In America in 2009, there was a proposal for Medicare, the government’s health insurance program for the elderly and the disabled, to provide end-of-life counselling. There was an outcry—Republican vice presidential candidate Sarah Palin for instance screeched about the spectre of government-sponsored “death panels” deciding when the game was over for hordes of frail and befuddled elders. It became a divisive issue that threatened to derail President Barack Obama's health care law.
This week, Medicare finally announced that it intends after all to proceed with end-of-life counselling. There were only a few murmurs of dissent. If the proposal is accepted, the elderly and their families will be able to have conversations with doctors and nurses in advance about what kind of care and interventions they want as they face the final curtain—and what they don’t want.
Giving people greater control over their death seems like an eminently sensible idea. Just because we have the technology to extend life with with a roomful of machines, tubes and drugs doesn’t always mean that’s the right thing to do, especially when the person involved has clearly expressed their desire not to “live” in this way.
A civilized society should help people to die with dignity. In some countries that means not just withholding excessive though potentally life-saving treatments but actively allowing doctor-administered death, especially when the person is suffering or in great pain from a terminal illness. Switzerland has allowed doctor-assisted suicide since 1942. Voluntary euthanasia—where the doctor actually administers the fatal dose at the patient’s request rather than merely prescribing it or handing it over to the patient—was made legal in the Netherlands in 2002, but only under strict criteria. The patient's request, awareness and level of suffering must be clear and sustained, suitable information and consultation must be provided, there must be absence of reasonable alternatives, doctors must consult with other doctors and they must report euthanasia to a review committee. Belgium followed the Netherlands later in the year, followed by Luxembourg in 2009 and, this year, Canada and Colombia.
The practices of assisted suicide and voluntary euthanasia are both illegal in the U.K., but that may change. According to a 2007 survey, 80 percent of Brits are in favour of giving terminally ill patients the right to die with a doctor's help.
In the U.S., a Supreme Court decision left rulings about assisted suicide to the discretion of individual states. Oregon swiftly passed a law allowing doctors to prescribe lethal drugs for people who have been given less than six months to live. Washington, Montana and Vermont now have similar laws in place.
Opponents of such laws are concerned that they could be abused. A compliant or confused parent for instance might be coerced into literally signing their life away by uncaring offspring who are eager to get their hands on an inheritance as soon as possible.
“I don’t want to be a burden,” the elderly often say.
“Ok, well sign here then,” the heartless son or daughter might reply.
But the problems, the violations, the abuses, do not alter the principle. Just because some people might exceed the speed limit, jump a red light or drive without a license does not mean that all driving should be banned.
We have some choices in how we live. Perhaps an enlightened government can offer some choices in how we die, too.
From the Boston Globe:
Medicare, the federal program that insures 55 million older and disabled Americans, revealed plans Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.
The proposal will be open for public comment for 60 days, but it is expected to be approved and take effect in January. If adopted, it would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up “death panels” that could cut off care for the sick.
Medicare’s plan comes as many patients, families, and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.
“We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team,” said Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, also known as CMS, which administers Medicare. “We think those discussions are an important part of patient- and family-centered care.”
Will George Osborne's budget give our children Hikikomori - Japan's new mental health problem?
George Osborne's budget will create a generation of young people too scared to leave their bedrooms and rendered mute by fear of the future, according to a British expert.
They will be suffering from Hikikomori a condition believed to affect as many as ONE MILLION Japanese.
Symptoms include hiding away from society and only interacting with the world to surf the Internet and reading fantasy literature.
The Chancellor's plans to limit the living wage to those aged 25 and older, along with scrapping grants to university students, increasing fees in line with inflation and cancelling housing benefit for 18-21 year olds are all likely to make matters worse.
Hikikomori is a huge problem among Japanese youth and can lead to people locking themselves away from the outside world for months and sometimes years on end.
Children's mental health must be cared for. Or the consequences will be dire
From former minister for mental health Paul Burstow, in The Guardian:
The chancellor tells us that he is putting into law the obligation to generate budget surpluses in the “interests of our children”. But the axing of funding for children’s mental health in the service of economic dogma will condemn a generation of young people to a life of misery for want of the right mental health support in their early years.
Half of life-long mental illness has its first signs and symptoms in the teenage years. Poor maternal mental health can have profound consequences for them, for their children and their children’s children. The LSE put a figure on this of £8.1bn.
Yet while one in 10 children and young people has a treatable mental illness just one in four receives treatment. It is a shocking indictment of our mental health services.
• School accountability triggering pupil mental health problems, research warns (The TES)
• Exam focus damaging pupils' mental health, says NUT (BBC News)
More provision needed for mothers during pregnancy and after birth
More research is needed to improve the identification and treatment of women with perinatal mental health issues, according to a new editorial co-authored by Professor Susan Ayers, the lead of the Centre for Maternal and Child Health Research at City University London.
Along with co-author Judy Shakespeare, from the Royal College of General Practitioners, Professor Ayers' article highlights how between 10 and 20 per cent of women suffer from mental health problems during this period, costing the NHS £1.2 billion a year. The editorial is published in the journal of Primary Health Care Research & Development.
Mental health problems can arise in pregnancy or after birth and most commonly consist of anxiety, depression, post-traumatic stress disorder (PTSD) following a difficult birth and stress-related conditions such as adjustment disorder. Severe postnatal mental illness, such as puerperal psychosis, is less common, but is one of the leading indirect causes of maternal death.
Researchers: Vampires are people, too, and need as much psychotherapy as the rest of us
From the Washington Post:
Vampires are real. No, not the impossibly perfect Cullens in the "Twilight" movies or tortured but well-dressed souls in CW shows. But human beings who self-identify as vampires and may drink blood or sleep in coffins. And these people need as much psychotherapy and medical help as the rest of us.
That's the conclusion of a study by D.J. Williams, director of social work at Idaho State University, and published in the July issue of the peer-reviewed journal Critical Social Work.
Williams and his co-author, Emily E. Prior, a researcher at the College of the Canyons, interviewed 11 vampires from across the United States and South Africa and found that they were reluctant to come out to clinicians because they were fearful about being labeled as being psychopathological or "perhaps wicked, and not competent to perform in typical social roles, such a parenting."
However, he noted that the people he interviewed "seem to function normally, based on demographic questions concerning their psychiatric histories, in their social and occupational roles, and some have achieved considerable success in their chosen careers."
India: counselling reveals anger, helplessness
From The Hindu:
Counselling sessions of the victims of the child prostitution case revealed their anger and helplessness at their precarious plight.
The victims are believed to have told counsellors arranged by the Child Welfare Committee that they were angry with themselves and with those who had pushed them into prostitution.
They reported feeling guilty and disoriented, and having haunting memories and an inability to remain calm according to information from the sessions overseen by the CWC.
Apart from the anxiety about the future, there was also fear about being recognised in public.
Sex therapy is making its way into couples counseling, and it's about damn time
From Lea Rose Emery, in Bustle:
Some “renegades” in the field of couples therapy are bringing sex into counseling, The New York Times reports. Although couples therapy and sex discussion may seem like obvious bedfellows, discussions of sex have often been, counterintuitively, absent during couples counseling. The reasons for this may be that the two arenas, couples counseling and sexual counseling, developed as completely different strains, meaning that overlap between them was limited. Often relationships counselors often have no sexual training, as there are currently no requirements for sexual education in traditional counseling licensing. And the opportunities to receive sexual training are limited. According to The New York Times there ”is only one certification program for sex therapists, the American Association of Sexuality Educators and Counselors, which means aspiring sex therapists may find access to courses and supervisors a challenge.”
But luckily the increased acknowledgement of the importance of sex in relationships may help change this. Some therapists are now “emphasizing the importance of good sex in relationships and sometimes suggesting the radical idea that couples fix the sex before tackling other issues”. This makes me so happy.
Psychiatric drugs are false prophets with big profits. Psychiatry has been hijacked
From Robert Berezin MD, Mad In America:
We have repeated the same mistakes over and over again, and we are doing so today. It doesn’t seem to matter that the chemical imbalance theory has been discredited. It doesn’t seem to matter that the multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives. A complete picture of the studies that pretended to validate antidepressants has now emerged which confirms that they do absolutely nothing. (See – “No, it’s not the Neurotransmitters, Depression is not a biological disease cause by an imbalance of serotonin.”) It rakes in a whopping $70 Billion a year for the drug companies. Unfortunately once people embrace a false belief it is so hard to think clearly again. I’m told its irresponsible to be so extreme. A thoughtful psychiatrist would use both drugs and psychotherapy. Apparently this sounds reasonable in today’s climate. Doing harm is never reasonable.
Human struggle is now, and always has been, the real issue. The very idea that drugs can cure what ails is an insult to the human condition.
The magical healing power of caring and hope in psychotherapy
From Allen Frances in the Huffington Post:
There are three consistent research findings that should make a world of difference to therapists and to the people they treat.
First, psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first.
Second, a good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used.
Third, there is a very high placebo response rate for all sorts of milder psychiatric and medical problems.
This is partly a time effect -- people come for help at particularly bad times in there lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological -- the body often actually responds to placebo just as it would responded to active medication.
These three findings add up to one crucial conclusion -- the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship, they hurt when they distract from it.