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Hot Topics of 2016: In and Around Psychiatry: Page 2 of 3

Hot Topics of 2016: In and Around Psychiatry: Page 2 of 3

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Physician-assisted suicide

Several of our contributors mentioned social issues or phenomena. Dr. Cynthia Geppert notes the rising trend for states in the US to pass laws that legalize physician-assisted suicide. She cites the important Pies article published in Psychiatric Times about a new Canadian law with frightening prospects for catastrophic outcomes.13 Unlike other laws in the US or abroad, the Canadian law codifies physician-assisted suicide not only for a life-limiting illness but also for what the bill calls “intractable” mental illnesses—to include not only dementia but also disorders such as depression or PTSD.

The most, but not only, appalling component of the law is that it applies to minors as well as the elderly or others with terminal physical illnesses. Dr. Geppert writes, “ . . . ask yourself if you believe we can define what intractable means in psychiatry? Do we really know when a patient’s case is futile? Are depressed adolescents truly capable of a rational decision to die?” Of even greater concern, she notes that this law was changed without long study, rigorous research, or important debate, which usually precede major changes in mental health public policy.

Violence

Dr. Renato Alarcon focuses our attention on the global epidemic of violence and its psychological impact. He writes,

The August 16 photograph of Omram Daqueesh, the 5-year-old boy from Aleppo, Syria, looking dusty, bleeding copiously, stunned and weary, unable to understand the why and how of deadly airstrikes over his hometown, was the most dramatic representation of a human crisis of universal proportions.14 As a reflection of cruelty, fanaticism, neglect, and opportunism, this development showed the global impact of violence as an emotional and behavioral trait almost gone out of control. Violence and its many faces, its presence in multiple forms (war, crime, abuse, exploitation, homelessness, murder) practically all over the world (and the US is not certainly an exception), has become in 2016 the most formidable challenge to American and world psychiatry’s discourse, role, and actions as a professional, academic, and scientific endeavor. . . . psychiatry has witnessed this year a seemingly unstoppable, world-wide dehumanizing process. Studying its nature, educating society and fighting against the emotional wounds of violence to correct its erosive course, must gain prominence as the main objectives of our discipline now and in the future.

Parity and politics

In the government action arena, I was very pleased to see the October announcement of the release of the final report from the Obama administration’s Federal Parity Task Force. The report outlines action steps to strengthen insurance coverage for mental health and substance use disorders.15 The comprehensive and lengthy set of action items and proposed regulatory changes are encouraging and long overdue. My enthusiasm is tempered by the November elections and the likelihood that the incoming administration will not take the needed actions to implement the recommendations nor support ongoing funding.

And, speaking of the election, I feel compelled to say a few words. Dr. Steve Moffic wrote that he thought the important issue for us about the presidential election is that we should re-evaluate the strictures placed on members of the American Psychiatric Association by the “Goldwater Rule.” This APA policy was put into place following the 1964 presidential election when a number of psychiatrists publically stated their belief that Barry Goldwater had a mental illness. The rule prohibits saying such a thing about a person who we have not personally evaluated nor without that person’s permission. Personally, I think it’s a good rule, although I agree that there may well be value in revisiting it. I wrote earlier in the campaign about my views of the very low value of untrained people wildly throwing around diagnoses, and you can read it again if you wish.16

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