximimisation of autonomy and minimisation of suffering — even when they conflict with the extension of life — then it follows that chronically depressed, competent individuals would be ideal candidates for the procedure," he asserts.

However, this could place psychiatrists in a particularly difficult situation, he warns. At the moment, contemporary psychiatry is committed to suicide prevention. Hence a psychiatrist would have to choose between acceding to a patient’s legitimate request and the unreasonable standards of his colleagues. To get around this, Appel suggests the use of "full-time thanatologists [a specialist in death] specially trained for the act".

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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