Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

BACKGROUND: A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. DISCUSSION: Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. SUMMARY: The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

The number of tibial bone SOS measurements with different size probes by age.

<p>The number of tibial bone SOS measurements with different size probes by age.</p

Scatter plots of tibial bone SOS in preterm and term infants with a cubic regression line versus age in months.

<p>(A) preterm girls, (B) preterm boys, (C) term girls, (D) term boys. Corrected age is used for preterm infants. Upper and lower individual 95% confidence intervals are shown as dashed lines. ○ = preterm infants; △ = term infants; values on X axis of Fig 1 (A) and (B): zero value = corrected gestational age 40 weeks; negative values -1 = corrected gestational age 36 weeks, negative -2 = corrected gestational age 32 weeks, negative -3 = corrected gestational age 28 weeks.</p

Trends in age-related changes for mean tibial bone SOS in terms of postnatal age (PNA) and preterm infants of PNA and corrected age (CA) during infancy.

<p>Tibial bone SOS in each age class of PNA in term infants and CA in preterm infants was compared using t tests. The corresponding p value (PNA in term infants versus CA in preterm infants) is shown for each age class. Post-hoc Bonferroni adjustment was applied to p values to account for multiple comparisons; hence, p values < 0.006 (≈ 0.05/8) were considered statistically significant (*) between term infants in PNA and preterm infants in CA.</p

Clinical characteristics of study infants.

<p>Clinical characteristics of study infants.</p

Tibial bone SOS and growth variables for term and preterm infants during the study period by age and sex.

<p>Tibial bone SOS and growth variables for term and preterm infants during the study period by age and sex.</p