In this paper we document some of the practical aspects of implementing medical assistance in dying (MAiD) since it became legal in Canada in 2016. The percentage of annual deaths in Canada due to MAiD varies widely, ranging from less than 0.5% in some areas to over 5% in others. By the end of 2019, approximately 13,000 people had an assisted death in Canada (1.6% of all deaths). The average age is 73 years and the majority have cancer (64%), followed by end-stage organ failure (17%), and neurological disease (11%). The safeguards in Canadian law include having two witnesses sign the patient request form, having two independent clinicians agree that the patient is eligible, and requiring a 10-day waiting period after the request is made. Although the criminal law is federal and applies throughout the nation, health services managed provincially, and there are many different models of care being used. Some provinces have standardized prescriptions and procedures for assisted dying with centralized care coordinators supporting both patients and providers. Other provinces expect individual providers to manage all aspects of assisted dying. The procedure and medications are provided free of charge to patients, but it took years before many providers were remunerated for their services. Access for patients has been a problem because there are too few providers of care (especially in rural areas), and many people have difficulty getting accurate information about the process. Many faith-based health care facilities continue to refuse to allow assisted dying within their facilities, so patients requesting MAiD need to be transferred to other locations in their last hours of life. Solutions to these problems have included the development of more training and support for providers and the creation of coordinating centres that provide information and support for patients throughout the process. Telemedicine is used for assessment of eligibility when required, especially during the COVID pandemic. There are similarities in problems of access to all end of life care options, including palliative care and residential hospices. The relationships between providers of assisted dying and specialists in palliative care vary, and examples exist throughout the spectrum from collegial to hostile. This is slowly improving, as individual clinicians gain more experience with patients choosing assisted dying. Public culture is changing as there are more conversations occurring about death and dying.

The Council for Accreditation of Counsellor Education Programs recognizes quality assurance of master’s-level counselling programs in Canada. Accreditation is important to the pre-service training of counsellors and psychotherapists who are preparing to enter into practice after graduation. This article identifies trends in counsellor education accreditation from a national perspective—ranging from changes in the regulatory landscape in Canada to the integration of social justice and diversity practices into programs of study while fostering innovative program design in times of fiscal restraint within Canadian post-secondary institutions. From an international perspective, this article highlights trends for counsellor education accreditation programs in the United States, Britain, and Australia. Overall, it is important to inform counsellor educators and personnel running counselling programs in Canada on counsellor education program development, with the goal of supporting quality standards for accrediting counselling programs in Canada while acknowledging professional mental health service regulations and public policy.

Introducción. La depresión y la ansiedad son condiciones frecuentes en la mujer en edad fértil y están asociadas a desenlaces perinatales adversos. Se desconoce la prevalencia en población colombiana de bajo riesgo obstétrico. Objetivo. Determinar la prevalencia de depresión y ansiedad gestacional, y las variables demográficas, psicosociales y clínicas asociadas, en mujeres consultantes a control prenatal en Bucaramanga y Floridablanca, Santander. Metodología. Estudio descriptivo, transversal aplicando una encuesta y las escalas de Depresión Posnatal de Edimburgo, autoevaluación de ansiedad de Zung, apgar familiar y cuestionario de apoyo social percibido. Se establecieron las razones de prevalencia con intervalos de confianza del 95%. Resultados. Se estudiaron 244 gestantes, con un promedio de 24.8 años. La prevalencia de depresión fue de 24.6%, IC 95% (19.1-30.0) y ansiedad fue de 25.8%, IC 95% (20.3-31.3). La depresión está asociada con antecedente familiar de depresión en primer o segundo grado, razón de prevalencia: 2.0, IC 95% (1.1-3.7); presencia de ansiedad, razón de prevalencia: 22.5, IC 95% (9.4-53.7); y consumo de alcohol, razón de prevalencia: 2.9, IC 95% (1.1-8.2). Como factor protector se encontró tener dos fuentes de ingresos (pareja y familia), razón de prevalencia: 0.6, IC 95% (0.4-0.8). Adicionalmente, la ansiedad se asoció a presencia de depresión, razón de prevalencia: 13.3, IC 95% (6.3-28.1); presencia de violencia psicológica, razón de prevalencia: 2.3, IC 95% (1.1-4.8) y tener confianza en la pareja, razón de prevalencia: 3.4, IC 95% (1.5-8.2). Conclusión. Existe una fuerte asociación entre ansiedad y depresión por lo que debe ser tamizada durante la gestación.

In what can certainly be considered another beat of a well-worn drum, Dr. Tanuseputro makes the case that “what matters most” with regard to end-of-life care is “increasing the reach of palliative care to prevent undue suffering and the excessive use of medical aid in dying [MAiD].”[1][1] We

Preston's account of Gendlin's implicit as a realm of awareness that is more than thoughts and feelings and that precedes Cartesian dualities defines his philosophy as quintessentially nondual and places his philosophy within the spectrum of the nondual and meditative contemplative traditions. Gendlin's investigation of the relationship between the implicit and the process by which it is symbolized in words is reframed as an inquiry into the relationship between lived nonduality and its paradoxical expression in the dualities of language In its clinical application, Preston's use of Gendlin's focusing-oriented psychotherapy constitutes part of a meditative nondual practice pointing to the cultivation of a nondual state of consciousness within the relational field. It is this expanded nondual awareness with its attendant features of letting go and unconditional acceptance that gives the power to and underwrites the various strategies employed by Preston in articulating the implicit realm. El relato que hace Preston sobre el concepto de Gendlin sobre lo implícito como el área de la conciencia que es más que pensamientos y sentimientos y que precede las dualidades cartesianas define su filosofía como fundamentalmente no-dual y sitúa su filosofía dentro del espectro de las tradiciones no-duales de la meditación y la contemplación. La investigación de Gendlin sobre la relación entre lo implícito y el proceso a través del que es simbolizado en palabras es reformulado como una investigación de la relación entre la no-dualidad vivenciada y su expresión paradójica en las dualidades del lenguaje. En su aplicación clínica, el uso que hace Preston de la psicoterapia focalizada y orientada de Gendlin forma parte de una práctica meditativa no-dual que se dirige al cultivo de un estado de conciencia no-dual dentro del campo relacional. Es esta conciencia no-dual expandida con sus características concomitantes de dejar hacer y de aceptación incondicional que potencia las distintas estrategias que Preston emplea para poner en palabras lo implícito. La description par Preston du concept de l'implicite chez Gendlin, comme étant un domaine de la conscience qui recouvre davantage que les pensées et les sentiments et qui précède les dualités cartésiennes, définit la philosophie de celui-ci par la primauté de la non dualité et situe sa philosophie parmi les traditions contemplatives, méditatives et non duelles. L'étude par Gendlin de la relation entre l'implicite et le processus par lequel il est symbolisé en mots est recadré ici comme une exploration de la relation entre la non dualité vécue et son expression paradoxale à travers les dualités du langage. Dans son application clinique, l'utilisation que fait Preston de la psychothérapie centrée sur le focusing constitue une partie d'une pratique méditative non duelle menant au développement d'un état de conscience non duelle à l'intérieur du champ relationnel. C'est cette conscience non duelle élargie, avec ses aspects associés de lâcher prise et d'acceptation inconditionnelle, qui donne un pouvoir aux et soutient les diverses stratégies utilisées par Preston dans l'articulation du domaine implicite. Prestons Schilderung zu Gendlins Implizitem als einem Gebiet des Bewusstseins, das aus mehr als aus Gedanken und Gefühlen besteht, und das der Dualität Descartes vorausgeht, beschreibt seine Philosophie als in der Quintessenz nondual und gibt ihr einen Platz innerhalb des Spektrums nondualer und meditativer komplentativer Traditionen. Gendlins Untersuchung des Zusammenhangs von Implizitem und dem Prozess, wobei mit Worten symbolisiert wird, trägt die Form einer Nachforschung über die Beziehung zwischen gelebter Nicht-Dualität und eines paradoxen Ausdruckes in den Dualitäten der Sprache in der klinischen Anwendung. Preston weist auf Gendlins fokusorientierte Psychotherapie hin und stellt sie als Teil einer meditativen nondualen Praxis dar, die auf die Kultivierung eines nicht-dualen Status des Bewusstseins innerhalb des relationalen Feldes verweist. Es ist dieses erweiterte nonduale Bewusstsein mit seinen Begleitumständen des Zulassens und der vorbehaltlosen Akzeptanz, was die verschiedenen Strategien ermöglicht und unterstreicht, die Preston benutzt, indem er das Implizite definiert. Il resoconto di Preston dell'implicito di Gendlin come un ambito di consapevolezza che è qualcosa di più dei pensieri e dei sentimenti e che precede le dualità cartesiane, definisce la sua filosofia come essenzialmente non dualistica e la colloca nello spettro delle tradizioni non dualistiche meditative e contemplative. L'indagine di Gendlin sulla relazione fra l'implicito e il processo mediante il quale esso viene simbolizzato in parole viene re-inquadrato come un'indagine nella relazione fra la non dualità vissuta e la sua espressione paradossale nelle dualità del linguaggio. Nella sua applicazione clinica, l'uso di Preston della psicoterapia focalizzata di Gendlin costituisce parte di una pratica meditativa non duale che punta a coltivare uno stato non duale di coscienza nel campo relazionale. Questa ampliata consapevolezza non duale, con le sue caratteristiche di lasciar andare e di accettazione incondizionata, potenzia e sottoscrive le varie strategie impiegate da Preston nel formulare l'ambito implicito.