Improving Palliative Care and Medical Assistance in Dying Practice in Canada: How Patients-Partners Could Contribute to Continuing Medical Education

Medical Assistance in Dying (MAiD) is still considered an evolving practice in Canada. Practitioners are facing the challenge of staying up to date and hence need efficient continuing medical education (CME). A patient-partner has been recently invited as a keynote speaker to CME activities in Canada to share her perspectives and views about patient engagement in palliative care and MAiD practice, calling for compassion. To our knowledge, few data exist on patient-partners' contribution to CME on these topics. Based on that experience, we discuss different issues on patient engagement's contribution in such CME events and call for further research.

[The psychiatric hospital in search of an extra soul]

The evocation of the meaning of the patients' suffering and their quest for appeasement refocuses the reflection on the missions of the psychiatric hospital around reception and accompaniment. It reminds us above all of the role of the carers in psychiatry, between availability, listening and benevolence. The maintenance of the link between the caregiver and the patient, in an atmosphere of trust, is essential to the care and quality of the accompaniment. We must not forget this.

Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations-A literature review

The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.

[Management of domestic violence in forensic emergency departments]

In forensic emergency departments, complainants are examined by a doctor who assesses the physical and/or psychological injuries on the request of the police or courts. The nurse is involved in the admission and care of victims. She also acts as a liaison between the different parties: police services, doctors, psychologists, legal professionals, associations, etc.

[Clinic of suicidal crisis]

Nearly 5% of the general population experiences a suicidal crisis every year in France. It is essential for any caregiver to learn to recognize it and intervene appropriately. This crisis most often occurs in a context of stress combined with individual vulnerability factors that causes the individual to lose their balance. The clinical presentation for suicidal crisis vary from one subject to another. It is usually fluctuating and temporary. The subject does not want to die; he wants to stop suffering. The suicidal act is the dreaded but not systematic outcome of the suicidal crisis. Here we will set out the general principles of the assessment of the suicidal crisis.

[Caregiver burden: From recognition to care]

The burden of caregivers of patients with chronic diseases has been the subject of research for several years, but few studies have focused on the suffering of family members from the time of their first hospitalization in psychiatry. The identification of the determinants of this burden would allow us to propose early management aimed at improving the well-being of the patients' family and friends and maximizing intra-family resources.

[Art therapy in all its forms]

Dance therapy favours self-expression. The body is the focal point for the dance therapist, although accessing the body can be a sensitive matter, involving as it does the patient's intimacy. The professional must be able to decipher body language and take it into account, in order to lead the patient towards possible pathways. Here, perceptions, feelings or emotions are the keys to successful therapy.

[Psychological intervention in the hemodialysis service: when psychological suffering needs to be expressed]

When a patient with renal failure goes on dialysis, the question that arises is when they will be discharged. Dialysis treatment causes a biographical break with multiple psychological implications. In this context, the presence of a psychologist is indispensable. The fact that dialysis is a chronic illness does not mean that the patient does not experience acute psychological crises. If it is important to accompany the patient, caregivers who are regularly exposed to the psychological assaults of patients must also be considered.

[Living with HIV/AIDS today, impacts on mental health]

The human immunodeficiency virus (HIV)/AIDS, at one time fatal, has now become a chronic disease. Physically, patients are generally in good health. However, 35 years after the discovery of the virus, mental suffering is still very much present. Morbid representations, understandable given the history of the disease, are still active on an individual level as well as on a broader level within society. Adapted information campaigns are essential in order to change behaviour.

[An educator's perspective, defusing tensions through mediation and the encounter]

Non-pharmacological alternatives which avoid or reduce the use of seclusion and restraint help to defuse psychological and/or physical tension to move towards appeasement. For the professional, the encounter with the patient requires questioning, reflection, availability as well as creativity. Mediation techniques such as hydrotherapy or equine assisted therapy, as well as the caregiver's general attitude, are perfect illustrations. Testimony.

[The emotions of caregivers in neonatal and paediatric intensive care]

When treating a child hospitalised in a neonatal or paediatric unit, the emotions of the child's parents are of particular concern for the caregivers. The emotional experience of the nursing teams, however, is rarely taken into account, despite it having an impact on the quality of the support. Group discussion and individual reflection around professionals' emotions is essential.

[A step-by-step recovery]

A patient retraces her care pathway with authenticity and emotion. While her memories of her time in hospital are still raw, her path towards recovery was built on constructive stages and encounters, from one structure to another, towards refound freedom. An interview with Marie-Paule Chanel.