Les enjeux liés à la légalisation de l’euthanasie et du suicide assisté au Canada

Si on désire légaliser l’euthanasie ou le suicide assisté, on doit préalablement conclure que les méthodes actuelles pour abréger la vie des personnes en phase terminale ne sont pas adéquates. Actuellement, le suicide, le refus de traitement, l’arrêt de traitement et le « double effet » ou le traitement agressif de la douleur même lorsqu’il compromet la durée de vie (dont la sédation terminale est un exemple) sont toutes des activités légales au Canada. Nous soumettons que si jamais d’autres pratiques doivent être légalisées, le suicide assisté devrait être privilégié plutôt que l’euthanasie puisque qu’il s’agit d’une approche plus respectueuse des droits du patient à changer d’avis. L’expérience observée dans les Pays-Bas et en Oregon indique que 40 % des personnes qui demandent l’euthanasie changent d’idée après avoir obtenu les moyens de mettre fin à leurs jours ou après avoir connu un soulagement de la douleur plus adéquat. L’euthanasie et le suicide assisté ne devraient pas se substituer à l’accès à de bons soins palliatifs.In order to legalise euthanasia or assisted suicide one must first conclude that existing methods to foreshorten the life of the terminally ill are not adequate. Currently the practices of suicide, treatment refusal, stopping life-sustaining treatment and the “double effect” or aggressively treating pain symptoms even if life expectancy is compromised (of which terminal sedation is an example) are all legal in Canada. We contend that if other practices are legalized, assisted suicide should be considered rather than euthanasia, since this practice respects better the rights of patients to change their minds. Experiences in the Netherlands and in Oregon indicate that 40 % or more of people who request euthanasia change their minds after obtaining the means or ending their lives or after being offered better treatment of their symptoms. Euthanasia and assisted suicide should not substitute for good palliative care

L’écologie familiale et la consommation de médicaments chez les personnes âgées : commentaires sur un facteur important ignoré dans les recherches et les projets de prévention

Une recension des recherches sur l'utilisation des médicaments chez les personnes âgées de 1986 à 1996 confirme les résultats de recension jusqu'à 1986 (Mishara et McKim, 1989) : peu de recherches empiriques portent sur le rôle de la famille dans les patrons d'utilisation des médicaments chez les aînés. Cet article résume brièvement des études sur les facteurs liés à une bonne utilisation des médicaments ainsi que les programmes de prévention de problèmes liés à l'observance et les réactions indésirables aux médicaments chez les aînés. Nous proposons une conceptualisation du rôle de la famille comme composante de la résilience des aînés et suggérons d'inclure la famille dans les stratégies de diminution des risques découlant d'une mauvaise utilisation des médicaments.A literature review from 1986 to 1996 on medication use by older persons confirms previous conclusions on studies up to 1986 (Mishara and McKim, 1989): there is little empirical research on the role of family members in patterns of medication use by elders. This article briefly summarizes studies of factors related to medication use and prevention programs aimed at reducing problems related to compliance and drug adverse reactions in older persons. We propose a conceptual model of the role of the family as a component of resiliency of elders and we suggest that family members be included in strategies for preventing the risks related to inappropriate use of medicines

Notes on the fish resources of the Bahuda estuary, Orissa, India

Estuaries form an important site for the zoologist as these are the places known to be very rich in food and nutrients and so, become nesting-cum-breeding grounds for many species and also, own good species diversity. Bahuda estuary of Orissa is located at the inter-state border of Orissa and Andhra Pradesh. Explored for many invertebrates, this estuary was not properly investigated for its rich fish fauna. Various surveys at Bahuda estuary revealed that it is an important site of study for the faunal diversity of fishes in the east coast. Forty-eight species belonging to 33 genera under eight orders and 22 families were examined referring standard literature· and methods. Most of the groups of fishes encountered are of commercial importance

Le soutien social peut-il protéger les hommes de la tentative de suicide ?

Cette étude tente d’examiner si le soutien social peut constituer un facteur de protection de la tentative de suicide chez les hommes et, le cas échéant, à identifier quelles sont les formes et les sources de soutien les plus importantes. Elle compare deux groupes d’hommes qui ont vécu des événements de vie sévères au cours des 12 derniers mois : 40 hommes admis à l’urgence d’un hôpital suite à une tentative de suicide et 40 hommes sans antécédent suicidaire. Les résultats indiquent que les hommes qui ont tenté de se suicider perçoivent moins de soutien disponible dans leur entourage et sont moins satisfaits du soutien reçu suite à l’événement le plus difficile survenu au cours de la dernière année. L’aide tangible et l’assurance de sa valeur sont les formes de soutien les plus importantes. L’étude souligne l’importance du soutien social dans la prévention des comportements suicidaires chez les hommes.The goal of this study is to investigate whether social support may constitute a protective factor for attempted suicide among men and, if so, to identify the most important sources and forms of support. The study compares two groups of men who experienced comparable stressful events during the last 12 months : 40 men admitted to hospital emergency following suicide attempts, and 40 men with no history of suicide attempts. Results indicate that the men who attempted suicide perceive less support available and are less satisfied with the support they received following the most difficult stressful event that occurred in the last year. Concrete help and reassurance of worth are the forms of support that appear to be of most importance. This study highlights the importance of social support in the prevention of suicidal behaviours among men.Este estudio intenta examinar si el apoyo social puede constituir un factor de protección de la tentativa de suicidio en los hombres y, en caso contrario, identificar cuáles son las formas y fuentes de apoyo más importantes. Compara dos grupos de hombres que han vivido experiencias graves en el curso de los últimos 12 meses: 40 hombres admitidos en urgencias de un hospital después de una tentativa de suicidio y 40 hombres sin antecedentes de suicidio. Los resultados indican que los hombres que han intentado suicidarse perciben menos ayuda disponible en su entorno y están menos satisfechos del apoyo recibido después del evento más difícil transcurrido en el curso del último año. La ayuda tangible y tener la seguridad de ser valiosos son las formas de apoyo más importantes. El estudio subraya la importancia del apoyo social en la prevención de los comportamientos suicidas en los hombres.Este estudo tenta examinar se o apoio social pode constituir um fator de proteção da tentativa de suicídio nos homens e, se for o caso, identificar quais são as formas e as fontes de apoio mais importantes. Ele compara dois grupos de homens que viveram acontecimentos de vida graves durante os últimos 12 meses: 40 homens recebidos na urgência de um hospital por uma tentativa de suicídio e 40 homens sem antecedente suicidário. Os resultados indicam que os homens que tentaram se suicidar recebem menos apoio disponível ao seu redor e são menos satisfeitos do apoio recebido após o acontecimento mais difícil que ocorreu durante o último ano. A ajuda tangível e a segurança de seu valor são as formas de apoio mais importantes. O estudo ressalta a importância do apoio social na prevenção dos comportamentos suicidários nos homens

No departure to "Pandora"? Using critical phenomenology to differentiate "naive" from "reflective" experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010)

The mind-body problem lies at the heart of the clinical practice of both psychiatry and psychosomatic medicine. In their recent publication, Schwartz and Wiggins address the question of how to understand life as central to the mind-body problem. Drawing on their own use of the phenomenological method, we propose that the mind-body problem is not resolved by a general, evocative appeal to an all encompassing life-concept, but rather falters precisely at the insurmountable difference between "natural" and a "reflective" experience built into phenomenological method itself. Drawing on the works of phenomenologically oriented thinkers, we describe life as inherently "teleological" without collapsing life with our subjective perspective, or stepping over our epistemological limits. From the phenomenology it can be demonstrated that the hypothetical teleological qualities are a reflective reconstruction modelled on human behavioural structure

An Integration of Predictive Coding and Phenomenological Approaches

Current theories in the framework of hierarchical predictive coding propose that positive symptoms of schizophrenia, such as delusions and hallucinations, arise from an alteration in Bayesian inference, the term inference referring to a process by which learned predictions are used to infer probable causes of sensory data. However, for one particularly striking and frequent symptom of schizophrenia, thought insertion, no plausible account has been proposed in terms of the predictive-coding framework. Here we propose that thought insertion is due to an altered experience of thoughts as coming from “nowhere”, as is already indicated by the early 20th century phenomenological accounts by the early Heidelberg School of psychiatry. These accounts identified thought insertion as one of the self-disturbances (from German: “Ichstörungen”) of schizophrenia and used mescaline as a model-psychosis in healthy individuals to explore the possible mechanisms. The early Heidelberg School (Gruhle, Mayer-Gross, Beringer) first named and defined the self- disturbances, and proposed that thought insertion involves a disruption of the inner connectedness of thoughts and experiences, and a “becoming sensory” of those thoughts experienced as inserted. This account offers a novel way to integrate the phenomenology of thought insertion with the predictive coding framework. We argue that the altered experience of thoughts may be caused by a reduced precision of context-dependent predictions, relative to sensory precision. According to the principles of Bayesian inference, this reduced precision leads to increased prediction-error signals evoked by the neural activity that encodes thoughts. Thus, in analogy with the prediction-error related aberrant salience of external events that has been proposed previously, “internal” events such as thoughts (including volitions, emotions and memories) can also be associated with increased prediction-error signaling and are thus imbued with aberrant salience. We suggest that the individual’s attempt to explain the aberrant salience of thoughts results in their interpretation as being inserted by an alien agent, similarly to the emergence of delusions in response to the aberrant salience of sensory stimuli

Application des connaissances scientifiques en prévention du suicide : Vérification d’une stratégie fondée sur la communauté de pratique

Cet article a pour objectif de décrire une expérience pilote fondée sur les principes d’action des communautés de pratique (CoP), afin de rapprocher chercheurs et milieux de pratique en prévention du suicide et favoriser une meilleure utilisation des connaissances scientifiques. Des professionnels (n = 15) de différents organismes concernés par la prévention du suicide au Québec et disséminés sur tout le territoire (Centres de prévention du suicide, centres jeunesse, direction de santé publique, milieux hospitaliers), ainsi que des chercheurs (n = 4) et un animateur de la communauté ont participé à cette expérience innovante. La CoP a permis d’obtenir des effets sur la réceptivité envers les connaissances, l’accès aux ressources et aux connaissances et le développement de collaboration entre les membres. Des conditions préalables semblent cependant nécessaires à des collaborations accrues entre recherche et pratique, notamment un rapprochement sur le plan des valeurs et une relation fondée sur la confiance et le respect de l’autre et la capacité d’investir du temps dans le développement de relations de travail.The objective of this article is to describe a pilot experiment based on community of practice (CoP) action principles and aimed at bridging the gap between suicide prevention researchers and practitioners and encouraging better utilization of research knowledge. Participants in this innovative experiment included professionals (n = 15) from a variety of Quebec organizations concerned with suicide prevention located throughout the province (suicide prevention centers, youth centers, public health department, hospital settings), researchers (n = 4) and one community animator. The CoP made it possible to obtain effects on receptivity to knowledge, access to resources and knowledge, and the development of collaboration between members. However, it would appear that certain preconditions are necessary for increased collaboration between researchers and practitioners, notably the development of greater common ground in terms of values and a relationship based on trust and mutual respect and the ability to invest time in the development of work relations