title: Physician assisted suicide and clinical vulnerability: a slippery slope.
abstract: The Belgian case of a 24 years' woman affected by resistant depression, who obtained the legal right to assisted suicide rehearsed ethical issues. From the famous Chabot case of the Dutch court in 1994, accumulating legal evidence indicates that the unbearable psychiatric suffering may be equate to the physical struggle of end of life patients. The Belgian law has addressed assisted suicide as an option in case of unbearable psychic suffering with no future prospective.
  
  
  
  It is unlikely that the practice of euthanasia may be mechanistically reduced to the provision of a suicide as alleviating the burden of suffering in depression is a long life commitment; moreover, the principle of patient's self determination and autonomy is highly debatable: the closure to the future, the hopelessness and the suicidal ideation represent per se core features of depression. Might they be discriminated as non pathological in assessing patients' competence and how?
  
  
  
  The slippery slopes is even more upsetting when dealing with elderly affected by chronic disability. Some body of evidence justified suicide in elderly as the final auto determination to preserve the person's dignity, and quality of life. The growing scenario of economic shortages in heath care system seems to further legalize the social prejudice and the ageistic discrimination towards elderly with disability. The silver tsunami will face the challenge of true self determination; will it be acted through assisted suicide or through a rebuilding of western heath care policies to fulfill the emergent needs of an aging population?
authors.affiliation: Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa.
authors.forename: F
authors.initials: F
authors.lastname: Monacelli
authors.affiliation: Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Martini
authors.affiliation: Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa.
authors.forename: P
authors.initials: P
authors.lastname: Odetti
authors.affiliation: Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Ciliberti
mesh_terms: D000368:Aged; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D026684:Personal Autonomy; D011788:Quality of Life; D017236:Suicide, Assisted
keywords: Assisted suicide; Elderly clinical vulnerability; Psychiatric suffering