This is essentially a guide on how to commit suicide, or alternatively, stage a ``safe'' suicidal gesture. Stone (who has studied pharmacology at George Washington University Medical School and the National Institutes of Health) offers little backgroundpersonal, occupational, educational, familial, religious, or otherwisewhich might help readers absorb this work into some kind of useful discussion. Stone does set out his basic premises: first, that it is each person's right to make decisions concerning his own death, and second, that most decisions to commit suicide are due to temporary problems and are therefore tragic mistakes.'' Stone goes on, in a pragmatic, almost cold-blooded, tone to set out an immense amount of information on suicide and attempted suicide. He delineates four groups of people who attempt to kill themselves: rational people facing an insoluble problem, usually fatal illness; those acting on impulse, temporarily miserableand often drunk; those who are irrational due to depression, schizophrenia, or alcoholism; and those who are making a desperate bid for attention or help. Stone also looks at issues around terminal illness and euthanasia. In Part II, he explains the following methods of killing oneself: asphyxia, cutting and stabbing, drowning, drugs, chemicals, poisons, electrocution, gunshot, strangulation, hypothermia, and jumping. He includes explicit instructions on how to go about each method, and what the likely physiological damage will be if the attempt fails. Difficult as all this is to take in, there is moreinformation on how to make a relatively safe suicidal gesture will certainly confound readers, as will descriptions of autopsy results and asides on the strange and various ways people hurt themselves. The technical information here is accurate. But to approach such a stunningly painful, morally loaded, politically hot subject constructively, we need more than information. We need to know who our guide is, how he has come to this place, how and why his view was formed. -- Copyright ©1999, Kirkus Associates, LP. All rights reserved.
I place suicide attempters in one of four groups: (1) Rational people facing an insoluble problem, generally a fatal or debilitating illness; (2) Impulsive people, frequently young, truly but temporarily miserable, sometimes drunk, who wouldn't even consider suicide six months later; (3) Irrational people, often chronically alcoholic, schizophrenic, or depressed; (4) People trying to make a safe gesture as a "cry for help" or to get someone's attention.
The first group---and most of us will eventually be in it---has, in my view, the right to decide the time, place, and manner of their death. It is clear that a competent person who really wants to kill him- or herself can almost always do so. However, seriously ill or physically impaired people often have both the greatest interest in, and least ability to carry out, suicide. I believe that they ought to have medical help to die peacefully and without pain if they so choose; but this, while sometimes surreptitiously done, cannot at present be relied on.
Many of us have known people who have suffered long, agonizing deaths because they became too ill to kill themselves and their physicians were unwilling to act on their request. I will not mince words by calling it "euthanasia" or "self-deliverance": if you're terminally ill, I hope to provide you with information that will help you determine the best way to kill yourself, if that's your well-considered decision.
What about the young and impulsive, particularly teenagers? At the moment, they seem to have the worst of all worlds, where: (1) lethal and not-so-lethal suicide methods are readily available; (2) neither they, their parents, nor their teachers are likely to know how dangerous particular methods are; (3) personal ("Are you thinking about...?) or practical ("How would you go about...?) discussion of suicide is largely taboo.
While many schools now teach about AIDS and its transmission, many more teenagers will attempt or commit suicide next year than will become HIV-infected. The ignorance, stigma, and fear about suicide would decrease if that topic were added to the curriculum and treated honestly.
What of "irrational" people? They too face a lack of information on suicide methods. Will they sit down and read a book before acting and will they choose more (or less) lethal methods as a result? No one knows. The most relevant data show that in the year after the publication of an earlier suicide-methods book, "Final Exit" there was a small increase in the number of people using the book's recommended methods (from 3477 to 3751), but a small decrease in the overall number of suicides (from 30,906 to 30,810). This is consistent with the notion that "Final Exit" merely shifted the method used by about one percent of suicides; but it can't resolve the possibility that the overall number of suicides would have decreased without the "recommended methods" increase.
As for the fourth group, those trying to carry out a "safe" suicidal gesture, the information in this book can only be beneficial.
A case will be made that people shouldn't commit suicide and that, therefore, a manual telling them how to go about it is pernicious. This is like one of the arguments against sex education: "If they know how, they'll do it." Well, they do it anyway. Thirty thousand suicide deaths a year in the U.S. should make this clear. In the absence of knowledge about suicide methods---and the consequences of failed attempts---people will continue to act in desperation and ignorance, as they have throughout recorded history, with gun, rope, blade, poison, and anything else available. That is the reality. And the methods people use all too often leave them neither dead nor fully recovered, but maimed and permanently injured: paralyzed from jumps, brain-damaged from gunshots, comatose from drugs.
But for anyone considering suicide (or even "safe" suicidal gestures; nothing is 100 percent reliable), I urge you to try every alternative first---and then try them again. These include a variety of anti-depressant drug therapies, various flavors of psychotherapy, electroshock, and "reality therapy"---helping people worse off than you. Each of these will work for some; no single solution will work for everyone. That's why it's vital not to give up if one or two or three don't do much to decrease your pain. How do you know that suicide is the best solution if you haven't tried everything else first? You can always kill yourself later.