In Western thought, suicide has evolved from sin to sin-and-crime, to crime, to mental illness, and to semilegal act. A legal act is one we are free to think and speak about and plan and perform, without penalty by agents of the state. While dying voluntarily is ostensibly legal, suicide attempts and even suicidal thoughts are routinely punished by incarceration in a psychiatric institution. Although many people believe the prevention of suicide is one of the duties the modern state owes its citizens, Szasz argues that suicide is a basic human right and that the lengths to which the medical industry goes to prevent it represent a deprivation of that right. Drawing on his general theory of the myth of mental illness, Szasz makes a compelling case that the voluntary termination of one’s own life is the result of a decision, not a disease. He presents an in-depth examination and critique of contemporary antisuicide policies, which are based on the notion that voluntary death is a mental health problem, and systematically lays out the dehumanizing consequences of psychiatrizing suicide prevention. If suicide be deemed a problem, it is not a medical problem. Managing it as if it were a disease, or the result of a disease, will succeed only in debasing medicine and corrupting the law. Pretending to be the pride of medicine, psychiatry is its shame.

Physician-Assisted Death is the eleventh volume of Biomedical Ethics Reviews. We, the editors, are pleased with the response to the series over the years and, as a result, are happy to continue into a second decade with the same general purpose and zeal. As in the past, contributors to projected volumes have been asked to summarize the nature of the literature, the prevailing attitudes and arguments, and then to advance the discussion in some way by staking out and arguing forcefully for some basic position on the topic targeted for discussion. For the present volume on Physician-Assisted Death, we felt it wise to enlist the services of a guest editor, Dr. Gregg A. Kasting, a practicing physician with extensive clinical knowledge of the various problems and issues encountered in discussing physician assisted death. Dr. Kasting is also our student and just completing a graduate degree in philosophy with a specialty in biomedical ethics here at Georgia State University. Apart from a keen interest in the topic, Dr. Kasting has published good work in the area and has, in our opinion, done an excellent job in taking on the lion's share of editing this well-balanced and probing set of essays. We hope you will agree that this volume significantly advances the level of discussion on physician-assisted euthanasia. Incidentally, we wish to note that the essays in this volume were all finished and committed to press by January 1993.

Part of the authoritative Oxford Textbooks in Psychiatry series, the new edition of the Oxford Textbook of Suicidology and Suicide Prevention remains a key text in the field of suicidology, fully updated with new chapters devoted to major psychiatric disorders and their relation to suicide.

Fatal Freedom is an eloquent defense of every individual’s right to choose F a voluntary death. By maintaining statutes that determine that voluntary death is not legal, Thomas Szasz believes that our society is forfeiting one of its basic freedoms and causing the psychiatric medical establishment to treat individuals in a manner that is disturbingly inhumane. Society’s penchant for defining behavior it terms objectionable as a dis­ease has created a psychiatric establishment that exerts far too much influ­ence over how and when we choose to die. In a compelling argument that clearly and intelligently addresses one of the most significant ethical issues of our time, Szasz compares suicide to other practices that historically began as sins, became crimes, and now arc seen as mental illnesses.

A concise review of current research into suicide providing a guide to understanding this disease and its increasing incidence globally.

Thomas Szasz wrote over thirty books and several hundred articles, replete with mordant criticism of psychiatry, in both scientific and popular periodicals. His works made him arguably one of the world's most recognized psychiatrists, albeit one of the most controversial. These writings have been translated into several languages and have earned him a worldwide following. Szasz was a man of towering intellect, sweeping historical knowledge, and deep-rooted, mostly libertarian, philosophical beliefs. He wrote with a lucid and acerbic wit, but usually in a way that is accessible to general readers. His books cautioned against the indiscriminate power of psychiatry in courts and in society, and against the apparent rush to medicalize all human folly. They have spawned an eponymous ideology that has influenced, to various degrees, laws relating to mental health in several countries and states. This book critically examines the legacy of Thomas Szasz - a man who challenged the very concept of mental illness and questioned several practices of psychiatrists. The book surveys his many contributions including those in psychoanalysis, which are very often overlooked by his critics. While admiring his seminal contribution to the debate, the book will also point to some of his assertions that merit closer scrutiny. Contributors to the book are drawn from various disciplines, including Psychiatry, Philosophy and Law; and are from various countries including the United States, Canada, New Zealand, United Kingdom and the Netherlands. Some contributors knew Thomas Szasz personally and spent many hours with him discussing issues he raised in his books and articles. The book will be fascinating reading for anyone interested in matters of mental health, human rights, and ethics.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

With recent studies using genetic, epigenetic, and other molecular and neurochemical approaches, a new era has begun in understanding pathophysiology of suicide. Emerging evidence suggests that neurobiological factors are not only critical in providing potential risk factors but also provide a promising approach to develop more effective treatment and prevention strategies. The Neurobiological Basis of Suicide discusses the most recent findings in suicide neurobiology. Psychological, psychosocial, and cultural factors are important in determining the risk factors for suicide; however, they offer weak prediction and can be of little clinical use. Interestingly, cognitive characteristics are different among depressed suicidal and depressed nonsuicidal subjects, and could be involved in the development of suicidal behavior. The characterization of the neurobiological basis of suicide is in delineating the risk factors associated with suicide. The Neurobiological Basis of Suicide focuses on how and why these neurobiological factors are crucial in the pathogenic mechanisms of suicidal behavior and how these findings can be transformed into potential therapeutic applications.