Abstract
This month’s issue continues the theme of voluntary euthanasia and assisted suicide that appeared in the November issue. When assisted suicide is discussed, a frequently raised issue is that the person wishing to die may have a treatable mental disorder and therefore requires psychiatric assessment. Malcolm Parker (2012) points out that this possibility is rarely raised in relation to a person who wants to terminate burdensome treatment that is keeping them alive, even though the desired result in both cases is death. He argues that this contrasting position reveals something about hidden values behind ethical positions taken on this issue. In a companion piece, Marina Vamos (2012) attempts to deconstruct the terms ‘physician-assisted suicide’ and ‘euthanasia’. She sees these as seemingly benign terms that hide a morally complex area where physicians are being asked to take on a god-like power. In the third piece on this theme, Leo Sher (2012) asks: What should medical students and other trainees be told about euthanasia and assisted suicide? He takes a clearly partisan position and argues that they should know that suicidality is a manifestation of psychiatric illness, that patient autonomy does not give the right to ask a physician to perform a non-medical act, that life expectancy is difficult to predict in individual cases, and that there is a danger that euthanasia could be misused to reduce healthcare costs. The issue of euthanasia and assisted suicide is one that merits continued debate among the psychiatric profession and the ANZJP would welcome correspondence from readers.
Suicide risk is another related theme in this issue. McLean and colleagues (2012) report that alcohol misuse increases risk of suicide attempts in people with schizophrenia, while use of illicit drugs does not. In the Correspondence section, letters from Goldney (2012) and Szmukler (2012) continue the discussion from the August issue about whether prediction of suicide is practically useful.
A third theme is recovery of people with severe mental disorders. Chang and colleagues (2012) examine the outcomes for a large cohort of young first-episode psychosis patients in Hong Kong. The findings are a concern, with 59% of these patients in remission and only 17% recovered after 3 years. The authors note the need for more intensive psychosocial interventions to improve the outcome. Berk and colleagues (2012) apply the concept of clinical staging to patients who remain symptomatic and functionally impaired despite treatment. Usually, the clinical staging concept is applied to people in the early stages of a mental disorder. They argue for a ‘palliative’ approach which involves improving the lives of these people despite continuing symptoms and disability.
Finally, it is notable that around half the contributions to this issue come from outside Australasia, reflecting the perception of the ANZJP as an international journal with growing stature.