I can highly recommend this comprehensive review of a possibly contentious topic which absolutely meets its full title. The book owes its existence to the lack of a previous comprehensive work on the subject. As the editors, two old age psychiatrists, pertinently state, “We needed guidance to sort out our cultural beliefs from our personal feelings from our clinical instincts.” (p ix). The resulting book is a triumph. The authors cover a wide spectrum of backgrounds: clinicians, both geriatricians and old age psychiatrists, as well as psychologists, theologians, philosophers, demographers, sociologists and historians.

Although, as a member of the Baby Boomer generation, I did not go first to the chapter on this subject, it is one of more than some interest to me, my family members, friends and colleagues. Will we be the cohort who decides to do away with ourselves as soon as the going gets tough, because for so many of us life has been pretty easy? This thought is echoed by the author of the chapter on the Baby Boomers, who suggests that because Boomers value youth and individualism and are questioners of authority they will not “conform to the traditional ways of being an older adult” (p 101). This is the generation which has defined the “good death” as one with little or no pain, in the place of their choosing with time to review their life and hand over important information to others; not the way that our parents died, nor the way that anyone outside the Western medical system dies. As a generation we have had a high suicide rate from adolescence on and may well be the first generation to embrace rational suicide in a big way. The one thing that might mitigate the Boomers’ desire for a hastened death is the use of classic psychedelics, with which Boomers have had some experience. According the author of the chapter on this subject their use may assist in the alleviation of the existential suffering that causes many to request an early death.

All of the chapters are extremely well written and fully referenced. And, a great plus to a reviewer and all readers, the authors have either read each other's work, or been given clear instructions from the editors, because repetition of information and ideas is rare and occurs only to reiterate important information. The one exception is chapters 10 and 12, where the psychological issues in late life suicide are duplicated in the very good chapter on the impact of psychotherapy on rational suicide. The authors of the latter chapter describe the various possible therapies with the evidence (where existing for older adults) and the possible application of the therapy to those proposing rational suicide.

The early chapters include an historical discussion of ageism, the history of societal attitudes to suicide and anthropological aspects of suicide in relation to aging plus a philosophical view of life's meaningfulness. This background framework greatly assists in considering the later more clinical chapters, as also does the later chapter on spirituality and religion.

All the clinician authors are very careful to emphasize the need to carry out proper assessment of patients so that a potentially treatable psychiatric illness is not missed. The great majority of the authors, when discussing why a mentally competent older person might want to end their life, suggest further elucidation of the person's current and past life experience, family and other support as part of a full assessment of such people, with the suggestions of endeavoring to discover what activities might assist the person to feel that life was worth living for a bit longer. Such a request from an older person should be treated as a call for help, not to be accepted immediately as valid. Although some such requests may be seen by all as inherently valid.

Chapter 12 which provides information on the impact of psychotherapy on rational suicide finishes with a plea for clinicians to be aware of their own views and values, especially those which consider that a hastened death is always wrong. In engaging with older people who contemplate rational suicide the clinician must be cognizant of their own opinions, and where appropriate consider discussing them in the consultation.