Voluntary euthanasia: responses of medical practitioners in NSW and the ACT to six open-ended questions.

Six open-ended questions from a survey of 1271 randomly selected medical practitioners on active voluntary euthanasia (AVE) and physician-assisted suicide (PAS) was examined. In spite of some extreme written views for and against the procedures, the majority of practitioners were considered, concerned, sympathetic and troubled about AVE and PAS.

Cybersuicide: the role of interactive suicide notes on the Internet.

As we approach the new millennium a new dimension in interactive communications has arrived. The internet is one such medium, and while it remains a relatively new form of information sharing, it has not escaped the attention of vulnerable young people. This paper discusses the internet resources on suicide and the issue of interactive suicide notes. Case examples of interactive notes followed by suicide fatalities are used to illustrate the potential influence of the internet on those who wish to share their suicidal ideation with others. Issues to do with modeling, ambivalence, group death wishes, research, and ethics are discussed. Finally, some recommendations are made for further studies.

Elective admission policies in New South Wales public hospitals.

OBJECTIVE: To assess the existence and content of elective admission policies in New South Wales acute public hospitals. METHODS: A questionnaire was sent to managers of all acute public hospitals (n = 76). Copies of elective admission policies were sought from respondents. Results were analysed with EpiInfo 5.01b and policy content by thematic analysis. RESULTS: Survey response was 91% (69/76). Policies existed in 71% (49/69) of hospitals. Of these, 96% (47/49) disseminated their policy, with 23% (11/47) disseminating it at least annually, 41% (19/47) only when updated, and 32% (15/47) infrequently, with one policy being new (2%) and one hospital not stating its frequency (2%). Policy compliance was assessed in 86% (42/49) of hospitals and guidelines reviewed periodically in 92% (45/49) of hospitals. Twenty per cent (10/49) of the policies had been developed since a departmental instruction of May 1994. Of the 20 acute hospitals with no policy, 75% (15/20) were rural and 85% (17/20) thought they should have a policy. Analysis of policy content revealed emphases on resource availability and clinical need as determinants of elective admission, an institutional rather than a patient focus, and a high level of senior nurse manager involvement in admission decisions in rural hospitals. CONCLUSIONS: Despite a specific departmental instruction, nearly one-third of hospitals still had no admission policy 18 months later. This could be indicative of miscommunication between hospitals and NSW Health or perceived irrelevance of department guidelines by hospital managers. Existing policies were mostly institutionally focused and dominated by perceived resource limitations. NSW Health might consider other medico-social factors and manager involvement in future policy development.

Suicides in an Australian inpatient environment.

Associated stressful life events both within and outside the hospital environment may contribute to the high-risk environment. The cohort studied here was hospitalized for a significant psychiatric problem, a factor which puts them in the high-risk category. When the severe psychiatric diagnosis is combined with a significant stressful life event, the risk of suicide is increased significantly.

Waiting times for non-urgent specialist appointments.

OBJECTIVE: To determine the waiting times for non-urgent appointments with specialist medical practitioners in private practice. METHODS: A telephone survey of specialists selected randomly by the Commonwealth Department of Human Services and Health was conducted. The waiting times for non-urgent appointments were measured, and the results were grouped by specialty and analysed. RESULTS: Waiting times to see various physicians and surgeons did not differ substantially. There were significantly longer (P < 0.002) waiting times for urological surgeons (median, 25.5 days) and for women obstetricians and gynaecologists (median, 40 days) than for other specialists. CONCLUSIONS: The average waiting time to see a specialist surgeon or physician for a non-urgent condition in private practice is acceptable by current community standards. However, the longer waiting times suggest that there are too few urologists and women obstetricians and gynaecologists.

Difficulties in admitting patients to metropolitan public hospitals: the view of medical practitioners.

OBJECTIVE: To investigate difficulties in public hospital admissions from the perspective of referring medical practitioners. METHODS: Referring surgeons, physicians and general practitioners (GPs) were randomly selected from three metropolitan (Sydney) health areas and formed into focus groups. Thematic analyses were undertaken of the groups' discussion transcripts to explore the problems of securing patient admissions, practitioners' perceptions of the reasons for these problems and the strategies they used to overcome them. RESULTS: Surgeons in two health areas reported major constraints affecting patient admissions. Physicians experienced fewer difficulties as this group was able to utilise outpatient services but was not always satisfied with such arrangements. GPs reported difficulties in communicating with full-time hospital medical staff. All practitioners felt that limited bed availability, restricted operating times, redefinition of many conditions as "non-urgent" and hospital budgetary constraints resulted in long waiting times for admission to public hospitals. This has led to an increasing move to use private hospitals for elective admissions, and to investigate patients in the community. CONCLUSIONS: Medical practitioners experienced difficulty in having their patients admitted to metropolitan public hospitals for both elective and non-elective procedures, and this was perceived to result in clinical and personal costs to patients.

The pricing of nursing care.

Despite the poor performance of the general economy, the health care industry in Australia has experienced constant growth for several decades. Overall, Australia's expenditure on health is relatively high and, with an increasingly aged population, this expenditure is not likely to decrease. With the current concerns over cost-containment in the health sector it is important to assess the value of nursing care in economic terms. This paper explores the issue of valuing of nursing care within the framework of the Australian Health Care System. Questions are posed of nurses as to whether they are prepared to confront the realities of the health care arena and whether they are ready to value nursing practice in terms of economic value. As well as answering these questions, the paper argues that nursing costs are not sufficiently reimbursed under the current Australian health benefits, and that this poor estimation of the worth of health care may stem from the historical and social influences of nursing and the care provided by nurses. The paper concludes that the Australian health care system is clearly no longer static and that the public cannot afford to support the costs associated with a growing health care industry. Moreover, nursing can no longer afford not to be viewed as an entity in it's own right. A greater awareness of nursing's output will result if organisational or institutional changes are encouraged for the benefit of the Australian society, as a whole, as well as for the nursing profession.

Perceptions of unmet need in four community services for elderly people.

Home-care services particularly, and food services to a lesser extent, are seen by elderly people as being critically important for their capacity to live independently in western Sydney. Home nursing and transport services are valued but are less critical. Consumers, providers of services and referral agents all identify significant levels of unmet need for community services. The home care service particularly is stretched by pressures which are likely to be exacerbated by demographic change and by cost-shifting between state governments and the Commonwealth Governments.

Euthanasia: attitudes and practices of medical practitioners.

OBJECTIVE: To record doctors' attitudes towards, and practice of, active voluntary euthanasia (AVE) and physician-assisted suicide (PAS) in New South Wales and the Australian Capital Territory. METHODS: A postal survey was sent to a random sample of 2000 practitioners on the Medical Register of NSW (which includes medical practitioners in the ACT). RESULTS: Almost half the practitioners had been asked to perform euthanasia, of whom 28% had complied. Of practitioners asked to assist with suicide, 7% had complied. There was majority support for changes to the law concerning euthanasia. CONCLUSIONS: There are relatively high levels of support for, and practice of, AVE and PAS by medical practitioners in New South Wales and the ACT, suggesting that the current legislation should be reviewed.

Suicide prevention: a public health approach.

This article proposes a model for developing a national or regional suicide prevention strategy. Suicide is examined from the perspectives of stress, coping behaviours, lethality and multiple causation. Public health concepts of primary, secondary and tertiary prevention are applied to suicide with minor modifications. This exercise facilitates clarity with respect to planning strategies. Conceptual clarity may improve prospects for success but ultimately evaluation will elucidate the outcome.

Suicide on the Internet: a focus for nursing intervention?

The Internet is a means for people who do not know each other to share information to their mutual benefit or harm. Whereas electronic communication without censorship has its benefits, the net has not escaped the attention of people contemplating suicide. If mental health nurses are to assist vulnerable people who surf the net in search of encouragement to complete suicide, they need to know about Internet resources on suicide and to understand how suicide fatalities influence the behaviours of vulnerable people who express suicidal ideation in cyberspace. The importance of suicide modelling, ambivalence, group death wishes, suicide notes and related research is considered. Mental health nurses are invited to consider the implications for suicide prevention.

Social and cultural patterns of suicide in young people in rural Australia.

The purpose of this paper is to describe patterns of suicide in young people in rural communities. Australian Institute for Suicide Research and Prevention and Australian Bureau of Statistics data are used to discuss regional and gender differences in suicide rates, with particular attention to completed suicides in young people. The regional distribution completed suicide in young people and gender differences in suicide rates are identified. Trends in the methods of suicide chosen by young people are also described. Patterns of male self-destructive behaviour are emphasised. The paper, as a whole, draws attention to the complex factors that influence deaths by suicide in young people. The factors implicated are associated mainly with suicide in young males, but much of the literature speculates on rather than demonstrates their influence. As the competing explanations have not been systematically evaluated, further research is required to establish the causal processes involved and to provide a firmer foundation for suicide prevention programs and services for those who live in suicide's aftermath.

Access to methods of suicide: what impact?

OBJECTIVE: The aim of this paper is to explore the conceptual basis of limiting access to potential methods of suicide as a public health measure. METHOD: A review of the literature was conducted. RESULTS: Both physical availability and sociocultural acceptability are important determinants of choice. There is considerable evidence of an association between method availability and method specific suicide rates. There is also evidence that restriction of method availability is often associated with a reduction in method specific suicide rates. There is some evidence that restrictions on method availability under certain conditions may reduce overall suicide rates. CONCLUSIONS: Suicide methods employed by young Australians are changing, with a disturbing rise in frequency of hanging and car exhaust suicides slightly offset by a decline in firearm suicides. Opportunities exist for further reducing firearm suicides and addressing exhaust suicides by practical measures. There are also obvious options for changing prescribing practices with respect to more lethal medications (e.g. tricyclic antidepressants). However, the rise in hanging seems problematic from this perspective and in need of ecological study.

Efficacy of two minor tranquilizers in relieveing symptoms of functional gastrointestinal distress.

Two minor tranquilizers, diazepam and lorazepam were significantly better than a placebo preparation in relieving symptoms of functional gastrointestinal distress in 28 patients who took part in a double-blind cross-over trial. The beneficial therapeutic effect may be group- rather than preparation-specific. Both agents were also of significant benefit to the sub-group of patients with aerophagy as a major symptom.