Advocates of physician-assisted suicide have focused attention on a very small group of competent, terminally ill patients in uncontrollable pain. Efforts by many to improve the quality of pain management will hopefully shrink the size of this group still further.
The question we will be primarily concerned with in this chapter is what would be the effect of the availability of physician-assisted suicide on the frequency of suicide in other groups, for example, terminally ill patients who are not in pain, patients with nonterminal diseases, or psychiatric patients?
Unfortunately, it is naive of advocates of physician-assisted suicide to think that guidelines will be able to create a special permission for certain patients while continuing to provide the same suicide prevention as usual for others. The availability and the sanction of physician-assisted suicide would forever change the relationship between any suicidal person and his helpers. It would alter the family and friends’ reactions to the suicidal person as well as the nature of any psychotherapy that he might undertake.
If many of our efforts to prevent suicide are currently successful, what would happen if these efforts were weakened, or even, in some cases, reversed? What would happen if, in some cases, we were to provide technical help and social support for suicide?
Thoughts of suicide are not at all uncommon. As cited by Goldman and Beardslee (1999) in a recent review, it has been estimated that 10–15% of all teenagers have contemplated suicide (p. 442).