Euthanasia and chronic mental illness – an uncomfortable discussion

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Many people in favour of legalising euthanasia fail to consider its implications for those suffering from long term mental health conditions. Earlier this month, a woman in her 20s, suffering from several chronic psychiatric conditions, was helped to die by a doctor in Holland. The unnamed Dutch national was the victim of sexual and physical abuse, which spanned over 10 years; she was reported to have been suffering from anorexia nervosa, PTSD and chronic depression. Many who struggle with severe mental illness deal with unbearable pain, while also being subjected to futile treatments that only further diminish their quality of life. But can this ever justify medically ending their life?

In the UK, the idea of a young, physically healthy individual undergoing assisted suicide does not sit comfortably with most people. Yet last year, 56 people in the Netherlands suffering from mental illness received the lethal injection, increasing from just 11 in 2013. In 2015, 13 per cent of the Belgians who were euthanised did not have a terminal condition, and around three per cent suffered from psychiatric disorders.

Without medical intervention, it is certain many of these patients would have taken matters into their own hands: perhaps succeeding, leaving family and friends to deal with huge emotional trauma. Or perhaps failing, and possibly doing lasting physical damage which would only add to their misery.

An article in the New Yorker reported that Dirk De Wachter, an assistant professor of psychiatry at the University of Leuven, reconsidered his opposition to euthanasia after a patient whose request he had rejected set up a camera in front of an Antwerp newsagents and set herself on fire. In contrast to these disastrous outcomes, a formal process of medicalised euthanasia is not only safe but may help loved ones to understand, engage and prepare. The article went on to suggest that some physicians find euthanasia requests useful since they create an opportunity to make therapeutic interventions with patients who may not otherwise have sought medical help. And many, given time and treatment, may decide they want to live.

The interactions between autonomy, nonmaleficence and beneficence are both ancient and intricate. Discussion in the UK surrounding euthanasia for psychiatric conditions remains hypothetical – although there are stories of people in Britain receiving assessments by the Swiss clinic Dignitas, under such circumstances. This is an imaginably painful scenario for friends, family and the of course the patients themselves. And while capacious patients’ wishes are ultimately infallible, our thoughts should also go to who must carry them out. Ethics aside, any physician who approves or performs such a procedure will surely be left with lasting internal conflict – is it too much to ask of a single profession, that it both save, and take lives?

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New hope for anorexia sufferers

Research published this morning has shown magnetic brain stimulation could play a role in the treatment of anorexia. The study by the Institute of Psychiatry, Psychology and Neuroscience (IOPPN) involved 60 volunteers. This is the first randomised trial to investigate this type of treatment in eating disorders.

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Tales of exodus: Talk at the junior doctors strike

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Dr Mathew Stone is on strike. He is one of around two dozen people stood holding placards in the cold drizzle waving at tooting horns from the adjacent road. The conversation between this small group of doctors skips between two topics: the contract and Australia. As they speak through scarves and hoods, the temperature across the coast of New South Wales creeps over 20°C, there is a 0% chance of rain. Dr Stone has a plane ticket to Sydney leaving in three weeks. Continue reading

One in five London GP practices at risk of closure

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109 GP surgeries in the capital could close over the next three years according to a recent survey.

Over 100,000 patients could be left without care by 2019 according to a survey conducted on behalf of Londonwide LMC, a group that represents the capitals GPs. The survey involved nearly half of London’s 1,300 GP practices,  19 of which said they intended to close in the next three years. Continue reading

Israel joins Fashion’s battle with Eating Disorders

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On New Years Day legislation designed to protect models in Israel will come into force. Is 2016 the year the fashion industry will take responsibility for it’s role in the prevalence of eating disorders? 

Israeli legislation which makes it a legal requirement for models to have a BMI over 18.5 will become active on January 1.

Adi Barkan, a fashion photographer, gynecologist, lawyer and member of Knesset started the campaign for healthier body image after the death of the model Hila Elmaliah.

Earlier this month French MPs voted in favour of similar legislation intended to combat eating disorders in the fashion industry.

The french bill will mean models have to  be confirmed as healthy by doctors in order to work. It also forces magazines to label Photoshopped images “touched up”.

Anyone found to have broken the law will be liable for a fine of 75,000 and up to six months in prison.

Previous drafts have proposed a minimum BMI for models however the idea resulted in protest by the fashion industry. This bill leaves the decision in the hands of doctors. Physicians will be asked to take into account a number of factors including weight, age and mental well-being.

In Britain

There is currently no legislation outlining a minimum BMI or health certificate for models in the UK.

The British Fashion Council (BFC) established an agreement with UK designers in 2008 following the publication of Fashioning a Healthy Future a report into models’ health.

The agreement outlined several measures:

  • A ban on models under the age of 16 at London Fashion Week:
  • The provision of healthy food and drinks for all workers backstage at fashion shows.
  • A BFC funded eating disorder awareness seminar for model agencies staff delivered by B-EAT.

At the same time the BFC introduced it’s own auditing process to monitor these measures. There is however no audit data or report available on the BFC website.

Following the reports publication, the BFC also commissioned an independent feasibility study which found: “the modelling industry (models, modelling agencies and Equity) universally reject the proposed introduction of Model Health Certificates in London.”

Rosie Nelson

An Australian born model, who has been featured in Vouge, has started a petition on change.org following a London based fashion agencies request that she get “down to the bone”, despite repeatedly losing weight.

Rosie is petitioning Minister for Women and Equalities, Caroline Dinenage, to create a law to protect models from getting dangerously skinny.

In her petition she said: “The agencies managing and recruiting models have a responsibility to the well-being of girls on the catwalk at fashion week, and in the industry as a whole.”

The petition still requires 33,000 signatures to meet it’s target. To sign Rosie’s petition click here

Legislation elsewhere

In Denmark brands must carry out ‘psychological and physical’ evaluations before working with models in order to spot eating disorders or mental health issues, according to the nation’s Fashion Ethical Charter, established in 2007.

It also states models must also be 16 or over in order to receive money for their work although younger models are said to receive sample garments in lieu of actual payment.

Similar measures have been taken in countries across Europe. Spain and Italy currently ban models with a BMI below 18 from taking part in Madrid fashion shows.

WHO guidelines state that an adult with a BMI below 18 is considered malnourished, and 17 severely malnourished.

Featured Image accredited to José Goulão

NHS goes for Christmas Number One

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NHS Staff from south east London are making a bid for the prestigious festive top spot.

Dr Harriet Nerva, from Queen’s Park London, started promoting the song with the campaign #NHS4XmasNo1 through Facebook and Twitter in October.

The song is performed by Lewisham and Greenwich NHS Choir, a group that includes nurses, physiotherapists, porters, doctors and administrators. They are performing a mash-up of ‘Bridge over troubled water’ and ‘Fix you’ by Coldplay.

The 26 year-old junior doctor has asked that people wait until Friday 18 December to download the song, when it will be available on iTunes. This means all sales will count towards the Christmas chart. Speaking to LGC she said:“It’s a really beautiful track and it’s a fantastic celebration of the work NHS staff do”“I really wanted to get the message out to the wider political establishment that we will fight for our NHS.” She addedThe group were runners up in the TV series Sing While You Work which aired on BBC Two in 2012. Since the competition, the choir has been active in the community participating in the campaign to save Lewisham A&E.

The competition

As well as the likes of Justin Beiber and Adele the Lewisham and Greenwich NHS Choir must battle NHS colleagues the National Health Singers who are also in the running.

The rival choir is formed of junior doctors from across the country. Their tune ‘Yours’ currently sits at number 90 in the iTunes download chart. But Dr Nerva, who works at Hinchingbrooke Hospital, is not worried about the competition.

“I’m really happy that we’ve got this kind of creativity in the NHS and it’s great that we’re getting this exposure. Their song’s message is fantastic, the lyrics very much focus on not overworking junior doctors.” she said.

She added: “The junior doctor contract does go to the heart of the NHS. You’d be quite hard pressed to find a junior doctor who doesn’t have quite low moral at the moment”

Celebrations

Even if the song does reach number one Dr Nerva said she won’t be celebrating. She is working a night shift in A&E on Christmas Day, but she is excited for what the songs success could do for the NHS staff moral:

“It would be a celebration in itself. To get the song out there to the NHS staff who will need a moral boost while working over the festive period. I will be happy for NHS staff to receive recognition for the really hard work there going to be doing over Christmas, it’s going to be a grueling time.”

Any money made from sales will be split between the charities Carers UK and Mind who support mental health and its research. Explaining the choice of charities Dr Nerva said:

“Carers are our partners in care they’re often unsung heroes who don’t get enough recognition.”

#LoveYourNHS

The campaign ‘Love your NHS’ was started in conjunction with Dr Nerva’s bid to make Lewisham and Greenwich choir number one this Christmas. They are asking people to post selfies to Twitter and Facebook holding a sign that says “I DO”.

Dominoes staff showing their support:

This year the Christmas number one will be revealed on Christmas Day.  BBC Radio One will be counting down the festive chart from 10am.

To show your support and download the track click here
Featured image accredited to PROdrp

London Nightline: Listening Saves Lives

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“I have made two attempts to kill myself. At the time I really felt there were no other options and that people would be better off without me” says Maxine Williamson

Through her twenties, she battled depression and post-traumatic stress disorder. Like most people, she believed suicide was a selfish option. But once you reach that point, misery masks itself like logic and you can come to some warped conclusions. “I actually thought it was the least selfish thing to do.”

The distressing root of her illness made her feel she couldn’t talk to her family. She felt like she was a burden. When you’re moving to a big city or starting university, friends can be difficult to find. Tougher still to find ones who you feel able share things with that you’ve never put into words before.

Suicide amongst students is a problem. There has been a 49% increase in student suicides between the years 2007-2011, according to data from the Office for National Statistics. Whilst male student suicides were up 36%, female student suicides almost doubled in the same period. It is likely those numbers are even higher now.

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First E-Cigarette Available on Prescription

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An E-Cigarette will now be offered as part of the NHS aids to quit smoking.

The news was quietly revealed by Jane Ellison MP during questions in the Commons at the end of November. The ‘Voke – nicotine inhaler’ which has been developed by British American Tobacco, was approved by Medicines and Healthcare Products Regulatory Agency (MHRA) earlier in the month.

MHRA said in a statement: “the Voke is the second product meeting the definition of an e-cigarette to receive a marketing authorisation, but is the first product that electronically produces a vapour containing nicotine for inhalation, and thus would be considered a true e-cigarette.”

Action on Smoking and Health (ASH) welcomed the move. The group said: “Other electronic cigarette manufacturers and importers should be encouraged to apply for licences too.”

Professor Kevin Fenton, from Public Health England said: “Evidence showed e-cigarettes can help smokers to quit, particularly when combined with additional support from local stop smoking services.”

It is hoped the approval of the “Voke” by MHRA will provide some clarity on safety of E-Cigarettes since research shows a growing number of smokers are failing to understand the growing risk of smoking versus “vaping”. Between 2013 and 2015 the proportion of people surveyed who believed E-Cigarettes were as harmful as regular cigarettes increased from 6% to 20% according to polls conducted by YouGov for ASH.

Since becoming available to buy in 2004 E-Cigarettes have been shrouded in safety concerns including worries they will become gateway for young people into smoking. However in 2015 about 60% of UK users are smokers and about 40% are ex-smokers, while use among those who have never smoked remains “negligible” according to a report by ASH.

Concerns still remain

In a statement on its website the World Health Organisation has expressed concerns regarding E-Cigarettes: “These devices have become popular over the last four or five years, so there are only a few studies on the health risks and we don’t know the long-term effects. We don’t have epidemiological studies, such as those on the links between tobacco and cancer, because such studies take decades to complete.”

Controversy amongst Doctors

With the NHS set to make £22bn of efficiency savings over the next parliament the decision has led to some negative reactions from some doctors.

In a comment on Pulse, the GP magazine, Dr Peter Swinyard said: “Why should the NHS pick up the tab for these scripts? If people can afford to smoke, by and large they can afford the nicotine replacement. And how long to continue?”

He added: “We have to have a reality check about what the NHS can afford on its drug budget and on our time and effort in prescribing.”

Featured Image accredited to  Vaping360.com