depicts Palliative Care as a ‘subversive’ element in a health system that is focused on ‘cure’.

Moving vulnerable and ‘incurable’ patients from the margins to the centre of health practice not only transforms the value of the patients and their families but also allows for the realisation that we are all vulnerable, and that while domination and control are futile, ‘accompaniment’ is transformational.

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those who suffer deprivation, disability, mental illness, or the limitations of ageing), are particularly vulnerable to the suggestion that their lives are not worth living. Suicide and Life-Threatening Behavior, 44(1), 58–77. https://doi.org/10.1111/sltb.12055 [21] https://nl/en-gb/news/2016/26/more-suicides Doctors are not necessary for the regulation or practice of euthanasia and assisted suicide Many doctors want no part in euthanasia or assisted suicide, including some who, on a personal level, are not opposed in principle.

There is an urgent need to counter the increasingly accepted and relationally impoverished societal narrative which equates the value of a person’s life with their subjective perceptions about the quality of their life, all too often based on factors that reflect an ableist or functionalist worldview. We note that the Strategy provides little specific or material direction for how suicide rates might be reduced, that organisations or agencies are not identified as taking a lead, and that the ‘Activities’ are very general. [19] Haw, C., Hawton, K., Niedzwiedz, C., & Platt, S. Suicide Clusters: A Review of Risk Factors and Mechanisms. As stated in “An Open Letter to New Zealanders” signed to date by more than 300 doctors, “Doctors are not necessary in the regulation or practice of assisted suicide.” There is evidence that the key reason proponents of a law change insist on the ongoing and unquestioned association between euthanasia/assisted suicide and the medical profession is a political one – a means of providing a cloak of medical legitimacy while promoting the idea that euthanasia and assisted suicide are a form of ‘medical treatment’.

A cornerstone of Catholic teaching is the belief that every human life has “intrinsic value” and is to be protected and nurtured at every stage of its development.

Those who do not conform to the increasingly dominant ableist idea of what a successful life looks like (e.g. The Impact of Exposure to Peer Suicidal Self-Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature.

The pathways and actions laid out in the Strategy can be interpreted to cover almost all possible interventions. We are concerned at the way that ‘Maori’, ‘Pacific’, ‘Maori communities’ and ‘whanau, hapu and iwi’ are tasked with many Activities while no agencies have been tasked with funding or providing resources to these groups and individuals. Suicide and Life-Threatening Behavior, 43(1), 97–108. https://doi.org/10.1111/j.1943-278X.2012.00130.x [20] Crepeau-Hobson, M. Euthanasia proponents such as Rob Jonquiere from the Netherlands openly admit that campaigners in The Netherlands originally wanted to argue for euthanasia on the grounds of ‘self-determination’ (that is, on the basis of unfettered personal choice and without needing to fulfil any particular conditions such as being terminally ill).

While it is essential that Maori and Pasifika are involved in the development of suicide prevention initiatives for their own communities, it appears from the Strategy that they are expected to already know what is needed to prevent suicide while being left to take full responsibility to undertake the various Activities suggested. We understand the focus on young people given their higher rates of suicidal behaviour but we suggest that there needs to be a complementary focus on older age groups as well, particularly for those over 75 years of age. However, it was deemed necessary at the time for doctors to be involved in order to gain public acceptance.

the New Zealand Longitudinal Study of Aging described less than half of participants as ‘not lonely’, 41.2 percent as ‘moderately lonely’, 7 percent as ‘severely lonely’ and 3 percent as ‘very severely lonely’. While there are many precipitating factors involved in elder suicide, we believe that much more attention needs to be given to critiquing the ageist and ableist societal narrative that is increasingly inclined to equate value of life and personal dignity with health and independence (‘not being a burden’). A focus on the suicide of elders, while ‘targeting’ a particular group and raising awareness of the ‘value’ and dignity of this group, may also work at a universal level by challenging societal attitudes about ‘useful’ or ‘successful’ lives that will assist in suicide prevention for all age groups. There is no mention of prisoners in the Strategy, yet the suicide rate for prisoners is higher than that of the general population. I also told him that should he become sicker or weaker, I would work to provide him the best care and support available.

In addition, the much higher suicide rate amongst M? No matter how debilitated he might become, his life was, and would always be, inherently valuable.

Most research estimates that between 2 to 5 percent of the older population may be victims of elder abuse. As stated by one doctor: In my practice, more than two dozen patients have discussed assisted suicide with me. One inquiry came from a patient with a progressive form of multiple sclerosis.