S13 – Irremediability, Palliation, and Futility in Psychiatry: Understanding Philosophical, Cultural, and Historical Perspectives to Inform Practice

S13 – Irremediability, Palliation, and Futility in Psychiatry: Understanding Philosophical, Cultural, and Historical Perspectives to Inform Practice

Le vendredi 20 octobre
15:45 – 16:45 (1 hr)
Salle de réunion : Port Alberni (4th floor – North Tower)
Suze Berkhout*, MD/PhD; Csilla Kalocsai, PhD; JJ Rasimas, MD, PhD; Sarah Levitt, MD, MSc.; Dan Rosenbaum, MD; Dan Buchman, PhD; Kenneth Fung, MD, MSc; G. Eric Jarvis, MD, MSc.; Marie Gojmerac, MD, MA; Laurence Kirmayer, MD
Parrainé par la Section sur l’histoire et philosophie de la psychiatrie

Rôles CanMEDS :

  1. Érudit
  2. Expert médical
  3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Discuss how definitions of treatment resistance (TR) have arisen and the limitations and challenges from philosophical and cultural perspectives; 2) Critically review current frameworks (or lack thereof) for determining TR and futility and offering palliation for mental health conditions; and 3) Reflect on one’s professional experience of palliation, resistance, and refractoriness in clinical care, including conditions that are hard to treat.

Notions of futility, treatment resistance (TR), and provision of palliation in mental health have divergent meanings and practices. These issues are embedded in social, cultural, and historical contexts: what concepts mean and how they are translated into practice differ across time, space, and place.
Methods: Through historical and philosophical analysis as well as cross-cultural case study, this joint symposium will offer a facilitated discussion for participants to critically engage with the ways that TR, futility, and palliation are understood and operationalized in psychiatry—concepts that shape notions of irremediability, a central consideration for providing medical assistance in dying. The symposium will be hosted by the Canadian Psychiatric Association (CPA) section on transcultural psychiatry and the CPA section on the history and philosophy of psychiatry.
Results: Presenters will explore (1) how historical and philosophical issues relating to TR, futility, and psychiatric palliation impact the application of these concepts in practice and (2) the ways that social and cultural context shape interventions, including palliation. The symposium will conclude with reflection on additional aspects of culture that inform the limits of psychiatric intervention.
Conclusions: Holistic, comprehensive, and patient-centred views of healing need to address the totality of patients’ relational existence. This includes understanding how psychological and spiritual well-being mediates suffering and how broader economic, religious, cultural, and geopolitical contexts influence recovery, illness, suffering, death, the end of life, and the afterlife. These have deep implications for when interventions are considered futile as well as undesirable. In exploring these issues, the symposium offers critical engagement with irremediability in psychiatry.

Références :

  1. Stoll J, Mathew A, Venkateswaran C, et al. Palliative psychiatry for patients with severe and persistent mental illness: a survey on the attitudes of psychiatrists in India compared to psychiatrists in Switzerland. Front Psychiatry 2022;13:858699.
  2. Levitt S, Buchman DZ. Applying futility in psychiatry: a concept whose time has come. J Med Ethics 2021;47:e60.