End-of-life issues for clinical practice present complex ethical, moral and legal dilemmas that have been heightened by advances in medical technology enabling a dying patient to be kept alive for longer than ever before. Respect for patient autonomy and dignity are fundamental ethical components that engage in end-of-life decision-making. A mentally competent individual has the absolute right ...

OBJECTIVE Peer-to-Peer, sponsored by the National Alliance on Mental Illness (NAMI), is a structured, experiential, self-empowerment, relapse prevention and wellness program led by trained peer mentors for people with mental illnesses. The authors conducted the first empirical evaluation of the program by using a pre-post survey design. METHODS Approximately 550 participants who were enrolled...

In this issue of the Journal, Swanson et al. explore the demand for and utilization of psychiatric advance directives (PADs), and discuss some of the barriers to their greater acceptance. This author suggests that PADs may be more widely accepted and utilized if they are viewed as tools for maximizing individual autonomy, with an emphasis on optimizing rather than merely restricting care.

Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced...

Dying with dignity – advance directives To the Editor: We may be grateful to Dr Larsen for drawing our attention to the recent launch of Dignity SA.1 Dignity SA aims to support the provision of palliative care plus an option of legalised assisted dying; their website is http://dignitysa.com/. In this aim, they reflect the UK organisation: Dignity in Dying, with its years of experience and their...

Several studies have explored differences between North American and European doctor-patient relationships. They have focused primarily on differences in philosophical traditions and historic and socio-economic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultur...

Continuing care settings cater for some of the most disabled individuals. Their care can often present major ethical dilemmas; teams involved in such care require a broad range of skills. We illustrate this with a challenging case history and discuss specific dilemmas, including investigation and treatment in the absence of specific consent and advance directives. We suggest that continuing car...

Introduction In Germany, advance directives (AD) are written documents explaining what medical treatment the individual would prefer in the future, should that individual lack mental capacity. AD are legally binding. When a patient has lost mental capacity, the treating physician judges whether the AD is applicable or not. The AD is applicable if the patient’s present condition matches the clin...