Irwin Kleinman

Informed consent and tardive dyskinesia. Long-term follow-up.

Informed consent allows patients to make treatment decisions based on the best possible information. The current study examines the long-term impact of the informed consent process on schizophrenic patients. Patients were administered a baseline questionnaire and were given an information form, which was read aloud to them by the investigator. Patients were re-administered the questionnaire at 4 weeks and were randomly assigned to no review (single-session group) or a review of the information (educational review group). All patients were administered the questionnaire at 2-year follow-up. Both the single session and the educational review process significantly increase the schizophrenic patients knowledge about the benefits and risks of neuroleptic medication. No previous study has examined the impact of informed consent for anti-psychotic medication at 2-year follow-up.

Written advance directives refusing blood transfusion: Ethical and legal considerations

A patients automony and right to determine his or her treatment is widely recognized in current ethical theory and medical practice. However, conflicts between the desire to respect a competent patients religious conviction not to be violated and societys interest in preserving life do arise. This paper examines two cases involving Jehovahs Witnesses who signed cards refusing blood transfusions and who were subsequently transfused. In the Canadian case, the physician was found liable for battery. In the American case, the courts upheld the appointment of a guardian who authorized the transfusion. In the emergency situation, if there is a reasonable doubt about the validity of a treatment refusal, the presumption must be to render life-saving treatment. The author believes, however, that a written advance directive could be developed that respects he religious convictions of Jehovahs Witnesses and the ethical and legal responsibilities of physicians.

Guidelines for the Psychotherapies in Comprehensive Psychiatric Care: A Discussion Paper

This discussion paper concerning guidelines on the practice ofthe psychotherapies by psychiatrists has been developed by a working group of the Steering Committee on the Psychotherapies formed in 1996 by the Canadian Psychiatric Association (CPA) to address the practice of psychotherapy by Canadian psychiatrists. This paper provides the profession with guidelines for clinical care related to the practice of the psychotherapies that reflect best practices based on the available evidence, with the aim of improving standards ofpractice within the profession. Such guidelines are intended to be linked to emerging strategies for medical education, as well as continuing medical education (CME) and clinical quality assurance (CQA) initiatives within the CPA. This paper reviews the literature, synthesizing theoretical and research contributions and available empirical data. This Working Group has attempted to reflect the clinical experience of Canadian psychiatrists and to report only material that could reasonably be applied to the various models ofpsychotherapy.

A new law for allocation of donor organs in Israel

www.thelancet.com Vol 376 July 24, 2010 231 Again, I commend Lavee and colleagues’ eff orts. I know the resistance encountered when dis cussing our proposal. I believe the system being implemented in Israel will save lives and will diminish the need for living donor transplants by making more organs available. Donor autonomy is enhanced when individuals register an advance directive that is likely to be followed. The welfare of those needing transplants is enhanced by increasing the supply of organs and the welfare of their family members is increased by decreasing the need for living organ donation with its potential risks and its attendant psychological confl icts. Justice is served when more people who need transplants receive them.

Tricyclic maintenance therapy in unipolar depression

The risk of recurrence of depression must be balanced against the problems and risks of maintenance therapy. The goal of maintenance therapy is to prevent new episodes of depression. A review of the literature reveals that the existing data does not provide sufficient evidence to demonstrate the usefulness of tricyclic maintenance therapy. Nonetheless, it would be premature to conclude that this type of treatment is not useful. Further studies of maintenance therapy are indicated and should include a continuation period of at least 16 weeks during which patients are symptom free (that is, Global Assessment Scale 71 or more). In the interim, each patient should be evaluated individually to determine the optimum duration of treatment.