Our latest issue focused on Uncertainty, an experience we all share regarding the future, though we manage it in different ways. Death is perhaps the concept most shrouded in uncertainty, while also being the most inevitable part of our lives. In our work as doctors, even as psychiatrists, death is a constant companion. To varying degrees, we feel comfortable discussing existential perspectives with patients, how they view the meaning of life and death.
Some psychiatric emergency conditions can, in themselves, lead to death due to somatic causes, while others, in the short or long term, may result in self-inflicted death, or even fatal violence towards another person. We have previously written about these topics, including in a special issue on perinatal health.
The psychiatrist's task is to constantly assess the risk of harmful actions, which could lead to the patient's or another person's death. Risk assessments are never completely certain, as you can read about in our latest issue on uncertainty. Structured assessment instruments have been applied to increase precision in this task, but is being increasingly abandoned, at least within suicide prevention, as their accuracy on their own in predicting future acts of suicide is low.
The incidence of suicide varies significantly between the Nordic and Baltic countries, and over time, which is closely linked to differing socioeconomic conditions. The process that ultimately leads to a completed suicide looks different in each case. Nevertheless, it has been shown that various preventive measures do reduce mortality from suicide. What can be done to further improve this work?
There are times when, despite best intentions, the outcome is unexpected, and the patient dies. Or even kills someone else. Left behind is the doctor, ultimately responsible for the care, always with a sense of powerlessness. What support is available in these situations, and how does it feel to be in the media spotlight when your patient has committed a crime, perhaps even a highly publicized one?
People with severe mental illness have an average of twenty years shorter life expectancy, due to both the illness itself and, more importantly, increased secondary somatic morbidity. How is this possible? Are patients with mental disorders treated differently in somatic care? Should we, in psychiatry, be more actively screening for and treating conditions like cardiovascular disease? There are varying experiences here.
There are different opinions on the psychiatrist's role in the dying process. Today, more and more voices are calling for doctors' involvement when patients with chronic illness, including psychiatric conditions, wish to end their lives. We are expected to evaluate whether such a decision is well-founded and free from temporary severe mental disorders. Most doctors agree that physicians should not actively participate in the process of ending life. However, there are differing views on this. And through history, there are experiences of physician involvement in ethically questionable processes.
Publishing an issue on the theme "Death in Psychiatry" stirs emotions. The perspectives are many, and it is not difficult to find colleagues from Nordic countries willing to contribute their knowledge on the subject. I hope that the content of this issue will also spark your interest. As always, you will find content on psychiatric research and reports from colleagues' work lives. I wish you a stimulating reading! â–¡
Best regards!
Hans-Peter Mofors Chief editor