1: Questions on the treatment of patients with severe and persistent mental illness (SPMI) |
In the treatment of patients with SPMI, how important is |
(a) curing the illness? |
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(b) reduction of suffering? |
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(c) the patient's ability to function in daily life? |
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(d) the patient remaining autonomous in their decision making? |
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(e) impeding suicide? |
According to the World Health Organization, palliative care “is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” |
How strongly do you agree or disagree with the following? |
(f) For me, the term “palliative” relates directly to end of life. |
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(g) For some SPMI patients, palliative care is indicated. |
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(h) In psychiatry, applying a palliative care model is important in providing optimal support for certain patients without a life-limiting medical illness. |
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(i) In severe, chronic and therapy-refractory anorexia nervosa, a palliative approach would be suitable. |
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(j) In severe, chronic and therapy-refractory schizophrenia, a palliative approach would be suitable. |
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(k) In severe, chronic and therapy-refractory depression, a palliative approach would be suitable. |
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(l) In severe, chronic and therapy-refractory bipolar disorder, a palliative approach would be suitable. |
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(m) In severe, chronic and therapy-refractory substance disorder, a palliative approach would be suitable. |
How strongly do you agree or disagree with the following? |
(n) SPMI can be a terminal illness. |
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(o) Sedation for the reduction of unbearable refractory psychological symptoms is justifiable in certain cases of SPMI. |
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(p) I would generally be willing to perform sedation as mentioned in item o. |
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(q) I generally advocate for the access to assisted suicide for patients with SPMI. |
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(r) I would generally support a patient in his or her wish to seek assisted suicide by writing a medical report or referring him or her to a respective organization. |
2: Questions about the three case vignettes |
Please evaluate the three case vignettes. |
(a) I would not be surprised if this patient died within the next 6 months. |
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(b) For this patient, further curative interventions would most likely be futile. |
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(c) In this case, I would be comfortable with a reduction of life expectancy to increase or maintain quality of life if consistent with the patient's goals. |
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(d) In this case, I would accept a temporary decrease in quality of life because of coercive measures. |
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(e) In this case, I would not proceed against the patient's wishes. |
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(f) In this case, sedation to reduce an unbearable refractory symptom is reasonable. |
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(g) If there is an explicit and enduring wish for assisted suicide, I would support this patient in his or her plan and refer him or her to a respective organization. |