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    Michael E. Holtby, LCSW, BCD


Because of my work with HIV/AIDS I have developed an expertise in mental health evaluations of what is commonly known as rational and physician-assisted suicide requests, and assisting clients who are considering this type of option. Because of articles I have written both in my column Shrink Rap, and professional journals on this subject I am frequently asked to speak on this topic. I have presented at a number of regional and national conferences, and in the coming months will present at the University of Colorado Medical School in May; the AIDS, Medicine & Miracles Conference in June; at the University of Plymouth in England in July with the prominent researcher in this area, Russell Ogden, M.A.; and at the University of Maryland in September.

In 1996 I testified before the Colorado State Legislature on physician-assisted suicide, and participated (albeit a small contribution) in the preparation of an amicus brief when the U.S. Supreme Court reviewed this issue in January of 1997. I am also on the Mental Health Advisory Board for the Hemlock Society, and presented at their National Conference in the Fall of 1996 with James Werth, Ph.D., the foremost researcher on mental health standards.

My position on this subject is that physician-assisted suicide needs to be legalized, in part to prevent the health care professional's abandoning patients seeking a hastened death. I have seen instances when this occurs and family members attempt to help -- and yet, as research by Russell Ogden, M.A. and Stephen Jamison, Ph.D. has shown a high percentage of these cases are tragic failures. They leave the individual alive, but crippled, or loved ones forced to consider becoming more actively involved, ie. smothering the patient to carry out his wish to die. If physicians could remain involved such violence and tragedy would not occur.

I believe that there is a need for a mental health evaluation to determine competency and rule out such conditions as depression, and dementia. And there needs to be a criteria which makes physician-assisted suicide acceptable in instances where the individual is already close to dying of an irreversible condition. I must emphasize that I am not an advocate of assisted dying per se but rather an advocate of an individual's right to self-determination. I would equally fight for an individual's right to continue to live, if that was their wish. However, as I have seen with AIDS, cancer, and ALS, patients should have a right to choose to die with dignity. In these cases it is not a matter of whether they die but how and when.

For further information about my views on this subject please refer to the following articles from the Shrink Rap column:

"AIDS' Impact on the Right-to-Die Movement"

"Dignity Dead In Committee"

"Self-Deliverance as a Security Blanket"

"Assisted Suicide -- Gone Wrong"

"Advanced Medical Directives"

"Fear of Dying"

"Death by Euphemism"

For further information contact:


The Hemlock Society

ERGO! Euthanasia Research & Guidance Organization

Choice In Dying

And read the following books:

    Stephen Jamison (1996). Final Acts of Love: Family, Friends & Assisted Suicide. N.Y.: Putnam & Sons.

This is the book to read if you are an individual considering the option of rational suicide or you are a family member. Dr. Jamison has probably interviewed more people who have gone through the experience than anyone. He offers practical advice, and helps you think through all the complex implications of such an act.

    Shavelson, Lonny. (1995) A Chosen Death: The Dying Confront Assisted Suicide. NY: Simon & Schuster.

I highly recommend this book by a physician and journalist. He interviews in detail a number of people considering self-deliverance -- some of whom follow through, others who, in the end, do not. The book includes a good discussion of all the issues involved but is personalized with the case studies.

Werth, James. (1996) Rational Suicide? Implications for Mental Health Professionals. Washington D.C.: Taylor and Francis.

This book outlines research in which Dr. Werth asked a number of ethicists, philosophers and mental health professionals under what circumstances they would consider suicide rational. From their responses Dr. Werth developed a ground breaking criteria which serves as a guide for mental health evaluations. His criteria was used by a psychiatrist screening one of Dr. Kevorkian's patients.

    Angell, Marcia (1997, Jan.2) "The Supreme Court and Physician-Assisted Suicide -- The Ultimate Right." The New England Journal of Medicine, Vol. 336, No.1, pp. 50-53.

    Foley, Kathleen (1997, Jan2) "Competent Care for the Dying Instead of Physician-Assisted Suicide." The New England Journal of Medicine, Vol. 336, No.1, 54-56.

This is a balance point-counterpoint set of articles which deftly presents the arguments for and against physician-assisted dying



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.