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Suicide: Right or Wrong? (second edition)
  1. Tim Helme
  1. Consultant Psychogeriatrician, Margate, Kent

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    Edited by John Donnelly, Amherst, New York, Prometheus Books, 1998, 335 pages, £14.99 sc.

    John Donnelly is a professor of philosophy at the University of San Diego in California. This volume is one of a series on contemporary issues of topical public interest ranging, for instance, from animal experimentation: the moral issues, to sexual harassment: confrontation and decisions. There is a separate title in the series on Euthanasia: The Moral Issues edited by the series editors, Robert Baird and Stuart Rosenbaum. This one deals specifically with the subject of suicide.

    After a comprehensive introduction, the book is set out in three parts. Part one: some historical background contains nine chapters with a careful selection of contrasting viewpoints, both ancient and modern. Seneca and St Thomas Aquinas, Hume and Kant, give way to a more parochially American perspective in the recent contributions. An interview with Jack Kevorkian is balanced by an article by Herbert Hendin, professor of psychiatry and Director of the American Foundation for Suicide Prevention. There is a chapter by Joseph Fletcher, the situation ethicist, and another by Celeste Fremon, based on an interview with Bruno Bettelheim, the child psychologist, shortly before his suicide. The section is closed by a report of the Council on Ethical and Judicial Affairs of the American Medical Association on physician-assisted suicide.

    Part two: when do we call it suicide? includes six chapters which attempt to clarify the limits of the concept. This is no easy task, and Donnelly's own definition, which he describes as “somewhat tentative” runs to a sentence of almost two hundred words. A paper by William Tolhurst includes an interesting distinction between strong and weak intentions, with the assertion that suicide must be strongly intentional. One by Suzanne Stern-Gillet on the rhetoric of suicide contains a discussion of the 1981 IRA hunger striker, Bobby Sands, and the manipulation of the concept for political ends. R G Frey considers whether a death has to be self-inflicted to qualify as suicide. Terence O'Keeffe, in another study of deliberate self-starvation, distinguishes between genuine suicides, which he condemns absolutely from a religious perspective, and what he terms instrumental self-killings, which he regards as more ambiguous. Glenn Graber explores a definition of rational suicide, and Joseph Kupfer links an appraisal of the definition of suicide with the next section on its moral interpretation.

    Part three: is suicide moral? Is it rational? is perhaps less philosophical in tone. It begins with an article by Edwin Shneidman taken from the American Journal of Nursing, which assumes that preventing suicide is inherently justified, and one by Thomas Szasz on the ethics of suicide, taking the opposite stance. Victor Cosculluela takes a less polar position. Milton Gonsalves elaborates a traditional theistic position against suicide, whereas David Holley explores and questions the relevance of the metaphor of divine property rights in the debate. Richard Brandt adopts a utilitarian position, whereas Philip Devine argues for the logical opaqueness of death, making utilitarian considerations unsatisfactory. Joyce Carol Oates decries the romanticising of suicide in the arts, denying the notion of death as liberation. Robert Weir provides a cautious defence of physician-assisted suicide in some cases. This section ends with a discussion of whether suicide is a right, with contrasting perceptions by Leon Kass and Margaret Battin.

    The second edition has been updated and expanded, and contains a new appendix with excerpts from the Supreme Court's 1997 decision on physician-assisted suicide. For the medical reader, the appendix is well worth the inclusion. For instance, Justice Stevens describes a patient's “interest in dignity, and in determining the character of the memories that will survive long after her death”, which seems to go beyond the judicial understanding in the Tony Bland case in England in which, in his persistent vegetative state, Tony Bland was deemed to have no interests of any kind.

    As an introduction to the subject of suicide for the general reader, or undergraduate student, this book has much to recommend it. It is scrupulously careful to be fair to opposing viewpoints and successfully maintains its philosophical detachment. It provides an eminently appropriate synopsis of the arguments. However, its very detachment may make it less useful for clinicians seeking ethical or moral discussions of more practical significance. We seldom see platoon commanders throwing themselves on grenades or submarines in danger of sinking, so moral critiques of more realistic examples may appeal more to our perhaps over-concrete minds.

    For my own part, I must leave with a confession. I was perplexed to read in the chapter on the Catholic view, a quote from St Thomas Aquinas that “whoever takes his own life, sins against God, even as he who kiss (sic) another's slave, sins against that slave's master … .” This curious juxtaposition of sex and violence provided what I felt were fascinating avenues for speculation on the Catholic mind. It only gradually dawned on me that it was merely a misprint.

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