Contested social care- is there a ?right? way? How public investments diminish attitudinal differences towards social care in 34 European countries

The COVID-19 pandemic has uncovered the critical nature of social care for modern societies and the moral dilemmas related to the organisation of care, specifically in terms of frail adults. The scarcity of personnel in nursing homes challenged the possibility of adequate care, spurring debates on both the dignity of dependent people and end-of-life treatments. While 'classical' social care policies already stimulate conflicts about the 'right way' of caring, non-classical care policies, such as assisted dying, are particularly contested. We advance existing research by analysing public attitudes on both care policies jointly and, hence, integrate the literature on morality policy and social care. Based on multi-level analyses, combining individual-level with macro-level data from 34 countries, we uncover that gender and religious identity drive deviating attitudes in both fields, while long-term care expenditure mitigates scepticism among Catholics but less so among Muslims.

Attenuated effects of rivastigmine in induced cytokine storm in mice

Background: A cytokine storm is a serious clinical condition that complicates infectious diseases, for example, coronavirus disease 2019 (COVID-19), and non-infectious diseases such as autoimmune diseases and cancer and may often lead to death. The patients who are affected by the cytokine storm are almost always severe/critical and at risk for acute respiratory distress syndrome or eventually death. Pro-inflammatory cytokines such as interleukin 6 (IL-6), IL-1 beta, and tumor necrosis factor alpha (TNF-alpha) have been repeatedly shown to be related to the COVID-19 disease severity and mortality. In this study, our objective was to evaluate the attenuated effect of rivastigmine (RA) in a cytokine storm in Swiss Albino mice in which the cytokine storm was induced by lipopolysaccharide (LPS) and to explore their effects on IL-1 beta, IL-6, and TNF-alpha levels. Method(s): This study was carried with 60 male Swiss albino mice that were divided equally and randomly into six groups as follows: *Group AH: Apparently healthy control group which received no induction, not treated. *Group LPS: Induced using LPS at 5 mg/kg and no treatment administered. *Group DMSO: Induced and treated with 1% dimethyl sulfoxide (DMSO). *Group RA: Induced and treated with 0.5 mg/kg RA. *Group MPA: Induced and treated with 50 mg/kg methylprednisolone (MPA). *Group RMPA: Induced and treated with 0.25 mg/kg rivastigmine and 25 mg/kg of methylprednisolone. All the mice were treated with drugs or vehicles for three consecutive days before LPS induction. The mice were then injected with LPS intraperitoneally at a dosage of 5 mg/kg for systematic inflammatory stimulation. After 48 hours of LPS induction, all the mice were euthanized by light anesthesia with chloroform, and blood was collected for the quantitative determination of IL-1beta, IL-6, and TNF-alpha levels using the enzyme-linked immunosorbent assay (ELISA) technique. Result(s): Administration of LPS to Swiss albino mice caused a significant elevation of IL-1beta, IL-6, and TNF-alpha levels than in the healthy control group. Significant reduction of these parameters were observed in the RA and MPA groups when compared with those in the non-treated group. Conclusion(s): RA was found to be effective in attenuating the induced cytokine storm by suppressing IL-1beta, IL-6, and TNF-alpha levels, and the results with RA were comparable to that of MPA. A combination of half-doses of both RA and MPA administered together shows no obvious advantage when compared with that of each of them alone.Copyright © 2022 Mansoor, Raghif, licensee HBKU Press

The Rise of Heatstroke as a Method of Depopulating Pigs and Poultry: Implications for the US Veterinary Profession.

Depopulation of food-producing animals is becoming increasingly common in response to both disease outbreaks and supply chain disruptions. In 2019, the American Veterinary Medical Association released depopulation guidelines classifying certain heatstroke-based killing methods as "permitted in constrained circumstances", when circumstances of the emergency constrain reasonable implementation of "preferred" methods. Since then, tens of millions of birds and pigs have been killed by such methods, termed ventilation shutdown (VSD) Plus Heat and VSD Plus High Temperature and Humidity. While no research using validated measures of animal welfare assessment has been performed on these methods, their pathophysiology suggests that animals are likely to experience pain, anxiety, nausea, and heat distress prior to loss of consciousness. Heatstroke-based methods may result in prolonged suffering and often do not achieve 100% mortality. Potential and available alternative depopulation methods are briefly reviewed. The veterinary profession's ethical obligation to protect animal welfare in the context of depopulations is discussed.

Economic Euthanasia in Dogs Requiring Emergency Surgery Increased during the Covid-19 Pandemic

INTRODUCTION: 'Economic euthanasia', defined as euthanasia of pets due to financial constraints despite treatable illness, is common in veterinary emergency medicine. Gastric dilatation-volvulus (GDV) in dogs is inexpensive to diagnose and has a high survival rate with corrective, but costly, surgery. Without surgery, GDV is lethal. The proportion of dogs with GDV euthanized pre-surgery emerged as a reliable metric of economic euthanasia. If the COVID-19 pandemic aggravated economic distress in dog owners compromising their ability to afford pet healthcare, an increase in pre-surgical euthanasia in dogs with GDV would be expected. We hypothesized that in dogs with GDV, the risk of pre-surgical euthanasia during the COVID-19 pandemic increased compared to such risk before the pandemic. METHOD(S): In this case-control study, we included nonreferred dogs with GDV that presented to 11 US veterinary hospitals. Dogs were cases if they were euthanized presurgery, and controls if they underwent surgical treatment. Exposure positive dogs were those presenting during the initial surge of unemployment due to COVID-19 (March 16 - July 5 2020), exposure negative dogs were those during the same period in 2019. Univariate analyses and binary logistic regression models were developed to quantify the association between COVID-19 status (present, absent) and euthanasia risk, adjusting for the effect of known confounders. The significance level was set at p < 0.05. RESULT(S): We recorded 118 dogs with GDV over the 2 time periods, with 30% of non-exposed and 52% of exposed pets being euthanized pre-surgery (OR, 2.6;95% CI, 1.2-5.4). After adjusting for age, breed, comorbidities and recumbency, the odds of euthanasia for dogs presenting during COVID-19 were 2.7 (95% CI 1.1 to 6.3) times those of dogs presented in 2019. Old age (OR, 2.6;95% CI, 1.1 to 6.1), but no other explanatory variables, were associated with pre-surgical euthanasia. CONCLUSION(S): Our findings show that in this study population, dogs with GDV presented in the period March 16 to July 5 2020 had a greater risk of euthanasia compared with dogs presented in the same period the year before. It is our inference that economic consequences arising from the COVID-19 pandemic directly impacted on the level of veterinary care owners were able to provide for their pets.

Euthanasia: Dilemma for Medical Practitioners or Panacea for a Dying Patient

Introduction: Doctors are synonymous oflife. In recent pandemic Covidl9, doctors were given novel appellation as "Devdoot", who fought selflessly with the pandemic to save the civilization. During the pandemic, doctors couldjustify the medical oath which is taken at the time ofpassing out ceremony. But when the same doctors are requested by patients or their family members for peaceful death of the patient, it put the medical fraternity under dilemma, whether they should accept the request or continue fight with the disease till last. Objectives: The article examines the different types of Euthanasia and medical practices prevailing in Europe and USA. It also explains the present status on Euthanasia in India. Authors also conducted a sample study to take the opinion ofdoctors in India. Conclusion: Modem inventions in Information Technology (IT) have revolutionized the world. Now the geographical distances among the countries does not matter. The entire world has become a global village. An invention in one country becomes available to the entire word within nano seconds. It has been proved by the recent pandemic Covid19 which engrossed the entire world. No part of the world could be spared from covid causalities. Despite such various magnificent inventions in medical science, "man is still mortal" and Medical Science still struggling to conquer the human death. A large number diseases are still out ofpurview ofdoctors which are incurable and causes ofunbearable pain and mental trauma for the victims as well as for their nearest and dearest, where ultimate death is certain. Medical Science could defer or delay the death but could not eliminate the death. Citizens ofWestern world are becoming more vocal for euthanasia, but Asian countries are still in discussion phase. India is still do not have any legal prescription on euthanasia. In general, doctors in India do not prescribe or administrate euthanasia directly or indirectly. Government should frame a law to protect the medical fraternity from any legal complicacies in this regard. © 2022 JK Practitioner. All rights reserved.

Impact of Covid-19 Visitation Restrictions on Veterinary Critical Care Staff

Introduction: Historically, visitation of critically ill animals had been common in veterinary ICUs, with visits chaperoned by both veterinarians and the nursing team. Visits may represent a source of comfort and information for owners, but may also be time-consuming to veterinary staff. During the COVID-19 pandemic, almost all specialty/emergency veterinary hospitals pivoted to curb-side service, and typically highly limited client entry into the building for staff safety. Similar restrictions on visitation were instituted in human ICUs, leading to stress among clinicians, nurses, and patient families. The proposed study aimed to assess the visitation policies reported by critical care veterinarians and technicians and the spectrum of effects on veterinary team members. Method(s): An electronic survey was distributed to the emergency and critical care community using email and social media. The study was exempted by the institutional review board. Survey questions included demographics, COVID-19 hospital policies, and questions about the impact of restricting visitation. Descriptive statistics were used. Result(s): There were 326 respondents to the survey, with veterinarians (53%) and veterinary technicians/assistants (40%) being the most common. Visitation restrictions were reported by 286 (88%) participants. Of those, 264 (81%) reported permitting visits only for euthanasia/endof life discussion and/or on a case-by case arrangement and 20 (6%) allowed no visitation at all. By comparison, prior to COVID-19, 309 (95%) respondents reported no visitation restrictions. For the veterinary team, 244 (75%) felt sad if they had to decline a visit, while 211 (65%) reported feeling anxious and/or guilty. Most respondents (218;67%) felt the owners were understanding. Restricting visits was perceived to improve time for patient care for 195 (60%) respondents, decrease overall workload for 192 (59%) respondents, and decrease stress for 137 (42%) respondents. Conclusion(s): Visitation restriction impacts veterinary staff both positively and negatively;careful evaluation of visitation policies is warranted. The impact on owners should also be evaluated.

Choosing to Die.

Two articles in the September-October 2022 issue of the Hastings Center Report discuss health-related reasons that people might have to actively bring their lives to an end. In one, Brent Kious considers the situation of a person who, because of illness, becomes a burden on loved ones. A person in such a situation might prefer to die, and Kious argues that, while there is no obligation to hasten one's death, the choice to do so could sometimes be reasonable. In a second article, Henri Wijsbek and Thomas Nys discuss a case in the Netherlands in which a woman with severe dementia was euthanized at a point when her advance euthanasia directive did not align with what she said, when asked, about death. Wijsbek and Nys defend the authority of her advance directive against a range of objections. In a third article, Henry Silverman and Patrick Odonkor, physicians at the University of Maryland Medical Center, where the first pig-to-human heart transplantation was performed in early 2022, develop recommendations for clinical trials of porcine heart transplantation. And an essay in the issue criticizes the allocation recommendations developed for Covid-19 vaccines by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

How is COVID-19 changing the ways doctors make end-of-life decisions?

BACKGROUND: This research explores how the COVID-19 pandemic has changed the ways doctors make end-of-life decisions, particularly around Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR), treatment escalation and doctors' views on the legalisation of euthanasia and physician-assisted suicide. METHODS: The research was conducted between May and August 2021, during which COVID-19 hospital cases were relatively low and pressures on NHS resources were near normal levels. Data were collected via online survey sent to doctors of all levels and specialties, who have worked in the NHS during the pandemic. RESULTS: 231 participants completed the survey. The research found that over half of participants reported making more patients DNACPR than prepandemic, and this was due, at least in part, to an increased focus on factors including patient age, Clinical Frailty Scores and resource limitations. In addition, a sizeable minority of participants reported that they now had a higher threshold for escalating patients to ITU and a lower threshold for palliating patients, with many attributing these changes to formative experiences gained during the pandemic. Finally, our study found that there has not been a statistically significant change in the views of clinicians on the legalisation of euthanasia or physician-assisted suicide since the start of the pandemic. CONCLUSION: The COVID-19 pandemic appears to have altered several aspects of end-of-life decision making, and many of these changes have remained even as COVID-19 hospital cases have declined.

Trends in Intake and Outcome Data From U.S. Animal Shelters From 2016 to 2020.

In this retrospective, exploratory study, intake and outcome data were compiled from 1,373 U.S. animal shelters for which such data were reported consistently across a five-year study period (2016-2020). Linear regression analysis was used to examine the five-year trends and the impacts of the first year of the COVID-19 pandemic (2020) on the overall trends in intake and outcomes in U.S. animal shelters. The results of the analysis reveal that total intake and euthanasia for both dogs and cats significantly decreased over the study period. The adoption, return-to-owner, return-to-field, and transfer (for cats) categories as a percentage of intake all showed significant increases. Live release rates as a function of total intakes and total outcomes for both dogs and cats showed significant increases over the study period. The findings from this study address a critical gap in the field by summarizing emerging trends at the national level in how cats and dogs are being served in U.S. animal shelters.

A curious method to commit suicide

Objective: The COVID-19 pandemic has generated an increase in anxiety-depressive disorders throughout society, with an evident impact on children and adolescents, further precipitated by limitations in social activities during confinement. The increase in home isolation with abuse of new technologies, often far from parental control, involves risky situations such as the case we present. Case report: A 19-year-old man diagnosed with major depressive disorder, with psychiatric admissions since July 2019 for overdose with suicidal intent was home treated with methylphenidate 40mg, mirtazapine 15mg and vortioxetine 10mg. In August, the patient was searching for information on the Internet about euthanasia and suicide without pain in different pages and Internet forums. He bought two products online (by Amazon) that seemed effective for this purpose: a kilogram packet of sodium nitrate and a bottle of antifreeze. Finally, he decided on the first option due to the risk of suffering after ingesting antifreeze. On August 26 (4:00 pm), he ate a tablespoon (80 mg) of sodium nitrate. He developed dyspnea and feeling overwhelmed so he decided to informed his family of what he had done and an ambulance was called. He was transferred to hospital and given oxygen. At 7:00 pm in the emergency department he was noted to have a greyish coloration (“hot dead” appearance) with poor respiratory mechanics, tachycardic, tachypneic, with signs of peri-arrest: blood pressure 96/50mmHg, heart rate 145 bpm, respiratory rate 30/min, oxygen saturations 70%. He also had uncoordinated movements, and could not obey orders. The patient was sedated for intubation and mechanical ventilation. An arterial blood gas analysis performed after intubation showed: pH 7.35, pO2 165mmHg, pCO2 24mmHg, base excess -10.4, bicarbonate 14.5 mEq/L, potassium 3.1 mmol/L, methemoglobin 83%, carboxyhemoglobin 1.4%, lactate 13.3mmol/L. Methylene blue 1% (75mg intravenously) and activated charcoal by nasogastric tube were administered (after intubation). Later, he was admitted to the intensive care unit (9:20 pm). Physicians from this unit decided to administrate hydroxocobalamin (5 g intravenously at 00.39 am). The patient was extubated and discharged from the intensive care unit 36 hours after his admission to the department of Internal Medicine, without clinical complications;later he was transferred to Psychiatry Department. Conclusion: The toxic mechanism of sodium nitrate is related to the generation of methemoglobin. This patient survived a potentially lethal methemoglobin level following intentional ingestion of sodium nitrate with prompt administration of an antidote.

PULMONARY CMV REACTIVATION FOLLOWING SARS-CoV-2: IMPLICATIONS for IMMUNOPATHOLOGY

Background: SARS-CoV-2 infection results in a spectrum of disease severity attributable to the magnitude of the underlying inflammatory response. Aged individuals with co-morbidities are most vulnerable and severely affected, but the mechanisms driving aberrant immune responses fueling SARS-CoV-2 immunopathology in this high-risk population are not fully elucidated. We hypothesized that asymptomatic CMV infection might exacerbate SARS-CoV-2 pathogenesis since its replication is both a cause and consequence of inflammation and appears to worsen oxygenation in critically ill patients (Limaye, JAMA, 2017). CMV-seropositivity was associated with increased hospitalization among people with SARS-CoV-2 infection (Shrock, Science, 2020). To begin to address this hypothesis, we utilized the rhesus macaque model of natural rhesus (Rh)CMV infection to investigate the extent to which SARS-CoV-2 induces CMV reactivation in the anatomic sites of SARS-CoV-2 pathology. Methods: To assess CMV reactivation, eight aged, type 2 diabetic RhCMV-seropositive rhesus macaques (sera anti-CMV IgG: 300-1400 ng/ml) were infected with high-dose SARS-CoV-2 (2.5x10 6 PFU) and monitored for 7 days prior to euthanasia. Samples from the respiratory tract, intestinal tract, and blood were collected to assess viral and inflammatory dynamics in distinct tissue compartments. Results: Following infection, SARS-CoV-2 replication was observed throughout the respiratory tract, which was associated with local and systemic inflammation and immune activation. Lung histopathological assessments revealed development of interstitial pneumonia with colocalization of SARS nucleocapsid protein within pneumocytes. qPCR assays targeting RhCMV gB showed CMV DNA within the caudal lung lobe (up to 103 CMV DNA copies/mg of tissue) in all animals at day 7, and the animal with the highest CMV DNA presented with the most profound clinical symptoms. Strikingly, CMV DNA copies strongly correlated with CD4 and CD8 T cell activation indices in blood and spleen (r = 0.96, p< 0.001). Additionally, we found RhCMV reactivation in the ileum, where high levels of ACE2 are reported. Conclusion: SARS-CoV-2 infection of RhCMV-seropositive macaques results in CMV reactivation in the anatomic sites where SARS-CoV-2 causes pathology. Future experimental studies should address whether CMV reactivation exacerbates SARS-CoV-2 pathogenesis.

Innovative Strategies for Managing Swine Welfare During Natural Disasters

Coronavirus Disease 2019 (COVID-19) was declared a global pandemic on March 11, 2020, by the World Health Organization. By April 2020, COVID-19 resulted in the simultaneous closure or reduced operations of many processing plants in the upper Midwest, which quickly resulted in supply chain disruptions. Iowa is the leading pork production and processing state, and these disruptions caused producer uncertainty, confusion, and stress, including time-sensitive challenges for maintaining animal care. The Resource Coordination Center (RCC) was quickly created and launched from the Iowa Department of Agriculture and Land Stewardship. The RCC had strategic collaborations with public representation from the Iowa Pork Producers Association, Iowa Pork Industry Center, and Iowa State University Extension and Outreach, and private partners through producers, veterinarians, and technical specialists. The RCC’s mission was four-fold: (1) implement appropriate actions to ensure the health and safety of RCC members, stakeholders, and the public, (2) evaluate and reassess appropriate actions as needed for continuity of pork production operations, (3) provide information to pork producers during supply chain disruptions, and (4) maintain a safe and abundant pork supply for consumers. The command structure included Incident Commanders, Command Staff, and four Section Chiefs whom worked with their respective experts. Sections covered (1) operations, (2) planning, (3) logistics, and (4) finance and administration. As it related to animal welfare, the RCC provided information on management decisions, dietary alterations to slow pig growth, pig movement to increase living space, alternative markets, on-farm euthanasia and mass depopulation. Veterinary oversight was continually maintained. A manual was created to provide up-to-date information to inform producer decisions and aid. Although originally created for swine, the RCC also assisted poultry, cattle and sheep producers. In a crisis, Iowa created a model that reacted to producer’s pragmatic and emotional needs. This model could be replicated for any emergency by other states.

Economic losses due to meat processing plants shutdown/slowdown

Temporary closure and slowdown of US meat processing plants due to the COVID-19 pandemic resulted in euthanasia or depopulation of livestock. This article outlines the methods of depopulation, and the federal programs to offset the associated costs and lost production value;and estimates the economic losses in 2020.

Inmate cancer patient - Highlighting the importance of a holistic approach to oncological care

Purpose: Inmate oncologic patients' rates increased drastically worldwide. Elderly, limited exercise, unhealthy diet, hepatitis, HIV + status, tobacco and alcohol use, constitute the main cancer risk factors. We present an outline of practical oncological management and ethical thinking, in the specific environment of a detention facility. Methods: PubMed, Cochrane Database of Controlled Trials, SCOPUS and grey literature were extensively searched up to October 2021. Incarcerated oncologic patients experience various everyday challenges:their confinement in high security facilities, the lack of access to critical care and related ethical dilemmas inherent to the context of a correctional facility. Results: The detention facilities may be inadequate in providing early cancer diagnosis and appropriate care mainly due to a lack of specialized personnel, b) in-house or in external specialized cancer hospitals, care variability (e.g. admissions in small local or regional hospitals), c) delays in providing access and d) gatekeeper systems. There is a paucity of administration of a)systemic therapy (chemotherapy, targeted drug therapy etc),b)radiotherapy, c) palliative care, and d)enrollment in clinical trials. Conclusions: Correctional facilities must encourage teamwork between healthcare and correctional professionals in order to improve the provided anticancer care.

Providing Legal Assisted Dying and Euthanasia Services in a Global Pandemic: Lessons for Ensuring Service Continuity.

Background & objectives: Identifying the impacts of COVID-19 on patients' and practitioners' access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic.Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services (n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered.Results: Following governments' responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated 'rule-breaking' considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change.

Physicians' Characteristics and Attitudes Towards Medically Assisted Dying for Non-Competent Patients with Dementia.

The federal and Quebec governments are both considering extending medical aid/assistance in dying (MAID) to non-competent patients who would have requested MAID prior to losing capacity. In 2016-2017, we surveyed 136 Quebec physicians (response rate: 25.5%) on their attitudes towards extending MAID to such patients. Complementing our published findings, we herein identify demographic and practice characteristics that distinguish physicians who reported being open to extending MAID to non-competent patients with dementia, or willing to administer MAID themselves should it be legal, from those who were not. We found that physicians who were older, had stronger religious beliefs, were trained in palliative care, practiced in a teaching hospital, and had not received assisted dying requests in the year preceding the survey held less favourable attitudes towards MAID for non-competent patients with dementia. These findings will inform current deliberations as to whether assistance in dying should be extended to non-competent patients in some circumstances.

Low and No-Contact Euthanasia: Associated Ethical Challenges Experienced by Veterinary Team Members during the Early Months of the COVID-19 Pandemic.

BACKGROUND: During the ongoing COVID-19 pandemic, many veterinary practices around the world have shifted to a low or no-contact consultation model to ensure the safety of their team members and clients, and comply with public health orders, while continuing to provide veterinary care. METHODS: We performed reflexive thematic analysis on a subset of data collected using a mixed-methods survey of veterinary team members globally. RESULTS: There were 540 valid responses available for analysis. Low and no-contact euthanasia we raised as a common and/or stressful ethical challenge for 22.8% of respondents. We identified five key themes: no-contact euthanasia as a unique ethical challenge; balancing veterinary team safety with the emotional needs of clients; low and no-contact protocols may cause or exacerbate fear, anxiety and distress in veterinary patients; physical distancing was more challenging during euthanasia consultations; and biosecurity measures complicated communication around euthanasia and end-of-life decision making. RECOMMENDATIONS: In light of concerns highlighted by respondents, we recommend the development of a toolkit of protocols that will assist veterinary team members in performing low-contact euthanasia in a range of circumstances, in alignment with their values and professional ethical codes. Professional bodies may be involved in developing, updating and disseminating this information, and ensuring a continuous supply chain of PPE.

Lessons and Recommendations from a Pentobarbital Shortage: US and Canada 2021.

In 2021, a shortage in the supply of the euthanasia drug pentobarbital sodium affected animal care professionals around the world, including in the United States and Canada. Pentobarbital sodium is the drug of choice for companion animal euthanasia in both countries. The decreased availability of pentobarbital sodium affected a number of animal care industries, forcing conservation of the drug and the use of alternative methods and other agents to facilitate humane death for all manner of animal species. Veterinary medical groups, laboratory research institutions, and the animal sheltering industry worked together to identify the best path forward to maintain routine euthanasia practices and to protect the welfare of animals. This article aims to explore the reasons behind the shortage and to highlight the necessary responses and adjustments made in order to continue providing euthanasia services in North America. Recommendations for handling future pentobarbital shortages are included.

Highlights of this issue

Combining data from 12 UK population studies, they found that people with poor pre-pandemic mental health experienced greater overall disruption to their lives across multiple domains, but specifically greater likelihood of economic and healthcare disruptions. Prior research demonstrating that clinician questions about suicidal behaviour don't increase the risk of such behaviour has been reassuring and influential for conducting safe and good-quality risk assessments. Using data from The Netherlands and Belgium, where psychiatric euthanasia and/or medically assisted suicide (EAS) is permitted, they critically examine the difference between EAS and suicide – arguing that the characterisation of suicide as impulsive or violent is not necessarily an accurate or sufficient distinction from the apparently calm ‘death wish’ of EAS.