End of life decisions and assisted suicide.

End of life decisions and hastened suicide are discussed following the passage of the Death With Dignity Act in Oregon in 1994. Case examples are presented including a vignette highlighting ethical issues. Arguments for and against suicide prevention are presented, and the pros and cons of rational suicide are detailed. The experience with physician-assisted suicide in the Netherlands is briefly presented, and it is noted that in rare cases physician-assisted suicide is permitted for individuals in the Netherlands suffering primarily from mental disorders. The role of the mental health professional in end of life decisions is discussed along with a description of the proposed work of the recently established American Psychological Association working group on assisted suicide and end of life decisions.