scholarly journals Palliative care for older people: the psychiatrist's role

2018 ◽  
Vol 25 (1) ◽  
pp. 37-46
Author(s):  
Victor M. Aziz ◽  
Rugiyya Saeed
Keyword(s):  
Older People ◽  
Assisted Suicide ◽  
Psychiatric Care ◽  
Learning Objectives ◽  
Personality Change ◽  
List Type ◽  
Physician Assisted Suicide ◽  
Individualised Care ◽  
Anxiety Depression

SUMMARYIn this overview we discuss the palliative psychiatric care of older people towards the end of life. We briefly consider ethics, dementia care, delirium, depression, anxiety, grief and physician-assisted suicide. We also discuss hope, dignity, spirituality and existentialism. We hope that this article will encourage clinicians to reflect on the effects of terminal illnesses on the mental health of dying people and the current provision of palliative psychiatric care.LEARNING OBJECTIVES•Appreciate that patient-centred care builds on providing individualised care for the dying person to meet their needs and wishes•Understand the collaborative role of psychiatry in assessing the aetiology and appropriate response to patients presenting with problems of loss, grief, anxiety, depression, hopelessness, suicidal ideation, personality change and confusion•Recognise that maintaining hope and living with hope is a way for terminally ill patients to endure and cope with their sufferingDECLARATION OF INTERESTNone.

Szasz, suicide, and medical ethics

Thomas Szasz ◽  
2019 ◽  
pp. 55-64
Author(s):  
George J. Annas
Keyword(s):  
Mental Illness ◽  
Informed Consent ◽  
Suicide Prevention ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
The Subject ◽  
The Right ◽  
Suicidal Patients ◽  
Commit Suicide

Szasz objected to the medicalization of suicide, the legalization of suicide prevention, and especially the coercive role of psychiatry in this realm. He declared that, by medicalizing suicide, we banish the subject from discussion. What is meant by acceptable and unacceptable “suicide”? Who has a right to commit suicide? How does suicide implicate freedom? Does it reflect abortion jurisprudence? How do psychiatrists become suicide’s gatekeepers? Current phenomena (e.g., new physician-assisted suicide legislation) illuminate these and other issues (e.g., euthanasia, informed consent, informed refusal, the “right to die,”), all suggesting how Szasz would react to each. Suicide is legal, but is almost always considered a result of mental illness. Courts approve psychiatrists who want to commit “suicidal” patients involuntarily. Granting physicians prospective legal immunity for prescribing lethal drugs is, at best, a strange and tangential reaction to our inability to discuss suicide (and dying) rationally. Szasz got it right.

scholarly journals Working with MAPPA: ethics and pragmatics

2019 ◽  
Vol 25 (3) ◽  
pp. 157-165 ◽  
Author(s):  
Richard Taylor ◽  
Jessica Yakeley
Keyword(s):  
General Medical Council ◽  
Legal Framework ◽  
Learning Objectives ◽  
Guidance Document ◽  
Medical Council ◽  
List Type ◽  
Management Board ◽  
Political Background ◽  
And Function

SUMMARYMulti-agency public protection arrangements (MAPPA) have been in operation for around 18 years in England and Wales. The primary purpose is for the sharing of information between agencies regarding the risk management of offenders returning to the community from custodial and hospital settings. The legal framework regarding information by psychiatrists is not dealt with in one single policy or guidance document. Psychiatrists must use their clinical and professional judgement when engaging with the MAPPA process, mindful of guidance available from professional bodies such as the Royal College of Psychiatrists, General Medical Council and British Medical Association.LEARNING OBJECTIVESAfter reading this article you will be able to: •Learn the legal and political background that led to the formation of MAPPA•Understand the structure and function of MAPPA•Understand the role of psychiatrists in the MAPPA processDECLARATION OF INTERESTR.T. is a member of the London Strategic Management Board for MAPPA.

Euthanasia and physician-assisted suicide in the Dutch homecare sector: the role of the district nurse

2007 ◽  
Vol 58 (1) ◽  
pp. 44-52 ◽  
Author(s):  
G.G. van Bruchem-van de Scheur ◽  
Arie J.G. van der Arend ◽  
Cor Spreeuwenberg ◽  
Huda Huijer Abu-Saad ◽  
Ruud H.J. ter Meulen
Keyword(s):  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
District Nurse

Experiences and Motivations Underlying Wishes to Die in Older People Who Are Tired of Living: A Research Area in its Infancy

2014 ◽  
Vol 69 (2) ◽  
pp. 191-216 ◽  
Author(s):  
Els van Wijngaarden ◽  
Carlo Leget ◽  
Anne Goossensen
Keyword(s):  
Older People ◽  
Assisted Suicide ◽  
Severe Depression ◽  
Personal Characteristics ◽  
Research Area ◽  
Physician Assisted Suicide ◽  
Age Related ◽  
Wish To Die ◽  
Life Threatening ◽  
Insight Into

The wish to die in older people who are tired of living and the possibilities to organize death are currently being discussed within the debate on self-determination and physician-assisted suicide. Until now insight into the experiences and thoughts of people who are tired of life but not suffering from a severe depression or a life-threatening disease is lacking. Studies focussing specifically on this topic are rare. This review provides an overview of this research area in its infancy. The existential impact of age-related loss experiences play an important role in developing a wish to die. Other influencing factors are: personal characteristics, biographical factors, social context, perceptions and values. Further research to experiences and motivations underlying these specific age-related wishes to die and the existential impact of the loss-experiences seems necessary to deepen the understanding of this group of older people and for the development of policy and good care.

A “Suicide Pill” For Older People: Attitudes of Physicians, the General Population, and Relatives of Patients who died After Euthanasia or Physician-Assisted Suicide in The Netherlands

Death Studies ◽  
2005 ◽  
Vol 29 (6) ◽  
pp. 519-534 ◽  
Author(s):  
Mette L. Rurup ◽  
Bregje D. Onwuteaka-Philipsen ◽  
Gerrit van der Wal ◽  
Agnes van der Heide ◽  
Paul J. van Der Maas
Keyword(s):  
General Population ◽  
The Netherlands ◽  
Older People ◽  
Assisted Suicide ◽  
Physician Assisted Suicide

The Euthanasia Debate: Attitudes, Practices and Psychiatric Considerations

1995 ◽  
Vol 40 (10) ◽  
pp. 593-602 ◽  
Author(s):  
Harvey Max Chochinov ◽  
Keith G Wilson
Keyword(s):  
Mental Health Professionals ◽  
Assisted Suicide ◽  
Psychiatric Morbidity ◽  
Physician Attitudes ◽  
Current Status ◽  
Physician Assisted Suicide ◽  
Recent Developments ◽  
Hastened Death ◽  
Desire For Death

Objective To review the current status of the euthanasia debate by examining public and physician attitudes towards euthanasia, the practice of euthanasia in the Netherlands, recent developments in Canada and other countries, psychosocial considerations related to the desire for death in terminally inpatients, and the roles that psychiatrists may be asked to play in the event of legislative reform involving decriminalization. Methods A literature review was conducted focusing on recent surveys regarding physician and patient attitudes towards euthanasia, the role of psychiatrists and empirical data pertaining to the mental state of patients who request physician-hastened death. Results Psychiatric morbidity among patients requesting physician-hastened death is considerable. Conclusion As a special case of suicide, euthanasia and physician-assisted suicide are of particular relevance to mental health professionals.

scholarly journals Role of non-governmental organisations in physician assisted suicide

BMJ ◽  
2007 ◽  
Vol 334 (7588) ◽  
pp. 295-298 ◽  
Author(s):  
Stephen J Ziegler ◽  
Georg Bosshard
Keyword(s):  
Assisted Suicide ◽  
Physician Assisted Suicide

Physician Assistance in Dying: An Option for Christians?

2021 ◽  
Vol 27 (3) ◽  
pp. 228-249
Author(s):  
Lloyd Steffen
Keyword(s):  
Natural Law ◽  
Ethical Theory ◽  
Assisted Suicide ◽  
Just War ◽  
Physician Assisted Suicide ◽  
Moral Issues ◽  
Christian Perspective ◽  
Controversial Problem ◽  
Natural Law Theory

Abstract Opposition to physician-assisted suicide is widespread in Christian ethics. However, on a topic as controversial as physician-assisted suicide, no one can reasonably speak for “the Christian” perspective. Natural-law and, specifically, just-war thinking are claimed in the Christian tradition, yet the natural-law contribution to a Christian ethical analysis of physician-assisted suicide requires explanation and defense. Natural-law ethical theory affirms the central role of reason in moral thinking and provides a theoretical resource in contemporary ethics to assist in analyzing specific moral issues, problems, and conflicts. This essay seeks to demonstrate how just-war thinking, derived from natural-law tradition, allows movement from the theoretical world of natural-law theory to the practical world of normative ethics. Here the case is made that the just-war model of ethics helps elucidate the moral problematic involved in physician-assisted suicide while clarifying direction on this particularly thorny and controversial problem.

Physician-assisted suicide and physician-assisted euthanasia: evidence from abroad and implications for UK neurologists

2021 ◽  
pp. practneurol-2020-002811
Author(s):  
Uma Nath ◽  
Claud Regnard ◽  
Mark Lee ◽  
Kiran Alexander Lloyd ◽  
Louise Wiblin
Keyword(s):  
Significant Variation ◽  
Assisted Suicide ◽  
Motor Neurone ◽  
Physician Assisted Suicide ◽  
Eligibility Criteria ◽  
Regulatory Oversight ◽  
Assisted Death ◽  
Common Cause ◽  
Loss Of Autonomy

In this article, we consider the arguments for and against physician-assisted suicide (AS) and physician-assisted euthanasia (Eu). We assess the evidence around law and practice in three jurisdictions where one or both are legal, with emphasis on data from Oregon. We compare the eligibility criteria in these different regions and review the range of approved disorders. Cancer is the most common cause for which requests are granted, with neurodegenerative diseases, mostly motor neurone disease, ranking second. We review the issues that may drive requests for a physician-assisted death, such as concerns around loss of autonomy and the possible role of depression. We also review the effectiveness and tolerability of some of the life-ending medications used. We highlight significant variation in regulatory oversight across the different models. A large amount of data are missing or unavailable. We explore physician-AS and physician-assisted Eu within the wider context of end-of-life practice.

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