I would like to share a few thoughts on physician-assisted suicide. A year ago I retired after 40 years in the private practice of psychiatry and have often thought of the dilemma that physician-assisted suicide would pose to psychiatrists.

Approximately 75 percent of my practice consisted of people dealing with depressive illnesses. I have no idea how many of these patients actually wanted to end their lives, but suicide was certainly a commonly expressed thought and desire. It is, of course, the hopelessness that they feel that leads them to consider suicide to end their suffering. If their depression becomes severe enough that they enter a psychotic phase, they begin to believe that their suicide would be in the best interests of their family in particular and everyone in general.

If physician-assisted suicide came to be an accepted practice, there would be many requests from family physicians to psychiatrists to evaluate patients seeking assisted suicide and determine whether they had a depressive illness for which adequate treatment would relieve them of their wish to end their life. This would surely test the diagnostic acumen of psychiatrists and place a heavy burden on them because they would be making clearly delineated life-and-death decisions. Even worse would be the situation in which a treating physician did not request a consult from a psychiatrist.

In the normal course of psychiatric practice we all run into cases of depressed patients who, for reasons that may not be apparent to us, can't seem to improve. If these patients request physician-assisted suicide, should we go along with it? I think not. I recall the case of a severely depressed man who simply continued to be severely and dangerously depressed despite everything I could recommend to him. He was transferred to another psychiatrist's care, and to my amazement he made a quick and complete recovery.

After struggling with suicidal threats by my patients for so many years, and seeing many suicidal patients improve and lead productive lives, I find it difficult to believe that psychiatrists should be directly involved in assisting suffering people to end their life. This is too large an ethical jump for this old doctor.

Robert Dale Jones M.D.
Omaha, Neb.

(Psychiatric News, April 4, 1997)