Spiegelman’s interview with Dr. James Werth (“Graduate Student
Spotlight”) in the Fall 2000 issue of Behavioral Emergencies Update
inspired a lively debate about end-of-life issues. Following are
comments from Dr. Bob Yufit, a response from Dr. Werth, and concluding
comments from Dr. Phil Kleespies.
I want to
respond to the
interview conducted by Student Representative Jason Spiegelman
with James Werth, PhD, in the previous (Fall 2000) issue of Behavioral
to a question, Dr. Werth indicates that a psychologist’s role should
be a "duty to assess" (the situation) as opposed to a "duty to prevent"
I do strongly
agree that there is a duty to assess, and the psychologist is in
the most unique position to provide such an assessment, even though
our assessment tools need to be more refined and focused. (In the
same Newsletter issue, our Past President, Dr. Phil Kleespies, bemoans
the absence of psychologists in such situations, and this should
be corrected, as we do have much to offer in terms of both assessment
strongly disagree with Dr. Werth's opinion that if the stress of
the situation cannot be improved, it "would be inappropriate for
me to intervene to prevent the person from following through with
his or her well-reasoned decision to hasten death..." I have devoted
over 30 years of my professional life to the diagnosis and treatment
of suicidal persons and have yet to find a "well-reasoned" decision
by a suicidal person. Suicide is not a rational act, which is why
the term "rational suicide" is an oxymoron. The suicidal person
typically suffers from highly constricted thinking. Alternative
options are almost always available, and certainly should be presented
by the therapist. To passively allow a suicide to occur is simply
wrong, in my considered opinion. We should not allow a depressed,
pessimistic, hopeless person make an irrational, irreversible decision.
pain and suffering of a terminally ill patient is often offered
as a compassionate reason for assisted suicide. I do feel that physicians
need to apply better pain management to ease suffering, and that
hospice should be better utilized to offer comfort to the dying
patient and their family. However, passive allowance of assisted
suicide is not an acceptable professional role for any mental health
provider. In the case of a suffering patient with an irreversible
terminal illness, I would not interfere with a family making this
decision on their own; however, I could not be a party to this decision,
and if asked for my professional judgment, I would indicate that
I could not approve.
in my opinion, would be the attempts to legalize assisted suicide.
The “slippery slope” clearly applies here, as was crudely exemplified
by the work of Kevorkian under the guise of “compassionate care.”
Legalization of assisted suicide would give the wrong message to
suicide-prone persons that we approve of such behavior, and many
younger suicidal patients in treatment have raised this issue. I
believe any such laws to legalize assisted suicide would create
confusion for suicidal persons, as we try to expand their constricted
horizons of the present and the future (we are expanders and not
shrinks!) Assisted suicide is against the law in 49 of 50 states.
Some of my
greatest professional satisfaction has been derived from calls and
letters from suicidal persons, after therapeutic treatment, expressing
their gratitude for being helped to decide to live. Once the patient
comes to see us, there is usually enough ambivalence about their
decision to die that we can show them a reason to live, and in fact,
have the professional duty to do so. Once a future time perspective
is developed (it usually does not exist, or exists only in a negative
framework for most suicidal persons), options are developed, and
life can be viewed in a broader perspective. Building some realistic
hope and trust can do wonders for many patients. I have seen this
happen many times. So, I would say "yes" to assess, but to assist,
we should desist.
an article in the March/April 2001 The National Psychologist, the
American Psychological Association Council of Representatives, after
intensive discussion, narrowly approved a policy in February that
states that it “neither endorses nor opposes assisted suicide at
this time.” One representative, Dr. James Bray, reportedly termed
the language “wishy-washy.” Some council members feared that a position
of neutrality could be interpreted as an endorsement of the issue.
I would hope that both the APA and the American Association of Suicidology
would give up their neutral positions and take a stronger stand
on prevention of all suicide, including assisted suicide. The AAS
mission, which I helped formulate in 1990, is “to understand and
prevent suicide...” I look forward to further considering these
issues on the APA Advisory Panel.
this issue are most welcome. I would especially like to hear other
contrary viewpoints (as well as support) on this important matter.
Robert I. Yufit, Ph.D. President, Section VII Past President, American
Association of Suicidology, Illinois Association of Suicidology