Autism Spectrum Disorder: A Guide For Physicians To Help Families

Most Canadian doctors oppose physician-assisted suicide, survey suggests

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A comprehensive evidence-based review published in CMAJ (Canadian Medical Association Journal) aims to help physicians provide appropriate medical support to families of children with ASD, from detection to treatment. “We have come to understand ASD as a remarkably heterogeneous constellation of conditions that covary with other disabilities and disorders (e.g., intellectual disability, epilepsy, ADHD, anxiety disorders) and various medical problems,” writes Dr. Stephen Scherer, senior scientist and director of The Centre for Applied Genomics at The Hospital for Sick Children (SickKids) and director of the McLaughlin Centre at the University of Toronto, with coauthors. “Recent discoveries of underlying genomic factors have shown great complexity and implicate various networks of causal factors.” ASD, which includes a variety of traits that range from mild to severe, is estimated to affect about 1% of the population, although it is under-recognized in the developing world. The review, by specialists in pediatrics, psychiatry, epidemiology, neurology and genetics from across Canada, outlines the current understanding of ASD and best practices for pediatricians, family doctors and specialist clinics, and identifies resources for clinicians. Topics include: How can ASD be detected early? What other illnesses or conditions are associated with ASD? What treatments and interventions are available and effective? “Community physicians play an essential role in identifying early signs of ASD and ensuring timely diagnosis,” write the authors. “The greatest impact on outcome will come from careful attention to parents’ concerns, observing early social and communication skills (e.g., interaction with parents and response to simple social games), immediate referral to available intervention services (e.g., infant development and/or speech-language services, and timely referrals for specialized assessments and interventions.” The authors describe “red flags” for autism as well as best practices for treatments, which include behavioural interventions such as applied behaviour analysis. This technique uses a variety of approaches to teach children skills to reduce problem behaviour.

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With physician-assisted suicide, the doctor provides a patient with the knowledge or means, or both, required to commit suicide, including counselling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs, according to the CMAs current policy, which was last updated in 2007. Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries, the policy reads. A change in the legal status of these practices in Canada would represent a major shift in social policy and behavior. The issue has taken on new immediacy with Quebecs move this summer to become the first province in the country to introduce a law that would protect from prosecution or jail doctors who offer the terminally ill medical assistance to die. In June, Quebecs Parti Quebecois government introduced Bill 52, an act respecting end-of-life care, which sets out the rules that would allow terminal palliative sedation as well as medical aid in dying. Under the bill, only a patient of legal age and capable of giving consent and who is suffering from an incurable illness and constant and unbearable physical or psychological pain would be permitted to seek a doctor-hastened death. Canadas Criminal Code prohibits euthanasia and assisted suicide, stating that, no person can consent to have death inflicted upon him. The issue is now before the courts: The federal government is appealing a B.C. court ruling that last summer struck down Canadas ban on doctor-assisted suicide, ruling it unconstitutional and granting a woman dying of Lou Gehrigs disease the right to seek a doctors help in ending her life. Its not a request Dr. John You has ever been faced with. I personally am uncomfortable with the idea, but I know its something that well need to have a societal debate about, said You, an associate professor at McMaster University in Hamilton, Ont., and a member of the Canadian Researchers at the End of Life Network. He said he worries the emotionally charged issue will overshadow the urgent need for better access to quality, end-of-life care for Canadians. In a recent article published in the journal Nature, Dr. Harvey Max Chochinov, Canada research chair in palliative care, said the culture of medicine largely ignores death and tends to abandon patients when cure is no longer viable. If were really, as a society, considering changing legislation that is going to allow for assisted suicide, it almost seems unfathomable that we would go that route before we have any obligation to be providing everyone quality, end-of-life care, he said in an interview. Chochinov is piloting a study, funded by the Canadian Cancer Society, of whats known as the Patient Dignity Question. The simple question What do I need to know about you as a person to give you the best care possible? is meant to help doctors and palliative care teams provide more empathetic care to the terminally ill. Chochinov and his team have been collecting patients responses over the past two years.

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