Desire for euthanasia or physician-assisted suicide in palliative cancer care.

OBJECTIVE: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. DESIGN: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. MAIN OUTCOME MEASURES: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. RESULTS: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p=.010), reduced functional status (p=.024), a diagnosis of major depression (p<.001), and greater distress on 12 of 22 individual symptoms and concerns (p<.025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. CONCLUSION: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring.     

Eight issues in studying organizational constructs: Tackling a complex problem

Much of the industrial/organizational psychology research literature involves abstractions called constructs. Frequently, new constructs are proposed and measures are developed, revised, and evaluated in studies for modeling or predicting organizational criteria. There are many hazards in these studies that lead to incorrect conclusions and decisions. This is especially applicable to the introduction and use of new constructs. We discuss several methodological issues that affect the interpretation of results from theoretical and applied studies and provide examples where construct confusion occurred due to failure to use best practices. A paradigm is proposed to increase the efficacy of studies regardless of which model of constructs has been chosen. Consideration is given to sample characteristics, range restriction, reliability of scores, criterion development, identifying latent sources of variance, content validity, comparing regression equations, and defining the nomological network.     

Separation-survivability as moral cut-off point for abortion

Abstract

We argue that separation-survivability is a significant developmental fetal milestone beyond which abortion is only rarely and exceptionally morally justifiable. Secondly, we argue that the continuous nature of prenatal development, and simultaneous parallel development and actuation of intrinsic and contingent potentiality that eventually results in the development of a person capable of moral thoughts and deeds, implies continuously incremental moral significance. We propose that the moral justifiability of each instance of non-therapeutic pre-viable termination should be the product of an internal dialectic or “moral enquiry”. Arguments should be of increasing power in order to trump the sliding-scale increase in prenatal moral significance. We agree that sentience is morally significant, but argue that survivability is of predominant importance, since human beings who have the potentiality of separate, relatively independent lives, should, normally, be allowed to continue living. We argue for a moderate position on abortion.     

Childhood abuse and depressive vulnerability in clients with gender dysphoria

Background: Childhood abuse in the early lives of gender variant people has been under‐reported, although higher psychiatric morbidity, particularly depression and suicidality, than in the general population is more widely recognised. There are increasing numbers of people seeking advice and treatment for gender dysphoria (GD) some of whose experiences of depression and childhood abuse may be additional treatment considerations. Aim: To illuminate the issues relating to childhood abuse, depression and GD via case examples underpinned by a summary review of the relevant literature, for their combined relevance to therapeutic practice and service provision. Methods: A review of relevant online literature was conducted and two case examples were developed subsequently to capture the core review themes from a practice perspective. Results: Nine studies met the inclusion criteria. Gender variant children and adolescents may experience abuse by peers and teachers, as well as parents and caregivers. Emotional abuse and neglect may have more adverse consequences than more active forms of abuse. Conclusions: This is an under‐researched area, and inconsistencies of design, definition, measurement and controls were evident in the literature. While no clear association between depressive vulnerability and childhood abuse could be found, prevalence of such abuse was high. A case is made for clients with GD to have the opportunity to explore the influence and meaning of their adverse childhood experiences on their social and psychological development, and for additional training and education for practitioners.     

Relational Psychoanalysis and the Tragic-Existential Aspect of the Human Condition

I suggest we may benefit by opening relational thinking to a certain aspect of a classical psychoanalytic worldview. Opening to what we can call the tragic and existential dimensions of the human condition: the universal experience of a certain inner dividedness, hiddenness, and self-deception—a strangeness within the “otherness” that constitutes ordinary, good-enough human environment; as well as the equally universal experience of impermanence—lack, inevitable loss, and finitude. Such openness entails listening to themes we hear in many critiques of relational thinking—critiques that often devolve into caricaturing relationality as avoiding the dark, internally divided side of our nature. It entails listening well enough to these universal themes in ourselves and in our patients so that we can radically reframe them—without recourse drives—in expanded, relational terms. As in Mitchell’s words, “dialectical tensions not taken as polarities … but rather as interpenetrating and, in some sense, as mutually creating each other.”