Physician-Assisted Suicide and Public Policy

Philosophical Studies -     

Adequacy of Official Suicide Statistics for Scientific Research and Public Policy

Many researchers have claimed that the study of suicide and the formation of public policy are not undermined by the misclassification of suicide as other causes of death. We evaluated this claim using a new technique and causes of death not previously considered. We examined computerized California death certificates, 1966-1990. Mortality peaks at symbolic ages are a characteristic feature of suicide. We sought such peaks in (1) causes of death commonly suspected of containing misclassified suicides (e.g., accidental barbiturate poisoning), (2) causes of death not hitherto suspected (e.g., pedestrian deaths), and (3) control groups. The first two categories displayed peaks at symbolic ages, but control groups did not. The size of the peak, indicative of misclassified suicides, varied markedly by race (p < .0001) and sex (p < .0001). Misclassification is evident for all time periods examined, large and small counties, and each race and sex. The maximum misclassification occurs for Blacks (14.92% of officially recorded suicides). We conclude that suicides are misallocated to at least five other causes of death (two of which have not been previously considered in the literature) and are most likely to be underreported for groups with low official suicide rates, that is, Blacks and females. Consequently, Blacks and females are not as protected from suicide as was previously supposed. It may be inadvisable to use official suicide data to test scientific hypotheses about suicide, unless the effects of underreporting are estimated and, if necessary, corrected for.     

Predictors of Client Satisfaction in Executive Outplacement: Implications for Service Delivery

This study examined various program components of professional outplacement relative to client satisfaction using a sample that comprised a majority of former executives seeking jobs. Results from a pencil-and -paper client survey suggest that outplacement content components (job search training, preparation) and process components (consultant relationship, clarity of expectations, assistance in maintaining focus) were better predictors of client satisfaction when compared with contextual components (library, software, administrative support). Findings from this study suggest that issues of self-efficacy may make a key contribution not only to client satisfaction, but to the design and the administration of outplacement services.     

The Challenge of Cultural Blindness: Implications for Family-Focused Service Delivery

When dealing with culturally diverse families, special education professionals need to be aware of the challenge of cultural blindness and acknowledge the cultural assumptions imbedded in the services they offer. Using data from qualitative interviews with Native American mothers and participant observations of a parent support group on their reservation, I analyze the implications of cultural blindness for the empowerment of minority families.     

A Psychological Autopsy of an Indian Adolescent Suicide with Implications for Community Services

This psychological autopsy of the suicidal death of an adolescent Indian boy includes a brief family background, a history of his difficulties, and a report of his psychological evaluation. There is an attempt to understand the societal and familial factors that seem to have predisposed him to commit suicide. The report includes an analysis of the resources currently available in Indian communities and a recommendation for the kinds of resources that might prevent suicide in this setting.     

Suicide: Dynamics and Implications for Counseling

‘The authors discuss the dynamics of suicide, how to work with a potentially suicidal client in the counseling relationship, and legal and ethical implications for the counselor.     

Self-Psychology,Shame, and Adolescent Suicide: Theoretical and Practical Considerations

Using the psychoanalytic self-psychology of Heinz Kohut as the theoretical foundation of this article, the authors discuss the role of shame in adolescent suicidal behaviors. Shame is described as a central component of suicidal behavior within the context of adolescence, a fundamental stage in the development of the healthy self. Normal and pathological self-development are described and important issues pertaining to the development of the self during adolescence are explored. A theoretical explanation of adolescent suicidal behavior from a self-psychology perspective is offered. Finally, suggestions for treatment of the suicidal adolescent and an illustrative clinical vignette are presented.     

Delivery of Psychological Interventions by Clinical Neuropsychologists: Current Practice in Australia and Implications for Training

Clinical neuropsychologists are increasingly involved in delivering psychological interventions to people with neurological conditions. This is a key competency for accredited Australian postgraduate neuropsychology courses; however it is not clear how effective courses are in preparing neuropsychologists to deliver interventions. The study aims were to (a) determine the frequency and confidence with which particular types of interventions are delivered by Australian neuropsychologists, (b) examine the availability of opportunities to deliver interventions on clinical placements, (c) identify barriers to delivering interventions in current workplaces; and (d) determine which factors influence the frequency and confidence with which neuropsychologists deliver interventions. An online survey was completed by 114 participants who had graduated from a postgraduate neuropsychology program. Results indicated that respondents delivered different intervention types with varying frequency. They reported limited opportunities to practice these interventions on placements. The majority wanted to be doing more interventions, with lack of time, resources, and adequate training being the major barriers. There were several significant relationships between the frequency and confidence with which respondents delivered interventions and the perceived quality of their postgraduate training. These results highlight the need to consider appropriate postgraduate training options in delivery of interventions, including increasing opportunities to practice interventions on placements.     

Assisted Suicide,Euthanasia, and Suicide Prevention: The Implications of the Dutch Experience

What impact would legalization of assisted suicide and euthanasia have on our ability to treat suicidal patients and to prevent suicide? Information from a study of the Dutch experience illustrates how legal sanction promotes a culture that transforms suicide into assisted suicide and euthanasia and encourages patients and doctors to see choosing death as a preferred way of dealing with serious or terminal illness. The extension of the right to euthanasia to those who are not physically ill further complicates the problem. So too does the tendency of doctors in such a culture to begin to feel that they can make decisions about ending the life of competent terminally ill patients without consulting the patient. “Normalizing” suicide as a medical option lays the groundwork for a society that turns euthanasia into a “cure” for suicidal depression.     

Problem Solving,Stress, and Coping in Adolescent Suicide Attempts

Twenty adolescents who had made suicide attempts were compared with 20 nonpsychiatric control subjects on measures of problem solving, stress, and coping. The suicidal group did not show evidence of “rigid” thinking or of deficits in the ability to generate solutions to standardized interpersonal problems. However, they did report recent histories of more severe life stress and had inaccurate appraisal of the extent to which stressful events could be controlled. Although suicidal patients were able to generate as many adaptive strategies as control subjects for coping with their own most severe recent real-life stressor, they actually used fewer. They were also more likely to identify maladaptive behaviors as ways of coping. These findings support a transactional model of adolescent suicidal behavior, whereby inaccuracies in the appraisal aspects of problem solving (but not in the solution-generation aspects) in the face of high life stress lead to a reduction in the use of adaptive efforts to cope.     

Prediction of Suicide Intent in Aboriginal and Non-Aboriginal Adolescent Inpatients: A Research Note

The relationship among depressive symptoms, anxiety, hopelessness, and suicidal intent was explored in a group of 77 adolescents who had been hospitalized after attempting suicide. Regression analyses indicated that hopelessness was the only significant predictor of suicide intent in Caucasian patients, and depressed mood was the only significant predictor in the Aboriginal group. Clinicians should be aware that measures of hopelessness may be of limited value in assessing suicidal risk in Aboriginal adolescents.     

Expanding the Conceptualization of Workplace Violence: Implications for Research,Policy, and Practice

Workplace violence generally refers to interpersonal aggression, sexual harassment, bullying, and other forms of discrimination and oppression occurring within the confines of the paid workplace. Workplace violence affects women across the globe, resulting in a wide range of health, economic, and social problems. We advocate for broader, transdisciplinary, intersectional, and transnational conceptualizations of workplace violence in research, policy, and practice. Supported by findings from research conducted around the globe, we argue that workplace violence occurs not only within the context of women’s paid employment in the formal workplace, but also within the contexts of other types of work in which women of all ages engage. An expanded, more inclusive conceptualization of women’s workplaces in research, policy, and practice will promote broader recognition and acknowledgement of women’s experiences of interpersonal violence in the contexts of their multiple work roles in unpaid and informal work, as well as the paid labor force. Incorporating intersectional, transnational, and transdisciplinary perspectives into research, policy, and practice related to workplace violence will expand understandings and interpretations of women’s experiences of workplace violence across the lifespan; within their own multi-faceted cultural contexts and racial, ethnic, gender, and class identities; and will facilitate transnational, cross-cultural comparisons. Implementation of policies based on expanded conceptualizations of workplace violence can contribute to more effective education and prevention efforts, improved reporting procedures, and enhanced post-violence support services and treatment programs that meet the needs of women across a wider spectrum of workplace contexts.     

Cross-Cultural Counseling and Psychotherapy: A Historical Perspective,Implications for Research and Training

This article examines the development of cross-cultural and psychotherapy in the United States, and theoretical models and their implications for research and training are reviewed.     

Predictors of Placement Outcomes in Treatment Foster Care: Implications for Foster Parent Selection and Service Delivery

Treatment foster care (TFC) is a normalizing environment in which to treat those children whose particular needs are not addressed in traditional foster care and for whom an institutional setting is a restrictive and unnecessary alternative. However, when the foster care placements of these emotionally and behaviorally disturbed children fail, as they often do, the children are shifted from one home to another without the opportunity to experience permanence or emotional attachment, resulting in poor adjustment to foster care. Placement stability, which depends in part upon effective matching of foster children with potential foster families, is critical for achieving positive outcomes in TFC. Yet, there is a dearth of information to guide placement agencies in making decisions about matching foster children with families. Moreover, once a successful match has been made, it is equally vital that service delivery be of high quality so that permanence is maintained. We review research on the predictors of positive outcomes in foster care, focusing on studies involving emotionally or behaviorally disturbed children, and provide recommendations for selecting foster parents and for ensuring high quality foster care services and placement stability.     

Through the Community Looking Glass: Reevaluating the Ethical and Policy Implications of Research on Adolescent Risk and Psychopathology

Drawing on a conception of scientists and community members as partners in the construction of ethically responsible research practices, this article urges investigators to seek the perspectives of teenagers and parents in evaluating the personal and political costs and benefits of research on adolescent risk behaviors. Content analysis of focus group discussions involving over 100 parents and teenagers from diverse ethnic and socioeconomic backgrounds revealed community opinions regarding the scientific merit, social value, racial bias, and participant and group harms and benefits associated with surveys, informant reports, intervention studies, blood sampling, and genetic research on youth problems. Participant comments highlight new directions for socially responsible research.     

Religion, Spirituality and Therapy: Implications for Training

Religion and spirituality are recognized coping resources but are neglected in psychological training and practice. However, religion and spirituality can be successfully used to cope with psychological disorders, prevent unhealthy behaviors and promote resilience. This study explored and described two questions regarding the concepts of the terminology religion and spirituality, and the perceptions of the use of religion and spirituality in therapy. Purposive sampling was utilized in a qualitative study of 15 registered psychologists, and data were analyzed using Tesch’s model of qualitative content analysis. The concepts religion and spirituality appear difficult to define but the importance of their use as coping mechanisms in their own and their clients’ lives was recognized. These findings have implications for professional training.     

道德、宗教和文化的完整性:对跨文化伦理学及公共政策论的意义

分析传统对宗教与道德之间关系的两种模式（A）与（B）都是过分偏激容易引起误解。它们所代表的观点亦不容易在实践中可以持续。（A）模式坚持道德必须直接地依赖宗教作为它的惟一来源。（B）模式则认为道德应完全独立于宗教。然而,欧洲启蒙运动所追求的一种具普遍性和独立于宗教的理性伦却明显已经“破产”。因为并没有任何一个群体能够完全摆脱它自身拥有的历史、文化与宗教遗产。提出一个辩证法的模式,即认为宗教与文化应有一个相互依赖、相互诠释的关系,一个群体／社会的文化完整性才得以保存。这模式对跨文化伦理对话以及公共政策的讨论都具有相当的意义。