Behavioral
Emergencies Update
Spring
2001
In this issue...
Section VII Programming at APA Convention
Debate on End-of-Life Issues:
Dr. Yufit Comments on Dr. Werth Interview
Reply to Dr. Yufit
Dr. Kleespies Comments on Yufit-Werth Exchange
New Center for the Study and Prevention of Suicide
A
Reply to Dr. Yufit
James L Werth, Jr., PhD
University of Akron Member
I am glad that some of my comments inspired a letter and I appreciate the chance to clarify a few things so that readers of Dr. Yufit’s reaction do not leave with misperceptions of my position. My comments are brief so I encourage anyone who has questions or wants citations to contact me (jwerth@uakron.edu).
After re-reading the section of the interview to which Dr. Yufit refers, I am unsure why he made some of his statements. Perhaps we are talking past each other because he is thinking about “traditional suicide” (i.e., irrational, impulsive, linked to mental illness, etc.) and I was talking about a person with a terminal illness whose judgment is not impaired and who wants to take an action that will hasten death (e.g., withhold or withdraw treatment, take medication a physician prescribed for the purpose of causing death, voluntarily stop eating and drinking) while in the midst of irremediable suffering. Unfortunately, the labeling of end-of-life decisions as suicide seems to be the crux of many disagreements because of the negative connotations associated with a behavior that is labeled “suicidal.”
I also need to make it clear that I have never advocated that mental health professionals do the following:
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Passively allow suicide
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Assist a person to complete a suicide
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Allow a depressed, pessimistic, hopeless person under stress to make an irrational decision, which is irreversible
Just because I believe that there is the possibility that a decision to hasten death may be the result of a sound decision-making process by a person whose judgment is not impaired does not mean that I would sit back and encourage (let alone assist) anyone to take action that may lead to death. In fact, I have consistently advocated for thorough evaluation of all end-of-life decisions.
Further, the assessment I recommend in such situations is more thorough, time-intensive, and lengthy than will be found elsewhere in the literature (see Appendix F of the Report to the Board of Directors by the APA Working Group on Assisted Suicide and End-of-Life Decisions for an example of the approach I suggest evaluators take; http://www.apa.org/pi/aseolf.html). This comprehensive assessment of the person’s life will allow for screening out those individuals whose desire to die is prompted by factors such as depression or hopelessness while also respecting a decision to hasten death if the person’s choice is well-reasoned (as measured by the holistic assessment outlined in the Report).
On a related note, Dr. Yufit states that although he would not interfere with a person and his or her loved ones making a decision that “assisted suicide” would be the best option, he could not be involved in the decision-making process. I respect that Dr. Yufit is aware of his values and would be able to be forthright with the dying person. I, however, would want to be professionally involved in such a situation so that I could help the person and the loved ones make sure that “assisted suicide” truly is the best option. I would want to do the assessment I alluded to above in order to see if there was a way to improve the person’s, and his or her loved ones’, quality of life. Maybe, if we find something that can be ameliorated, the person will change his or her mind or delay implementing the decision; but, maybe not. In any event, I think that I, as a mental health professional, have a great deal to offer in such a critical situation.
I cannot close without also commenting on a misperception expressed by Dr. Yufit about the resolution recommended by the APA Working Group that was then passed by the APA Council of Representatives. The resolution is not for a “neutral” position. In fact, when we were drafting the resolution we explicitly rejected such a stand (see the Jan., 2001 Monitor, pp. 68-69). I do not have the space to explain the entire lengthy and intricate resolution (see Appendix E of the aforementioned Report for the draft version), but as was stated in the Monitor article, it is designed to allow psychologists “to explore and shed more light on the issues involved” (p. 69). Further, because suicide prevention was not the issue at hand, any attempt to connect the resolution with a position about this important topic is unwarranted.
I know these brief remarks cannot respond fully to the statements made by Dr. Yufit, so I hope that there will be an opportunity for us, and others, to enter into a dialogue in order to find areas of agreement and clear up areas of misinterpretation.