SHOULD LAWS AGAINST assisted suicide be rescinded as "paternalistic?" Should assisted suicide be transformed from what is now a crime (in most places) into a sacred "right to die"? Should assisted suicide be redefined from a form of homicide into a legitimate "medical treatment" readily available to all persistently suffering people, including to the mentally ill?

According to Brown University professor Jacob M. Appel, the answer to all three of these questions is an unequivocal yes. Writing in the May-June 2007 Hastings Center Report ("A Suicide Right for the Mentally Ill?"), Appel argues in that assisted suicide should not only be available to the terminally ill, but also to people with "purely psychological disease" such as victims "of repeated bouts of severe depression," if the suicidal person "rationally might prefer dignified death over future suffering."

Given the emphasis assisted suicide advocates and the media normally give to the role of terminal illness in the assisted suicide debate, it might be tempting to dismiss Appel as a fringe rider. But he most definitely is not. Over the last several years, advocacy for what is sometimes called "rational suicide" has been growing increasingly mainstream, discussed among the bioethical and academic elite in mental health publications, academic symposia, and books. Indeed, it is worth noting that Appel's essay appeared in the world's most prestigious bioethics journal.

As disturbing as Appel's proposal is--it is essentially a call for death-on-demand--it is refreshing that Appel has written so candidly. After years of focus group-tested blather from the political

Moreover, unlike a restricted right to assisted suicide, Appel's call for near death-on-demand is logically consistent. There are two weight-bearing intellectual pillars that support euthanasia and assisted suicide advocacy: (1) a commitment to a radical individualism that includes the right to choose "the time, manner, and method of death" (often called "the ultimate civil right" by assisted suicide aficionados); and (2) the fundamental assumption that killing is an acceptable answer to the problems of human suffering. Appel describes these conjoined beliefs succinctly as the "twin goals of maximizing individual autonomy and minimizing human suffering" by avoiding "unwanted distress, both physical and psychological" through creation of a legal right "to control . . . when to end their own lives."

HOPING TO whistle past the graveyard, some might dismiss all of this as mere theoretical posturing. Were it so. Assisted suicides for the mentally ill are already taking place in euthanasia-friendly locales. Indeed, nearly every jurisdiction that has legalized assisted suicide for the seriously ill--as well as those that have refused to meaningfully enforce anti-assisted suicide laws--has either formally expanded the legal right to die to those suffering existentially, or shrugged in the face of illegal assisted suicides of the depressed. To wit:

Switzerland: In February, the Swiss Supreme Court ruled that the mentally ill have a constitutional right to assisted suicide, because, as reported in the International Herald Tribune, "It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term."