Not so great expectations: why we should accept and respect hopelessness and futility

Medicine and health care attempt to prevent and cure disease, restore lost function, and relieve suffering. These are positive aspirations in the face of disvalued states of being. Part of the approach to countering illness can be to encourage or therapeutically increase such states as optimism, emotional wellbeing, peace and meaning, and to try to decrease mental and existential distress and despair, feelings of vulnerability, feelings of loss and loss of meaning. The column briefly examines examples from three fields--cancer, psychotherapy and end-of-life--and the relationships between therapeutic and social pressures for optimism and hope, on the one hand, and wellbeing, health and freedom, on the other. It suggests that in each field there are risks that arise from premature and/or excessive accentuation of the positive, and neglect of the presence and importance of what is conventionally regarded as the negative.     

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment: part 2 (Queensland)

This is the second article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Queensland, including the parens patriae jurisdiction of the Supreme Court. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals' legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance health directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals' knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Queensland.     

Dosage of treatment to sexual offenders: are we overprescribing?

A sample of 337 offenders who received treatment in a variety of sex offender treatment programs in the Ontario region of Correctional Service Canada between 1993 and 1998 were divided based on the highest intensity sex offender programming that they received (low, moderate, and high). The three groups were compared with reference to a variety of actuarial risk assessment measures, criminogenic factors, and the number and type of treatment programs completed. It was hypothesized that the high-intensity group would have more criminogenic risk factors, higher actuarial scores, and participate in more treatment programs than both the moderate- and low-intensity groups. The results indicate that in general, the hypotheses were supported. Nonetheless, the results suggest that the low-intensity group may be receiving too much sex offender-specific treatment.