Book prefaces often are skipped. This one should be read because it is important for readers to appreciate the intent and nature of what follows and to whom it is addressed.

This book is about the rationality, and so the permissibility, of choosing to die and is addressed to medical ethicists and to those on their way to being medical ethicists. More particularly, the book is addressed to medical ethicists who deal or will deal with terminal patients. And most specifically, the book is addressed to those who deal or will deal with terminal patients considering ending their lives to escape the physical and personal devastation and torment that many terminal conditions produce.

The writing of this Preface was prompted by events at a recent conference on end-of-life issues to which I was invited. I presented some material from the first two of the following chapters, with a view to both sharing my observations with participants and seeking constructive criticism.

The conference participants were mostly clinicians, with a significant number of health-care administrators and some lawyers specializing in terminal-illness issues. I regret that the comments and questions about the material I presented made it clear that few in the audience thought what I had to say was relevant to their work. My commentator ridiculed the abstractness of my presentation and dismissed my concern with the rationality of choosing to die by saying simply that we cannot be rational in terminal suffering.