TheSwiss Supreme Court recently ruled that people with mental illnessescan be legally assisted in suicide. The case came about when a memberof Dignitas, an organization, which, for a fee, provides a safe housefor—and assistance with—suicide, brought a lawsuit seeking the right todie. The man does not have cancer, AIDS or other physical illness, asthat term is popularly understood. Rather, he is depressed from bipolardisease. But this did not prevent the court from giving its imprimaturto his assisted suicide. According to the International Herald Tribune,the Swiss high court ruled, ‘It must be recognized that an incurable,permanent, serious mental disorder can cause similar suffering as aphysical (disorder), making life appear unbearable to the patient inthe long term.’

No one should be surprised bythe Swiss ruling. The two weight-bearing ideological pillars ofeuthanasia/assisted suicide advocacy—a radical individualistic notionof ‘self ownership’ and the deemed propriety of killing as anacceptable answer to the problem of human suffering—virtually compelthis result. After all, many people suffer more intensely and for farlonger than people who are dying. And, if ‘choice’ is the be all andend all of personal freedom, then who can gainsay a suffering person’sdecision to die? Hence, rather than being a radical extension ofassisted suicide ideology, the Swiss court decision is simply itslogical outcome.

Indeed, the Swiss court isnot the first to issue such a ruling. More than ten years ago, theDutch Supreme Court reached a strikingly similar conclusion in adecision interpreting the parameters of the Netherlands’ euthanasiaprogram.

The case involved the 1991 assistedsuicide of a depressed woman named Hilly Bosscher. After Bosscher’s twosons died, she became obsessed about being buried between them. Sheapproached the Dutch psychiatrist Boutdewijn Chabot, an assistedsuicide advocate, seeking his help in killing herself. Chabot met withher on four occasions, but did not attempt treatment. Instead,believing that she would never improve, he assisted Bosscher’s suicide.The Dutch Supreme Court subsequently approved, finding, like the Swisscourt after it, that the law cannot distinguish between sufferingcaused by physical illness and that caused by mental anguish.

TheseEuropean cases are consistent with ongoing advocacy among some Americanmental health professionals for the recognition of what is called’rational suicide’ or ‘permitted suicide.’ Under this view, if apatient is deemed by a psychiatrist or psychologist to suffer from a’hopeless illness,’ and if the patient has a sustained desire to die,the mental health professional is not duty-bound to engage in suicideprevention, and indeed, may even be permitted to facilitate a patient’sdemise.

This begs the question: What is ahopeless illness? The term has been defined broadly in mental healthliterature as ‘including but limited to people with: