Psychiatric Times Vol 15 No 6

Just as the first scattered incidents of homicide involving urban children in the early 1980s were not isolated episodes precipitated by "criminally ill" children, the recent episodes of school homicide in nonurban middle-class America, including the massacre in Littleton, Colo., are not isolated incidents of violence involving seriously "mentally ill" children.

A leader of a key mental illness patient advocacy group indirectly but pointedly criticized psychiatrists for the care they give schizophrenics. Laurie Flynn, the executive director of the National Alliance for the Mentally Ill (NAMI), said she was "appalled" by the results of face-to-face interviews with over 700 schizophrenics during a 16-month period. The interviews turned up evidence of under- and overdosing of patients and a failure to get patients into effective community treatment plans.

It is now obvious to most knowledgeable observers that managed care will transform the American health care system. Managed care brought competitive market forces into medicine, and demonstrated that the right financial initiatives can reverse a century of rising professional standards and make health care just another lean and mean downsizing industry.

After the U.S. Department of Veterans Affairs shut down research programs in its Greater Los Angeles Healthcare System (GLAHS) in March, the VA's undersecretary of health, Kenneth W. Kizer, realized that, rather than defending the facility's "failure to correct deficiencies," he would need to launch a reform initiative.

Is it appropriate for physicians to accept assisted-death requests at face value, or should they be interpreted as clinical indications of suffering? Should physicians act on patient requests to die, or should they address patient needs through other measures? Such are the difficult questions facing most physicians today.

What has happened to our nation since the 1960s and 1970s? The quest for racial equality appears to be rapidly dissipating. Blatant pre-civil rights racism has been replaced by a more virulent, yet camouflaged, form of racial bigotry.

Dual agency often presents a confusing situation for the clinician who must simultaneously serve two separate roles in a legal case, such as a treatment role and a forensic role (Berger, 1997). The two roles have different purposes, procedures, relationships with the patient or evaluee, and different ethical principles.

A few decades ago, ethics was widely understood in the professions to be a synonym for etiquette; it described the consideration that members of a profession showed to each other. More recently, it has come to refer to the rules governing the relationship between a professional and a client or patient.