… and suicide. On watching “It’s a Wonderful Life” last night, I was struck by many things. But maybe most of all by the accuracy of its portrayal of the suicide. As Paul McHugh says in The Mind Has Mountains … “Most suicidally depressed patients are not rational individuals who have weighed the balance sheet of their lives and discovered more red than black ink. They are victims of altered attitudes about themselves and their situation, which cause powerful feelings of hopelessness to abound.” (p. 75) The data support the pertinence of this in those nearing end-of-life who request to hasten their death (physician assisted suicide, euthanasia, palliative sedation to unconsciousness) – this is not an “autonomous” choice but a final act of despair by one who sees no other options.