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The Last Word

For Wesley Smith, author of Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder, the circumstances surrounding the death of Jana Van Voorhis provide a chilling example of a movement running amuck.

"This is the secret that a lot of media has not reported much on," says Smith, an attorney whose opinions on assisted suicide, bioethics and myriad other topics have appeared in some of the world's most influential publications.

"Assisted suicide is not about terminal illness. That's a pretext, in terms of the political fight to get people to accept the concept."

Smith suggests that "none of us know what our limits are or how we might react to pain or what mental illness might do to us, which is why when someone is suicidal, the rest of us have an even greater obligation not to accept that person's definition necessarily."

He is unabashedly judgmental "about people who, pursuant to their own ideology, would facilitate these kinds of things, because a lot of people who could be helped, instead will be dead. I frankly think some of the people get off on this."

Smith's passion reflects the controversial nature of the hot-button topic. Clearly, good thinkers on all sides of the endless debate on assisted suicide seem to find themselves at each other's throats (metaphorically, at least most of the time) before too long.

It's not a new story: Suicide itself (forget assisted suicide) has raised ethical, legal, and religious issues for centuries.

The ancient Greeks considered it morally acceptable to commit suicide if you no longer considered your life to be worthwhile.

But in English common law, suicide was a felony punishable — no kidding — by burial in the public highway with a stake driven through the body and forfeiture of one's goods to the crown.

The stigma of suicide may have abated somewhat in our culture these days (no more stakes into dead people, and some families now at least try to come to grips with self-inflicted deaths of loved ones).

Still, it remains one of the most grievous sins for Catholics and many Christian denominations — "a grave injustice toward Him," as the Catholic Encyclopedia puts it.

Like Wesley Smith, Jacob Appel, a New York City-based bioethicist, has written extensively about assisted suicide.

Most recently, Appel wrote for the May-June issue of Hastings Center Report, considered the nation's most prestigious bioethics journal.

Appel analyzed a momentous ruling by Switzerland's highest court early this year that put mental illness on the same level as physical illness in terms of assisted suicide.

Since 1942, Swiss law has allowed anyone to help another person commit suicide as long as a physician has been consulted and the motives are not malevolent.

"It must be recognized that an incurable permanent serious mental disorder can cause similar suffering as a physical disorder, making life appear unbearable to the patient in the long term," the Swiss court wrote.

The judges noted that "a distinction has to be made between a death wish which is an expression of a curable, psychiatric disorder and which requires treatment, and a death wish based on a person of sound judgment's own well-considered and permanent decision which must be respected."

The case was brought by a suicidal 53-year-old man suffering from severe manic depression who wanted to acquire a lethal dose of phenobarbital without a doctor's prescription.

It isn't clear from news accounts whether the depressed man has done himself in.

Appel argued in his article that assisted suicide can be a rational decision by those suffering from psychological illnesses.

"If the offer is that an effective treatment may eventually be found but a person will have to suffer for some decades more until that happens," Appel writes, "then it might still be rational to prefer suicide."

Appel, by the way, is a professor at Brown University, a licensed attorney, an oft-published playwright, and is currently completing medical school. According to his Web site, he also is a licensed tour guide in New York City (in his spare time).

He tells New Times that the many nuances of the Jana Van Voorhis case raise cutting-edge questions.

"We don't know, in this case, whether, on the one hand, this woman was delusional — believed she had disorders she didn't have," he says, "or on the other hand, claimed to have disorders she didn't have in order to achieve an end she wanted, namely assisted suicide, or some mix in-between."

Appel says the Van Voorhis case "demonstrates why, if you're going to have some form of assisted suicide, you probably want it in the context of the medical system and people who are capable of making these evaluations and licensed to do it. That's because very well-meaning people who take someone at their face value could do a grave disservice to them and to the community."

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Paul Rubin
Contact: Paul Rubin