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EUTHANASIA & ASSISTED SUICIDE.
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Definitions, types, prevalence, gender, age groups, motivations, causes, legal issues, living wills, role of health care professionals.... More...
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Paper Abstract:
Definitions, types, prevalence, gender, age groups, motivations, causes, legal issues, living wills, role of health care professionals.
Paper Introduction:
EUTHANASIA AND ASSISTED SUICIDE
Introduction
The issue of assisted suicide has been brought to the forefront of public attention in the United States largely through the activities of Dr. Jack Kevorkian (Ferraiuolo, 1994, p. 78). Long before Jack Kevorkian became a public figure, however, the Hemlock Society was advocating a person's right to make a choice about her or his own death the individual's right to die (Byock, 1991, pp. 51 66).
Definitions and Types of Suicide
Further complicating the issue of the right of an individual to make decisions concerning her or his own death is the confusion introduced into the debate through attempts to equate an individual's right to die with euthanasia. Euthanasia is most
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Singleton, K. N. I., & Sadock, B. Informed consent: An ethical dilemma havinglife/death and legal implications. Suicide rates for the elderly (as defined for this research, age 66 orolder) also vary by sex and race. 93). A. Vol. R. Jury acquits Dr. Kevorkian ofillegally aiding a suicide. (199 ). In the wake of the 199 Supreme Court decision allowing thediscontinuance of life support for Nancy Curzon, health care providers arebeing forced to reconsider their positions toward patient right and familyrights generally and to living wills particularly (Keyser, 1992, pp. (1992). Grant, K., & S. Keyser, P. (199 b). The American Medical Association,however, remains "vehemently opposed to assisted suicides" (Gianelli, 1994,p. Countries with suicide rates lower than 12. The significance of Nico Speijer's suicide:How and when should suicide be prevented? 514). Boyle, L. A1). (1992). Deans Notes, 12(2), 1-2. HospiceJournal, 7(4), 51-66. Thus, the very idea of a right todie or the right to refuse care is difficult for many health care providersto accept, much less become an advocate for a patient in suchcircumstances. 215). Thedecisions of health care professionals to permit death are amalgams ofmedical, ethical, and legal judgments. 76). L. Rational suicide among older adults: Acause for concern? The rate for black females increases from childhood through age34, after which it decreases through age 44, when it begins to increaseonce again and continues to increase through age 64, when the rate againbegins a decline which continues through all successive ages. Hospital administrators and legalcounsel, by contrast, out of fear of an exposure to legal liabilitytypically attempt to limit the rights of patients and their families. 311-322). In such situations, the nursemust act as the advocate for the patient (Broom, 1991, pp. P. (1994, 12 October). Keyser (1992, pp. J. The rate for black males increases from childhood throughage 34, after which it decreases through age 64, when it begins to increaseonce again. (1993). (1993). (1993, August). 1-5). A., R. (1993, March). A similar initiative was defeated, alsonarrowly, in California in 1992. Dever, & T. 168-175; Shook, 1992, pp. Kelner, M. 23-25). 2 -2294, 327-334. These issues include considerations of apatient's right to die (Laben, 199 , pp. 1 6-11 ). The oncology nurse's role in patient advancedirectives. (1994, 14 February). Whatthese ostriches cannot see from their disadvantaged perspectives is that inthe evolving contemporary society a refusal to accommodate patient rightsin itself will expose health care institutions and providers to legalliability. The trend among all healthcare professionals, however, appears to be shifting. Advance care directives: Counseling the patient andfamily in the primary care setting. References Allen, A. Baltimore: The Williams and Wilkins Co. 22-25). Thisproposal is ludicrous because, after an individual has thoughtfullyconstructed a living will at a time of emotional stability and unduephysical pressures, the suggestion is now made that the same individual berequired to take a test or complete a survey form while on her or his deathbed. This culture is the pattern of individualattitudes and orientations among the members of both the nursing professionand the larger society of which the profession is a part. J., & Bourgeault, I. To beable to act as an advocate for the patient, the nurse must be able andwilling to overcome her or his own individual value-based objections to apatient's right to die or to a patient's right to refuse further treatment. Surveys indicate that a majority of nurses favor active assistance forterminally ill patients desiring to die. Living wills generally apply in the context of terminalillness or irreversible coma (Grant and Huntington, 1989b, p. (1993). Dimensions of Critical Care Nursing,1 (3), 16 -168. (1992). Journal of Advanced Nursing, 15(12), 1358-1362. Gianelli, Diane M. Sri Lanka's other killing ground. A living will is recognized under thislegislation as a part of a patient's decision-making rights (Boyle, 1992,pp. For all females, the suicide rate increases from childhood through age54, after which the rate declines through all successive ages (Bureau ofthe Census, 1993, p. (1986). The Prevalence of Suicide For all age groups, the suicide rate in the United States is 12.8persons per 1 , thousand population (Bureau of the Census, 1993, p.4 2). (1989). St. Hussey, T. American Medical News, 37(6), 3, 27. Grant, K., & S. The be able to deal effectively with the complex issues associatedwith patient autonomy, the nurse must be capable of identifying the threatsto that autonomy, and the nurse must be able to respond effectively as anadvocate for the patient (Singleton and Dever, 1991, pp. In the initiative campaign in Washington,Roman Catholics and Fundamentalist Christians acted without scruples in thepurposeful misinterpretation of the specifics and intent of the initiativewording. In addition to thosereasons indicated above, suicide in the elderly may be higher than forother age groups because of a widening social acceptance of the concept ofthe rational suicide for those individuals in the advanced stages ofterminal illnesses, with serious and incurable physical illnesses, andthose experiencing debilitating pain, with no recourse for relief whichwould leave then as alert and viable human beings (Evans and Farberow,1993, p. Health care decision making:Choices for incapacitated patients. 58-62). (1994, 3 May). 1271-1276). There are many people, organizations, and religious groups inthis country who strive to prevent suicide by the elderly, regardless ofthe circumstances involved. By contrast,the rate for white females increases from childhood through age 54, afterwhich it decreases through age 74, when it begins another increase throughage 84, after which it declines through all successive ages. Depression in older adultsis often accompanied by anxiety borne of repressed resentment and rage.Depression in older adults is often induced by a sense of uselessness.Contemporary studies have also indicated that depression in older adultsresults from a sense of powerlessness on their part (Rodin, 1986, pp. Euthanasia is most often defined as painless putting to deathpersons suffering from incurable diseases or other types of incurable andintolerable health conditions. 4 2). 37-49) suggestion smacks of one more effort toput a roadblock in the path of patient autonomy. 38. Decisions to discontinue intensive therapy.Intensive Care Nursing, 4(3), 1 6-111. Patients areseeking autonomy and self-determination through the use of living wills(Flaray, 1991, pp. 4 3). Theabsurdity of such laws lies in the inability of the state to punish theperson who is successful in committing suicide. Ferraiuolo, Perucci. Living wills are not a new concept. To be an effective patient advocate, the nurse must not permit her or hisreligious beliefs to interfere with the nursing duty to the patient.Strong value systems are essential for health care providers. Assisted Suicide and the Law Suicide is prohibited by law in all states in the United States. Human Life Review,2 (1), 112-122. LosAngeles: The Hemlock Society. Polls indicated strong public support for theinitiative. 25-27). 335-342). International Journal of Nursing Studies, 3 (4), 311-322. Yarling, R. The professional nurse in the 199 s must confront the issues ofa patient's right to die and assisted suicide. (1993). Conversely, the majority of American experts continue to holdthat suicide among the elderly and terminally ill should be preventedregardless of the circumstances involved (Heilig, 1993, pp. Dever, (1991). 2 -2294,335-342. 1. While the professional nurseis dealing with these provocative issues, he or she must sweep away theconfusion purposefully introduced into the public discussion by thereligious opponents of the concepts, while simultaneously dealing with heror his own personal value system that may cause her or him abhor eitheract, and attempting to balance the responsibilities of a nurse to assist apatient regardless of personal philosophical predilections. Juries in Michigan, however, continue to acquit Dr. Kevorkianfor such acts (Margolick, 1994, p. Definitions and Types of Suicide Further complicating the issue of the right of an individual to makedecisions concerning her or his own death is the confusion introduced intothe debate through attempts to equate an individual's right to die witheuthanasia. Thus, thevery idea of a right to die or the right to refuse care is difficult formany health care providers to accept, much less become an advocate for apatient in such circumstances. -to-19.9 persons per 1 , population),along with such countries as Bulgaria, Canada, Czechoslovakia, Norway,Poland, Sweden, and Germany. 157-161). 37-49). Shook, M. Clinical Nurse Specialist, 2(3), 157-161. Singer. 1-2) to adhering to physicians'"do not resuscitate" orders (Yarling, 199 a, pp. (1994, January-February). Heilig, S. Medicaleducation and socialization focus on offering and providing treatment, asopposed to the facilitation of death. Suicide should always be prevented. This position has been accepted by courts in theNetherlands. The intellectuallybankrupt opponents of the right of an individual to make decisionsconcerning her or his own death, however, extent their flawed argument evenfurther by contending that, regardless of who makes the decisions regardingan individual's death, if the individual asks and receives assistance tocommit suicide, then the assisting individual is practicing euthanasia.This latter contention has served as the basis for religiously-orientedpublic prosecutors in Michigan who have laid charges against Dr. Kevorkianfor the assistance he has provided to persons deciding to end their ownlives (Margolick, 1994, p. Oncology Nursing Forum, 19(6), 891-896. (113th ed.). Nevertheless, health careproviders, physicians and hospitals specifically, more often than not havethwarted patient wishes on the pretexts that living wills fail to provideclear and convincing evidence of a patient's desires. Moral dilemmas in nursing research. The prosecutors have consistently failedin their efforts to send Jack Kevorkian to prison for these acts. The professional nurse in the 199 s must confront the issues of apatient's right to die and assisted suicide. (1991). Rethinking the nurse's role in "do notresuscitate" orders. Doctor-assisted suicide in legal in the Netherlands. Nursing ethnics and Project 2 . Conflict resolution strategies: When ethicaldilemmas evolve into conflict. New York: Oxford University Press. The decisionsof health care professionals to permit death are amalgams of medical,ethical, and legal judgments (Dubler, 1993, pp. Dubler, N. R. Michigan was one of the state without a specific law coveringproviding assistance to a person in committing suicide. Ethics innursing: An anthology, National League of Nursing Publication No. (6th ed.). 36). Bellocq, J. There appears to be noend to the efforts that will be made by the opponents of the concept ofpatient autonomy to impede that autonomy in pursuit of their own valueagenda or power preservation. This approach to therelationship between euthanasia and an individual's right to die suffers,however, from a lack of intellectual honesty. In this context, many elderly persons have indicatedclearly that they no longer want to be burdens, and want to end their liveswith dignity and grace while they are still aware and alert human beings(Portwood, 1983, p. In numbers ofdeaths, as opposed to rates per 1 thousand population, somewhat less than3, persons in the 15-19 age group commit suicide each year, while morethan 6, aged 66 and older commit suicide each year (Bureau of theCensus, 1993, p. Oregonian (Portland),B1. Conclusion The issues of an individual's right to die and assisted suicide wereexamined. Nurse Practitioner Forum, 3(1), 12-15. Margolick, David. 112-122). New Jersey and New York share the lowest statesuicide rates (7.6), while the highest state rates are found in Nevada(24.1) and Montana (21.7). A., & R. The encyclopedia of suicide. C. 3). An initiative legalizing assisted suicide was defeated narrowly in theState of Washington in 1991. Durable power ofattorney: Nursing implications. The practice hasbeen legal for years, and there are no reported instances of abuse of thelaw (Kuhse and Singer, 1993, pp. While the nominalresponsibility for such decisions is that of physicians, other health careprofessionals and members of hospital establishments contribute to suchdecisions. Deadly compassion. Journal of Nursing Administration, 21(11), 16-22. R. Donner, (1992). Moore, S. Following thefailure of Michigan juries to convict Dr. Kevorkian for such acts, thestate legislature and the governor rushed through legislation making theprovision of assistance for the purpose of committing suicide a crime inthat state. Comprehensive textbook ofpsychiatry/VI. Singleton, K. The rate for whitefemales is 5.9, while that for black males is 11.1. Depression is possibly the most serious of the psychological problemsthat are faced by older adults (Kelner and Bourgeault, 1993, pp. Aging and health: Effects of the sense of control.Science, 233, 1271-1276. As a leading cause of death, suicide ranks thirdfor persons in the 15-24 age group, while it ranks only 14 for persons aged66 and older (Evans and Farberow, 1993, p. Roman Catholic Archbishop William Levada in Portland termedthe initiative "murder in the name of mercy" (quoted in Legal, 1994, p.B1). It is thesubjective realm that underlies and give meaning to nursing actions. 78). American Journal ofPublic Health, 93(1), 23-25. 41-46). A1). Nurse Practitioner Forum, 3(1), 25-27. Health care decision making:Legal and ethical principles. 1358-1362). 311-322; Zimbleman, 1994, pp. Advanced directives: In search of self-determination. Paul, Minnesota: GreenhavenPress, 58-62. In the United States, the suicide rate varies not only by age group,but also by sex, race (white/black), and geographic region.Geographically, the suicide rates in New England, the Middle Atlanticstates (with a rate of 9.1 persons per 1 , population, the lowestsuicide region in the country), and the East North Central states are lowerthan the national rate of 12.8 persons per 1 thousand population, whilethe West North Central states, the South Atlantic states, the West SouthCentral states, the Mountain states (with a rate of 18.7 persons per 1 thousand population, the highest suicide region in the country), and thePacific states are higher than the national rate, and rate for the EastSouth Central states is the same as the national rate (Bureau of theCensus, 1993, p. Yarling, R. Rodin, J. (1992). Huntington, (1989a). Brooke, P. Dimensions of Critical Care Nursing, 1 (6),354-363. The relentless advance of medical technology assures that thepressures on health care providers will continue as the means to maintainbiologic life far surpass the health care professional's ability to protectthe quality of a patient's life (Allen, 1991, pp. EUTHANASIA AND ASSISTED SUICIDE Introduction The issue of assisted suicide has been brought to the forefront ofpublic attention in the United States largely through the activities of Dr.Jack Kevorkian (Ferraiuolo, 1994, p. Social Science and Medicine,36(6), 757-765. Johnson, M. Someof these American experts, however, are now beginning to distinguishbetween death with dignity for the terminally ill individual and suicideand other individuals desiring to end their lives. The issues surrounding suicideby teenagers and healthy, non elderly adults are not within the scope ofthis examination.Among the many reasons why the suicide rate is so high forthe elderly, say experts, is the isolation and loneliness that leads todespair, also boredom, depression, uselessness, loss of loved ones,economic hardships, general feeling of unhappiness with life, and personswho suffer from a psychological affliction, from loss of purpose and asense of meaningfulness after retirement and separation from family andfriends (Evans and Farberow, 1993, p. Common sense suicide: The final right. Dimensions of Critical CareNursing, 7(3), 168-175. (1994, Winter). A. 4 3). Nursing Clinics of North America, 24(4),1 41-1 5 . 12-15). These rates are as follows: Male Female ------------ ------------ White Black White Black Total ----- ---------- ----- ----- 66-75 years 37.6 16.1 7.7 2.8 19.7 76-85 years 58.9 16.2 8. Nurses, however, are increasingly beingasked and expected to assume such advocacy roles (Bellocq, 1988, pp. Final exit: A wake-up call to hospice. (2nded.). Portwood, D. (1986). L. 23-25). Nurses are in the best position of all health care providers toprovide the counseling required by patients in situations wherein livingwills are applicable (Towers, 1992, pp. Dimensions of Critical Care Nursing, 11(1),41-49. After Curzon: The "values base" to advancedirectives. The enactment of the Patient Self-Determination Amendment requiresthat facilities funded through either the Medicaid or Medicare programsinform patients of their decision-making rights related to health care(Dimond, 1992, pp. Legal suicide on the ballot. Kuhse, H., & P. 51-66). (1991). Dimond, E. McElmurry, B. The highest suicide rate is for white males (22.3),while the lowest rate is for black females (2.3). Ethics in nursing: An anthology, National League ofNursing Publication No. Nurses may also be expected to become involved in controversies amonghealth care professionals on how a particular living will should beinterpreted (Dunaway, 1988, pp. Archives of Psychiatric Nursing, 7(2), 1 6-11 . Diekstra, R. J., & Zabroki, E. 327-334). The American Medical Association,however, remains opposed to assisted suicides. Journal ofAdvanced Nursing, 15(12), 1377-1382. Livingwills provide a means by which patients and families may describe theirwishes and set forth legal guidelines for nurses and physicians (Bellocq,1988, pp. Dunaway, P. 22-37). 168-175). R. Huntington, (1989b). (199 ). Byock, I. Motivations to End One's Life Within the context of this examination, decisions related to anindividual's right to end her or his life and the assistance provided tosuch individual's to effect such decisions are considered in relation toterminally ill persons and elderly persons. 1377-1382). 891-896). (1993, April). Certainly, not all people agree with thisposition. Considered only in this very generalcontext, the act of a person opting to commit suicide in some painless wayto escape an intolerable health condition could be viewed as a form ofeuthanasia. (1983). Views and Concerns of Health Care Professionals That nursing is based on a moral foundation is recognized (Yarling,199 b, pp. The counseling provided bynurses in such instances should assist patients in understanding andapplying their own values, as opposed to an attempt by the nurse to changepatient values. The nurse, with a traditional role that is patient-centered,must counsel the patient and the patient's family, and where requiredbecome an advocate for the patient. The moral foundation of nursing. R. Bureau of the Census. Thecomponents include cognitive orientations, affective orientations andevaluative orientations, or, in other words, judgments and opinions aboutfactors involved in the process of nursing. (1992, 28 November). Because suicide isprohibited by law, however, many states also specifically prohibitproviding assistance to help someone commit suicide, and even in thosestates where specific legal prohibitions are not in place, other statutesare used by prosecutors to lay charges against persons assisting others tocommit suicide. (1992). W. *2 .8 * less than .1 The above rates compare to the suicide rate for the 15-19 year old agegroup (the so-called teen suicide epidemic) of 1 .2 persons per 1 thousand population (18.2 for white males, the highest in this age group,and 2.1 for black females, the lowest in this age group). Journal of Post Anesthesia Nursing, 6(2), 15 -151. K. Nurse Practitioner Forum, 3(1), 3 -34. (199 ). Balancing life and death. Surveys indicate that a majority of nurses favor active assistance forterminally ill patients desiring to die (Kuhse and Singer, 1993, pp. (1993). (1991). 16 -168). While the professionalnurse is dealing with these provocative issues, he or she must sweep awaythe confusion purposefully introduced into the public discussion by thereligious opponents of the concepts, while simultaneously dealing with heror his own personal value system that may cause her or him abhor eitheract, and attempting to balance the responsibilities of a nurse to assist apatient regardless of personal philosophical predilections. 3 -34). The professional obligations of nurses demand thatnursing personnel have a grasp of the ethical bases of their profession(Hussey, 199 , pp. Suicideattempts are particularly troublesome among older adults, because, unliketeenagers attempting suicide, the older adult attempting suicide probablyreally does want to end her or his life, and probably will succeed (Kaplanand Sadock, 1993, p. Society is being required by such individualsto collectively confront the issue of whether suicide can be a rationalchoice for such persons (Moore, 1993, pp. 1 6-111). Zimbleman, Joel. Suicide and Life-ThreateningBehavior, 16(1), 1-5. One issue within this context concerns theefficacy and feasibility of the relating of natural sociology and moralquestions within the nursing context (Johnson, 199 , pp. Good life, good death, andthe right to die. While this legislation establishes the right of the patient tomake decisions related to personal health care, the legislation fails toprovide legal immunity for the nurse and other health care providersassociated with advice provided to the patient with respect to suchdecisions (Brooke, 1988, pp. Orthopaedic Nursing, 11(5), 37-49. F. Nurses, however, are increasingly being asked and expectedto assume such advocacy roles. Physician Assistant, 13(6), 93, 96, 98. Keyser's (1992, pp. New York Times, A1. Health decisions: Maintaining control of health carechoices. For all males, the suicide rate increases from childhood through age34, after which the rate declines through age 44, when it begins toincrease once again, and continues to increase through all successive ages(Bureau of the Census, 1993, p. 15 -151). (1988). 354-363), andmust assist patients in making informed decisions (Grant and Huntington,1989a, p. Statistical abstract of the UnitedStates. 42). Studies have indicated that older adults "are commonly subject todepression" (Kaplan and Sadock, 1993, 263-264). The reasons behind thisapparent anomaly is the susceptibility of older persons to so many moreserious diseases and health conditions which affect few teenagers. By contrast, the rate for white males increases from childhoodthrough age 24, after which it decreases through age 54, when it begins toincrease once again. Euthanasia implies that some party other than the individual who is todie makes the decision concerning how and when that individual should die.The essence of the concept of the right to die, however, is that suchdecisions are made by the individual who is to die. Individuals suffering from diseases that are at one incurable,painful, and led to a loss of personal dignity are frequently motivatorsfor an individual to decide on a course of suicide--assisted or unassisted(Marker, 1994, pp. The practice of nursing takes place within a culture (McElmurry andZabroki, 1989, pp. The pattern is different for white and blackfemales. 1 41-1 5 ). For males in the United States, the suicide rate is 19.3 persons per1 , population, while the rate for females is only 5.1 (Bureau of theCensus, 1993, p. This approach to the issue is favored by Roman Catholics andFundamentalist Christians opposed to the concept of an individual's rightto make decisions concerning her or his own death. The nurse, therefore, is in asituation wherein he or she must be prepared to advocate patient autonomy,while simultaneously providing assurance to the patient that any caredesired by the patient will continue to be provided. 37-49) has advanced a ludicrous proposal to require patients to complete a so-called value history form to provide clear and convincing evidence ofpatient's wishes regarding advance directives such as living wills. Legal issues related to the right to die:implications for nursing education. At the same time, patients often worry thatadvanced directives such as living wills may foster abandonment by healthcare providers (Dubler, 1993, pp. Ethical concerns in caringfor older women in the community. Legal implications of the Patient Self-Determination Act. Physician Assistant, 13(7), 76, 78, 8 -82. Towers, J. L. In November 1994, a similar initiative was placed before Oregonvoters (Legal, 1994, p. B1). In Rohr, J.Death and dying: Opposing viewpoints. The challenge of autonomy:Respecting the patient's wishes. Patient control overdying: Responses of health care professionals. Nurses in the 199 s, as is true of all health care professionals, arebeing confronted with an array of issues that contain moral dimensions(Clarke, 1991, pp. L. Journal of Professional Nursing, 1 (1), 22-37. S. 333). Controversy surrounds the concept of a patient's right to die and theexercise of that concept through the use of a living will. In 195 , thesuicide rate in Sri Lank was 6.5 per 1 , . 757-765).Depression in older adults often results in suicide attempts. Marker, Rita. Flaray, D. Laben, J. Natural sociology and moral questions in nursing:Can there be a relationship? 23-25). The pattern is different for whiteand black males. In a class by themselves are Hungary and Sri Lankawith suicide rates of 44.1 persons per 1 , population and 47 people per1 , thousand population respectively (Sri, 1992, p. Clarke, J. This rate places the United States in the middle range of countrieswith respect to suicide (12. Long before Jack Kevorkianbecame a public figure, however, the Hemlock Society was advocating aperson's right to make a choice about her or his own death--theindividual's right to die (Byock, 1991, pp. Those countries withsuicide rates of 2 . Medicaleducation and socialization focus on offering and providing treatment, asopposed to the facilitation of death (Dubler, 1993, pp. The relentless advance of medicaltechnology assures that the pressures on health care providers willcontinue as the means to maintain biologic life far surpass the health careprofessional's ability to protect the quality of a patient's life. NursePractitioner, 4(4), 22-25. (1991). (1988). Right to die, freedom of choice, and assisted death:Implications for nurses. 4 3). Voluntary euthanasia and thenurse. (199 a). Z. Evans, G., & Farberow, N. 4 4). (1994, 8 April). Broom, C. Living Wills As An Alternative A living will is a written and witnessed advanced directive thatcommunicate a patient's care preferences (Singleton, Dever, and Donner,1992, pp. The living will. Economist, 325,38. Washington: United States Government Printing Office. Controversy surrounds the concept of a patient's right to die and theexercise of that concept through the use of a living will. 16-22). 2.6 25.2 86 years + 66.3 17.9 5. Such valuestructures, however, must not be permitted to diminish the quality of careprovided. K. Kaplan, H. Minister embraces "Dr. persons per 1 , population include Australia, England and Wales, Italy,the Netherlands, New Zealand, Portugal, Scotland, and Spain with the lowestrate of all--4.8 persons per 1 , population. persons per 1 , or higher include Austria,Belgium, Denmark (with a rate of 26.9 persons per 1 , thousandpopulation, the highest among this group of countries), Finland, France,Japan, and Switzerland. (1991). Euthanasia group wooingdoctors. (1988). A growing number of sociological and medical experts outside of theUnited States are moving toward acceptance of the concept of the rationalsuicide for the elderly person, as long as such choices are free-willdecisions, the individual's physical or emotional pain may be described asunbearable, the wish to die can be identified as an enduring one, and theindividual at the time of the suicide decision is compos mentis (Diekstra,1986, pp. Death."Christianity Today, 38(4), 78.
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