Death on Demand: The Assisted-Suicide Movement Sheds Its Fig Leaf.(Jacob Appel's article on the assisted suicide for mentally ill patients)

Should laws against assisted suicide be rescinded as "paternalistic?" Should assisted suicide be transformed from what is now a crime (in most places) into a sacred "right to die"? Should assisted suicide be redefined from a form of homicide into a legitimate "medical treatment" readily available to all persistently suffering people, including the mentally ill?

According to Brown University professor Jacob M. Appel, the answer to all three of these questions is an unequivocal yes. Writing in the May-June 2007 Hastings Center Report ("A Suicide Right for the Mentally Ill?"), Appel argues that assisted suicide should not only be available to the terminally ill, but also to people with "purely psychological disease" such as victims "of repeated bouts of severe depression," if the suicidal person "rationally might prefer dignified death over future suffering."

Given the emphasis assisted suicide advocates and the media normally give to the role of terminal illness in the assisted suicide debate, it might be tempting to dismiss Appel as a fringe rider. But he most definitely is not. Over the last several years, advocacy for what is sometimes called "rational suicide" has been growing increasingly mainstream, discussed among the bioethical and academic elite in mental health publications, academic symposia, and books. Indeed, it is worth noting that Appel's essay appeared in the world's most prestigious bioethics journal.

As disturbing as Appel's proposal isit is essentially a call for death-on-demandit is refreshing that Appel has written so candidly. After years of focus group-tested blather from the political wing of the euthanasia movement claiming that legalizing assisted suicide would be strictly limited to the terminally ill, we finally have a clearer picture of where the right-to-die crowd wishes to take America.

Moreover, unlike a restricted right to assisted suicide, Appel's call for near death-on-demand is logically consistent. There are two weight-bearing intellectual pillars that support euthanasia and assisted suicide advocacy: (1) a commitment to a radical individualism that includes the right to choose "the time, manner, and method of death" (often called "the ultimate civil right" by assisted suicide aficionados); and (2) the fundamental assumption that killing is an acceptable answer to the problems of human suffering.

Appel describes these conjoined beliefs succinctly as the "twin goals of maximizing individual autonomy and minimizing human suffering" by avoiding "unwanted distress, both physical and psychological" through creation of a legal right "to control ... when to end their own lives."

Hoping to whistle past the graveyard, some might dismiss all of this as mere theoretical posturing. Were it so. Assisted suicides for the mentally ill are already taking place in euthanasia-friendly locales.