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The Last Choice establishes that preemptive suicide in advanced age can be rational: that it can make good sense to evade age-related personal diminishment even at the cost of good time left. Criteria are provided to help determine whether soundly reasoned, cogently motivated, and prudently timed self-destruction can be in one's interests late in life. In our time suicide and assisted suicide are being increasingly tolerated as ways to escape unendurable mental or physical suffering, but it isn't widely accepted that suicide may be a rational choice before the onset of such suffering. This book's basic claim is that it can be rational to choose to die sooner as oneself than to survive as a lessened other: that judicious appropriation of one's own inevitable death can be an identity-affirming act and a fitting end to life.

Discussion of preemptive suicide goes beyond contributing to current widespread debate about assisted suicide. It is a matter tightly interrelated with other right to die questions and one bound to become a national issue. If there are good arguments for escaping intolerable situations caused by age-related deteriorative conditions, most of those arguments will equally support avoidance of those conditions. If assisted suicide becomes more generally acknowledged and accepted, preemptive suicide will almost certainly follow. It is crucial, then, to examine whether preemptive suicide constitutes a rational option for reflective aging individuals.