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Kowalinski E, Ziltener T, Staub S, Moeller J, Trachsel M, Schneeberger AR, Franke I, Lang UE, Huber CG. Physician assisted-dying in mentally and somatically ill individuals in Switzerland: Protocol for survey-based study. Front Psychiatry 2022; 13:987791. [PMID: 36386979 PMCID: PMC9651943 DOI: 10.3389/fpsyt.2022.987791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Article 115 of the Swiss Penal Code (StGB) permits physician-assisted dying (PAD), provided it is not performed for "selfish reasons," and thus, occupies a special role in international comparison. However, the Swiss federal law does not regulate who exactly is entitled to access PAD, and there is no universal agreement in the concerned professional societies. Additional uncertainty arises when assessing the wish for PAD of a mentally ill person compared to a somatically ill person. OBJECTIVES This study aims to contribute to the discussion of PAD among the mentally ill and to provide insight into the current situation in Switzerland. METHODS This is a monocentric prospective observational survey-based study. We will conduct an exploratory online/telephone survey about PAD in somatic vs. mental illness in Switzerland. The survey sample will comprise 10,000 Swiss residents of the general population from all three language regions (German, Italian, and French) as well as 10,000 medical professionals working in the seven states ("cantons") of Basel-Stadt, Basel-Landschaft, Aargau, Lucerne, Graubünden, Ticino, and Vaud. Opinions on PAD in mentally and somatically ill patients will be assessed using 48 different case vignettes. Each participant will be randomly assigned a somatic terminal, a somatic non-terminal, and a mental non-terminal case vignette. Furthermore, the attitude toward the ethical guidelines of the Swiss Medical Association of 2004, 2018, and 2022, as well as the stigmatization of mentally ill people will be assessed. DISCUSSION Physician-assisted dying in mentally ill persons is a highly relevant yet controversial topic. On the one hand, mentally ill persons must not be discriminated against in their desire for PAD compared to somatically ill persons while at the same time, their vulnerability must be considered. On the other hand, treating physicians must be protected in their ethical integrity and need security when judging PAD requests. Despite its relevance, data on PAD in the mentally ill is sparse. To regulate PAD for the mentally ill, it is therefore important for Switzerland-but also internationally-to gain more insight into the ongoing debate. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT05492461.
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Affiliation(s)
- Eva Kowalinski
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Tiziana Ziltener
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Staub
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Julian Moeller
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Manuel Trachsel
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Clinical Ethics Unit, University Hospital Basel (USB), Basel, Switzerland.,Biomedical Ethics, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Andres R Schneeberger
- Behavioral and Mental Health Care, University of San Diego, San Diego, CA, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Adult Psychiatry, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Departments of Adult and Forensic Psychiatry, Psychiatric Services Grisons (PDGR), Chur, Switzerland
| | - Irina Franke
- Departments of Adult and Forensic Psychiatry, Psychiatric Services Grisons (PDGR), Chur, Switzerland.,Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Undine E Lang
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Christian G Huber
- Department of Adult Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
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Abstract
The authors report of their experience of mammary augmentation with anatomical implants from 10 years ago. The important proportion of rotation of those anatomical implants obliged them to stop the clinical serie. Sylvain Staub return to a "revisited" classical technique with round implants, smooth in a majority of cases and placed them most of the time in a retromuscular pocket. Eric Auclair, ceduced by the concept of anatomical implants, decided to continue in this direction with a personal concept of anti rotation system. He shows a strategie of mammary augmentation that favorise the premuscular position and define the respective place of round and anatomical implants.
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Affiliation(s)
- E Auclair
- IECEP, 10, rue Anna Jacquin, 92100 Boulogne, France.
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Leygue E, Gol-Winkler R, Gompel A, Louis-Sylvestre C, Soquet L, Staub S, Kuttenn F, Mauvais-Jarvis P. Estradiol stimulates c-myc proto-oncogene expression in normal human breast epithelial cells in culture. J Steroid Biochem Mol Biol 1995; 52:299-305. [PMID: 7734397 DOI: 10.1016/0960-0760(94)00180-t] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The proto-oncogene c-myc is involved in the stimulation of cell proliferation, and its expression is known to be stimulated by estradiol (E2) in human breast cancer cell lines and various non-cancerous E2-dependent tissues. However, little information is currently available concerning its expression and regulation in normal human breast tissue. We therefore studied c-myc expression and hormone modulation in normal human breast epithelial (HBE) cells in culture, routinely obtained in our laboratory and which remain hormone-dependent. On these normal HBE cells, E2 induced a biphasic increase in c-myc mRNA level, with a first peak as early as 30 min, and a secondary increase after 2 h of treatment; this stimulation was dose-dependent, with an optimal concentration of 10 nM E2. Its primary action is probably at the transcriptional level since the half-life of c-myc mRNA measured in the presence of actinomycin D (12 +/- 3 min) was not modified by E2 treatment. In addition, E2 stimulation of c-myc mRNA does not require protein synthesis since it was not suppressed by cycloheximide treatment. Western blot studies of c-myc protein in HBE cells revealed the same biphasic pattern of stimulation, with a first peak after 60 min and a second one after 2 h of E2 treatment. In conclusion, the c-myc proto-oncogene is expressed in normal HBE cells, as in breast cancer cells. Moreover, E2 stimulates c-myc expression which, therefore, may partly mediate the growth-promoting effect of E2.
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Affiliation(s)
- E Leygue
- Department of Reproductive Medicine, Hôpital Necker, Paris, France
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