This is an interesting read. I got a little stuck on Chapter 1, which was very competent on ethics, but it reminded me of Wittgenstein saying that philosophy ‘leaves everything as it is’: 21 pages to establish that ‘suicides in the elderly can be both rational and ethically justifiable’. Nevertheless, it usefully set out criteria for what might count as rational in this regard, which were then put to the test in Chapter 2. The authors also used the sad case of Gillian Bennett, who had dementia and took her own life, to bolster their arguments. They quote Gillian Bennett writing about her ‘mindless body’, her carers looking after her ‘carcass’ and of her being a ‘vegetable’; and they talk of her ‘being bodily alive but lacking a self’. They do not, however, question whether it is reasonable to talk this way about people with dementia. Many of us involved in dementia care would like to argue it is not. Of course, the view that you can live well with dementia can be contested, and many people do not live well; but it may be that things – the psychosocial environment – could be improved so that suicide would look less rational than it did to Gillian Bennett.
There is a brief foray into the law, mostly American, Sallowed by a very interesting chapter on refractory depression. It raises questions about when we should give up and let our patients, like their counterparts with physical illnesses not responding to treatment, say enough is enough. Chapters follow on ageism and the effects this might have on demands for suicide, on anthropology (the cultural context is always an issue) and a stimulating chapter on the meaning of life. The effects of the Baby Boomers as a cohort on the demand for rational suicide is not something I had considered previously.
The second half of the book covers demographics, psychological issues, psychodynamics and the psychotherapies in relation to rational suicide. A chapter on spirituality and religion is suitably penetrating in its analysis of mainly Christian teaching. The penultimate chapter suggests (in effect) that magic mushrooms might be the ‘cure’ for demands for suicide. But in many ways I thought the final chapter, by Anthony Daniels (one of only two authors from the UK), was the most elegant and thoughtful of all.
The editors of this book have done a sterling job. It includes very practical and sensible advice about how we should react to those who demand suicide seemingly on rational grounds. My one concern is this: although we are told that the proportion of suicides that are rational is very small, it is almost as if we are gradually talking-up the possibility of rational suicide rather than considering the many good reasons, set out in the book, to look harder at the potential causes (individual and social) of the inclination to a rational suicide. Even if it is rational, it may be an inclination equally rational to resist.
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