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Some have argued that all self-intended death, regardless of circumstances, is irrational, and this includes requests for assisted dying in the case of a terminal illness. Opponents have argued that studies of suicides, even those among the terminally ill, find that nearly all were suffering at the time from a definable psychiatric disorder. To begin with, it is easy to retrospectively interpret a now deceased patient’s prior statements of "hopelessness" as an indicator of depression, forgetting that terminal illness indeed is "hopeless" by definition. In addition, there are other serious problems with this rationality argument, not the least of which are methodological. Nearly all assisted deaths are never documented as suicides, but as natural deaths. Therefore, discovered suicides and assisted deaths are two very distinct populations. Simply, suicidologists never see rational suicide because those who are rational never see them. Moreover, acts of suicide and assisted dying are not comparable, because in the latter case death shortens the suffering of a life that could not continue for much longer under any circumstances.
Part of the problem here is our cultural attitude toward death that sees that life as the only rational choice. This suggests an approach to death that lacks both a spiritual and natural orientation, is rooted in fear, and fails to see that death can sometimes be welcomed as an inevitability. Although it is likely that man y requests for assisted deaths - and some assisted deaths that are completed - may be partially motivated by treatable depression or other causes.
Unfortunately, these will continue undiagnosed without options until a system of guidelines are in place that enable the decision-making process to be opened up to scrutiny, consulting opinions, and opportunities for therapeutic counseling.