When The Last Choice was first published in 1990, I felt the book was timely; now I feel it was somewhat ahead of its time. I agreed then with Margaret Battin's dust-jacket comment that suicide would "replace abortion as the social issue" of the 1990s, and seven years into the decade, she's certainly been proven right. But the focus of public debate hasn't been suicide per se; it's been physician-assisted suicide as an alternative to slow and agonizing death. While we've seen considerable "right to die" and "death with dignity" activism, professional, public, and media interest in physician-assisted suicide hasn't yet extended to the broader issue of elective death in general, nor in particular to what I introduced in the first edition as preemptive suicide in advanced age.

The idea of preemptive suicide, of self-destruction as an unforced anticipatory option as opposed to suicide forced by actual circumstances, remains disturbing to many. Consider that even such ardent supporters of the right to die as Derek Humphry and Jack Kevorkian haven't pressed the cause of preemptive suicide. Humphry, who at the time was head of the Hemlock Society, made it clear in his review of The Last Choice that his concern is limited to affording people the opportunity to end lives that are already irredeemably jeopardized. Humphry's much-read and much-debated Final Exit is a manual devoted to curtailment of the process of dying . . .