Reply to Lokhandwala and Westefeld.

Abstract

Abstract Lokhandwala and Westefeld's article highlighting the ethical dilemma in rational suicide raises the pragmatic question of how one would actually assess a client's situation. A particularly relevant diagnosis that should be ruled out is clinical depression. The DSM-IV lists nine symptoms of major depressive disorder, eight of which could easily be masked as symptoms of the physical illness or side effects of treatment. These symptoms can be grouped into three categories: central features of depression, physical signs of depression, and cognitive signs of depression. All three of these categories, particularly physical signs, could easily be mistaken for medical problems. Reviewing the nine criteria for a diagnosis of clinical depression might be a good way to explore the possibility of clinical depression in a terminally ill person who is supposedly making a “rational” decision to commit suicide.