In the midsummer of 1999, Surgeon General David Satcher issued "The Surgeon General's Call to Action to Prevent Suicide 1999" in which he declared that suicide is "a serious public health problem." He wrote that, in 1996 (the last year for which statistics are available):

• There were nearly 31,000 suicides.
• There were about 20,000 homicides.
• Suicide was the ninth leading cause of death in the United States.
• Each year in the United States, approximately 500,000 people require emergency room treatment as a result of attempted suicide.

A version of the following article appeared in the August 3, 1999 edition of the Wall Street Journal.

SUICIDE NATION
By
Wesley J. Smith

Last week, with mental health maven Tipper Gore at his side, Surgeon General David Satcher, issued an urgent "Call to Action to Prevent Suicide." Suicide, Dr. Satcher wrote, is one of the country's worst public health problems. Approximately 31,000 Americans die annually at their own hands (compared with approximately 20,000 homicides per year).

Dr. Satcher bemoaned the appalling statistic that between 1952 and 1996, the number of suicides among adolescents and young adults, tripled. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. Suicide strikes elder Americans especially hard. Nearly 18 kill themselves each day, with the highest rate being among white American males, aged 65 or older.

Unfortunately, Dr. Satcher's campaign faces an uphill battle. The United States is growing increasingly pro-suicide and suicide promotion is ubiquitous.

Consider, for example, the deleterious impact the euthanasia movement is having on the nation's belief in the inherent value of all human life and the insidious message sent to suffering people when suicide is extolled as "death with dignity." Recall also that Derek Humphry's book, Final Exit, which taught people how to commit suicide with drugs and a plastic bag, became a national best seller.

Humphry is nothing compared to the assisted suicide icon and murderer Jack Kevorkian, who, if public opinion polls are to be believed, is a very popular man despite, or better stated because, he helped kill about 130 suicidal people. The media elite certainly approves of him. Mike Wallace and Larry King are fans and Time magazine feted him at its 75th Anniversary party where actor Tom Cruise rushed up to shake his hand.

When it comes to suicide, America is Dr. Jeckyl and Mr. Hyde. Oregon voters legalized assisted suicide for people diagnosed with a terminal illness, but when local newspapers run headlines about the state's soaring suicide rate among adolescents, nobody connects the dots. Such willful "compartmentalization" isn't restricted to Oregonians. Some newspapers that have editorialized in favor of legalization of physician assisted suicide, also favor implementing Satcher's 15-point prevention plan.

Dr. Satcher also failed to address the growing belief among many bioethicists, psychiatrists, psychologists, and social workers that mental health professionals do not have a duty to prevent all suicides. Instead, they divide suicide into two categories: "rational" and "irrational."

Under this theory, which is all the rage in mental health circles, professionals only have a duty to attempt to stop "irrational suicides," e.g. those based on impulse or which are relatively frivolously based. If the suicidal person has a "rational" basis for self-destruction, however, the professional's duty to the patient is to nonjudgmentally help sort out the pros and cons of self-destruction and assist the patient in the use of proper decision-making techniques. If the suicide is then deemed rational, the mental health professional is to do nothing to impede the patient's death. Indeed, some advocates believe that the proper response of the professional in such cases is to help the patient die.

The exact definition of rational suicide is still being worked out among its adherents in the professional literature and at mental health symposia. But a rough consensus has already been crafted. James L. Werth, Ph.D., one of the nation's foremost proponents of the concept, has written that a decision kill oneself, in his parlance, "to suicide" (he uses the term as a verb), should be viewed as "rational" if the patient has a "hopeless condition." Werth's definition of hopeless condition, "includes but is not limited to terminal illnesses, sever physical or psychological pain, or mentally debilitating or deteriorating conditions, or a quality of life that is no longer acceptable to the individual."

But that could include almost everyone with a significant suicidal ideation. If someone wants to die, by definition, they don't they find their quality of life acceptable. If Werth's concept becomes widely practiced, it could amount to a program of death-on-demand for nearly anyone with more than a transitory desire to die.

What is truly alarming is that proponents of rational suicide are respected mainstream academics and clinical practitioners, professionals who treat suicidal people or teach those who do. More worrisome still, Werth recently reported that 80 percent of respondents from the American Psychological Association's Division of Psychology and other equally prestigious mental health associations supported his definition of rational suicide and a five-step process he created for determining whether the patient's suicide decision making processes are "sound." An appalling 85 percent of survey respondent's believed that a mental health professional who follows Werth's published guidelines would be acting ethically.

If Dr. Satcher really wants to run an effective campaign against suicide, he is going to have to confront the euthanasia and assisted suicide movements. And he is going to have to forthrightly warn Americans that they face a crucial choice about the nation's cultural future.

Shall we view self-killing as a terrible tragedy that devalues human life or, as Derek Humphry has it, as the "ultimate civil right?" Do we want to be a society that embraces the value of each and every one of us or do we accept the nihilistic notion, that some of our lives can be deemed not worth living and subject to rational self extermination?

Until we sort all of this out, the Surgeon General's warning is so much dust in the wind.

Author, Wesley J. Smith, is an attorney for the International Task Force on Euthanasia and Assisted Suicide. His most recent book is Culture of Death: The Destruction of Medical Ethics in America, (Encounter Books, 2000).