Sherwin Nuland (1993), in his powerful book, How We Die, has spoken of the “rescue credo of high-tech medicine” (p. 253). He uses this terminology to refer to the devoted physicians who are uncompromising in their fight against injury and disease. When patients are terminally ill and at death’s door, however, the restorative and curative drive of high-tech medicine needs to give way. The Karen Ann Quinlan case is the prototypical example of such a scenario, and the Patient Self-Determination Act of 1991 was a clear statement of the nation’s wishes in this regard.

I would suggest that there is also a rescue credo for professionals who wage a determined fight to prevent suicide, and Dr. Robert Yufit is deservedly considered in their ranks. These are deeply committed people who are prepared to assail any suggestion that our commitment to this cause be weakened.

At this point, I think that I have read a good deal of and have a reasonable understanding of Dr. Werth’s work. In no way did I see his comments in the last issue of this newsletter as suggesting that we, in any way, reduce our efforts to prevent suicide that stems from mental illness. To the contrary, he encouraged Section VII members to lobby Congress for funding for suicide prevention and mental health services. I read his remarks as clearly referring to the terminally ill who are competent, not afflicted with a mental disorder, and suffering intolerably from physical disease. These are patients for whom pain management has failed (unless one wishes to put the patient into a permanent state of sedation) and for whom the comfort of hospice is inadequate. It is not that they see no options; it is that dying could, in fact, be their best option. What can future time perspective mean to such a patient?

Physicians have quietly helped to end the suffering and hasten the deaths of patients such as these for centuries. Sigmund Freud was one such patient. This, of course, is not to argue that assisted suicide should be institutionalized or legalized in this country. Such an event could have many undesirable ramifications, and I did not hear Dr. Werth advocating it in his newsletter remarks.

Clearly, very learned professionals have taken very strong ethical positions on both sides of this issue. I believe that is why the American Psychological Association and the American Association of Suicidology made the very wise decision to neither endorse nor oppose assisted suicide. Their language was not “wishy-washy”. The issues involved are far too complex, do not lend themselves to easy answers, and should not be brought to closure prematurely.

Reference: Nuland, S. (1993). How we die: Reflections on life’s final chapter. New York: Vintage Books.