{"id":4703,"date":"2019-02-17T06:09:07","date_gmt":"2019-02-17T11:09:07","guid":{"rendered":"https:\/\/collectif.lesartsmartial.com\/en\/?p=4703"},"modified":"2025-08-12T00:20:55","modified_gmt":"2025-08-12T04:20:55","slug":"truchon-gladu-and-the-euthanasia-of-people-who-are-not-terminally-ill-february-2019-newsletter-of-the-physicians-alliance-against-euthanasia","status":"publish","type":"post","link":"https:\/\/collectifmedecins.org\/en\/truchon-gladu-and-the-euthanasia-of-people-who-are-not-terminally-ill-february-2019-newsletter-of-the-physicians-alliance-against-euthanasia\/","title":{"rendered":"Truchon, Gladu and the euthanasia of people who are not terminally ill : February 2019 newsletter of the Physicians&#8217; Alliance against Euthanasia"},"content":{"rendered":"<p><img decoding=\"async\" class=\"alignleft\" src=\"https:\/\/tvndy.ca\/wp-content\/uploads\/2013\/08\/AmyAsstSuiCartoonEN_sm21.jpg\" alt=\"AmyAsstSuiCartoonEN_sm2\" width=\"243\" height=\"187\" \/>In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include <a href=\"https:\/\/collectifmedecins.org\/en\/advance-directives-authorizing-death-we-can-do-better\/\">people with dementia<\/a> (by advance directive), <a href=\"https:\/\/collectifmedecins.org\/en\/maintaining-humanity-at-the-heart-of-pediatric-care\/\">\u201cmature\u201d minors<\/a> (with or without parental consent or knowledge) and those for whom <a href=\"https:\/\/collectifmedecins.org\/en\/psychiatry-and-euthanasia-profound-implications-for-all-medical-practice\/\">psychiatric illness<\/a> is the sole underlying condition.<\/p>\n<p>Unfortunately, by virtue of a challenge currently undertaken by Mr. Jean Truchon and Ms. Nicole Gladu before the <a href=\"https:\/\/www.theglobeandmail.com\/canada\/article-two-quebecers-suffering-from-incurable-degenerative-diseases-in-court\/\">Qu\u00e9bec Superior Court<\/a>, there is now something quantitatively much worse on the table: euthanasia for people who are not at the \u201cend of life\u201d (as required by the Quebec law) or for whom, contrary to what Canadian law requires, \u201cnatural death is not reasonably foreseeable\u201d. In other words, doctors may soon be asked to \u201cmedically\u201d kill people who are not dying. <a href=\"https:\/\/collectifmedecins.org\/en\/truchon-gladu-and-the-euthanasia-of-people-who-are-not-terminally-ill\/\">Continue reading editorial&#8230;<\/a><\/p>\n<p>Make euthanasia unimaginable.<\/p>\n<p>Sincerely,<\/p>\n<p>Catherine Ferrier<br \/>\nPresident<\/p>\n<div>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">Alliance news\u00a0<\/span><\/b><\/p>\n<\/div>\n<p><a href=\"https:\/\/collectifmedecins.org\/?page=CiviCRM&amp;q=civicrm%2Fevent%2Finfo&amp;reset=1&amp;id=3\"><strong>Registration <\/strong><\/a>is currently open for the Physicians\u2019 Alliance against Euthanasia 2nd bilingual medical conference, <strong>Improving Care 2019<\/strong>, which will take place in Montreal on Saturday, April 6th, 2019.\u00a0Physicians, allied-health professionals and anyone with an interest in the conference topics\u00a0are\u00a0welcome.<\/p>\n<p>Please send in your questions in advance to:\u00a0<a href=\"mailto:info@collectifmedecins.org\">info@collectifmedecins.org<\/a>, for the panel discussion.<\/p>\n<p><strong>Conference topics<\/strong> include:<\/p>\n<ul>\n<li><em>Consent and capacity at the end of life<\/em> (Dr. Louis Morissette)<\/li>\n<li><em>Medical-legal issues regarding MAiD and Conscience<\/em> (Dr. Richard Mimeault, CMPA)<\/li>\n<li><em>Advanced pain management<\/em> (Dr. Patrick Vinay)<\/li>\n<li><em>Palliative care at home <\/em>(Dr. Golda Tradounsky and Joan Foster, N.)<\/li>\n<li><em>General public talk: The future of Palliative Care?<\/em> (Dr. Stephen Liben)<\/li>\n<\/ul>\n<p>Click here to download a\u00a0<strong><a href=\"https:\/\/collectifmedecins.org\/sites\/collectifmedecins.org\/wp-content\/plugins\/files\/civicrm\/persist\/contribute\/files\/ImprovingCare2019posterRectoVerso0211.pdf\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/collectifmedecins.org\/sites\/collectifmedecins.org\/wp-content\/plugins\/files\/civicrm\/persist\/contribute\/files\/ImprovingCare2019posterRectoVerso0211.pdf&amp;source=gmail&amp;ust=1549997687782000&amp;usg=AFQjCNGiS1bULBmjB4toh6JZkTEkY1_JEQ\">PDF of the poster<\/a>.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">Doctor&#8217;s voices\u00a0<\/span><\/b><\/p>\n<p><strong>Responses<\/strong>\u00a0to two articles by Drs.\u00a0<a href=\"https:\/\/collectifmedecins.org\/wp-content\/plugins\/civicrm\/civicrm\/extern\/url.php?u=8310&amp;qid=468652\">Jeff Blackmer<\/a>\u00a0and\u00a0<a href=\"https:\/\/collectifmedecins.org\/wp-content\/plugins\/civicrm\/civicrm\/extern\/url.php?u=8311&amp;qid=468652\">Sandy Buchman<\/a> in the British Medical Journal, promoting Canadian-style euthanasia and the CMA\u2019s so-called \u201cthird way\u201d.<\/p>\n<p><a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l412\/rr-18\"><strong>Take off the rose-coloured glasses.<\/strong> A response to Drs Buchman and Blackmer, by Canadian palliative care physicians<\/a> <strong>Leonie Herx<\/strong>, Srini Chary, Ed Dubland, Robin Fainsinger, David Henderson, Bernard Lapointe and Valerie Schulz.<\/p>\n<p><strong>Letter by Dr. <a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l412\/rr-21\">Williard Johnston<\/a><\/strong><\/p>\n<p><strong>CMA\u2019s \u201cthird way\u201d may be a third rail<\/strong> by <a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l412\/rr-11\">Sean Murphy<\/a> of the Protection of Conscience Project.<\/p>\n<p><strong>Amy Hendricks<\/strong>, internist at St. Martha\u2019s Regional Hospital in Antigonish offers a physician\u2019s perspective against pressure to offer MAiD at St. Martha\u2019s Hospital: <a href=\"https:\/\/www.thechronicleherald.ca\/opinion\/opinion-as-a-doctor-im-not-here-to-facilitate-death-271128\/\">OPINION: As a doctor, I\u2019m not here to facilitate death.<\/a><\/p>\n<p><a href=\"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/01\/wmj_4_2018_WEB.pdf\"><strong>Why Euthanasia is Unethical<\/strong> and Why We Should Name it as Such<\/a> by Leiva, Friesen &amp; Lau, WMJ Dec 2018.<\/p>\n<p><a href=\"http:\/\/www.doctorssayno.nz\/\">&#8216;<strong>Doctors say no<\/strong>&#8216;<\/a> is an Open Letter to all New Zealanders by doctors supporting the World Medical Association and New Zealand Medical Association position statements that euthanasia and assisted suicide are unethical, even if they were to become legal.<\/p>\n<p>&#8220;<strong>Physician Assisted Suicide <\/strong>&amp; Euthanasia of Patients with Non-Terminal Mental Disorders: An Emerging Ethical Crisis&#8221; A talk by <a href=\"https:\/\/youtu.be\/MtnMLZgt4Jw\">Mark S. Komrad, MD<\/a>.<\/p>\n<p><strong>A Reflection <\/strong>on Voluntary Assisted Dying and Conscientious Objection by Australian Palliative Medicine physician, <a href=\"https:\/\/dr892t1ezw8d7.cloudfront.net\/wp-content\/uploads\/2018\/08\/Voluntary-Assisted-Dying-Conscientious-Objection-Dr-A-Dabscheck-.pdf\">Dr. Adrian Dabscheck<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">Call to action<\/span><\/b><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">\u00a0<\/span><\/b><\/p>\n<p>The <a href=\"http:\/\/cqmf.qc.ca\/\" data-cke-saved-href=\"http:\/\/cqmf.qc.ca\/\">Quebec College of Family physicians<\/a> is inviting members to submit their candidacy for the Board of directors. The Annual assembly will be held on May 31st, 2019. Deadline for submission: April 16<sup>th<\/sup>, 2019. <a href=\"https:\/\/collectifmedecins.org\/sites\/collectifmedecins.org\/wp-content\/plugins\/files\/civicrm\/persist\/contribute\/files\/Bulletin%20mise%20en%20candidature_2019_2_.pdf\" data-cke-saved-href=\"https:\/\/collectifmedecins.org\/sites\/collectifmedecins.org\/wp-content\/plugins\/files\/civicrm\/persist\/contribute\/files\/Bulletin%20mise%20en%20candidature_2019_2_.pdf\">More details here<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">In<\/span><\/b><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">\u00a0the news\u00a0<\/span><\/b><\/p>\n<p><strong>Canada\u2019s new <a href=\"https:\/\/www.theglobeandmail.com\/canada\/article-david-lamettis-appointment-as-justice-minister-raises-hope-for-less\/\">Justice Minister, David Lametti<\/a><\/strong>, may be more inclined than his predecessor to extend euthanasia to more vulnerable groups.<\/p>\n<p><a href=\"https:\/\/collectifmedecins.org\/wp-content\/plugins\/civicrm\/civicrm\/extern\/url.php?u=8322&amp;qid=\" rel=\"nofollow\"><b>Two Quebecers with disabilities <\/b>are challenging the end of life provision in the Quebec and Canadian euthanasia laws<\/a>. The Physicians\u2019 Alliance against Euthanasia is an intervener in this case. Interview with our lawyer Me Michel Racicot:\u00a0<a href=\"https:\/\/collectifmedecins.org\/wp-content\/plugins\/civicrm\/civicrm\/extern\/url.php?u=8388&amp;qid=\" rel=\"nofollow\">Opposition \u00e0 l&#8217;aide m\u00e9dicale \u00e0 mourir<\/a>\u00a0(January 31, 2019)<\/p>\n<p><a href=\"https:\/\/collectifmedecins.org\/sites\/collectifmedecins.org\/wp-content\/plugins\/files\/civicrm\/persist\/contribute\/files\/access-palliative-care-2018-en-web.pdf\" data-cke-saved-href=\"https:\/\/collectifmedecins.org\/sites\/collectifmedecins.org\/wp-content\/plugins\/files\/civicrm\/persist\/contribute\/files\/access-palliative-care-2018-en-web.pdf\"><b>Canadian Institute of Health Information report<\/b><\/a> on access to Palliative Care in Canada.<\/p>\n<p><a href=\"https:\/\/montrealgazette.com\/pmn\/news-pmn\/canada-news-pmn\/quebec-professional-orders-ask-province-to-challenge-assisted-dying-law\/wcm\/791a319a-d39d-4db9-8c83-e5bee025954e\"><strong>Six Quebec professional orders<\/strong> are calling on the province to challenge the constitutionality of federal legislation on medical assistance in dying<\/a>.<\/p>\n<p><em>If you have an article, letter or interview relevant to our work published in any media, please let us know at\u00a0<\/em><a href=\"mailto:info@collectifmedecins.org\" data-cke-saved-href=\"mailto:info@collectifmedecins.org\"><em>info@collectifmedecins.org<\/em><\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">From the trenches<\/span><\/b><\/p>\n<p><strong>A letter by K. Hetherington and G. Fecteau, <\/strong>President and chief executive officer of the Canadian Mental Health Association \u2013 Quebec Division and Montreal Branch, addressing MAiD for \u00a0patients with psychiatric conditions.Original article available in French only: <a href=\"https:\/\/www.ledevoir.com\/opinion\/idees\/545676\/exclure-les-patients-psychiatriques-de-l-aide-a-mourir\">Exclure les patients psychiatriques de l\u2019aide \u00e0 mourir<\/a>:\u00a0Lettre en r\u00e9ponse au texte\u00a0\u00a0<a href=\"https:\/\/www.ledevoir.com\/societe\/sante\/515529\/aide-a-mourir\">\u00ab\u00a0L\u2019<\/a><a href=\"https:\/\/www.ledevoir.com\/aide-medicale-a-mourir\">aide m\u00e9dicale \u00e0 mourir<\/a>\u00a0\u00bb r\u00e9clam\u00e9e pour certains patients atteints de troubles mentaux\u00a0\u00bb.<\/p>\n<p><strong>An interview with Aubert Martin<\/strong>, the Executive Director of Living with Dignity reviewing euthanasia in Quebec (2018). Original interview available in French only: L\u2019entrevue de Aubert Martin, le directeur g\u00e9n\u00e9ral de Vivre dans la Dignit\u00e9: \u00ab\u00a0<a href=\"http:\/\/www.le-verbe.com\/on-nest-pas-du-monde\/emission-du-7-janvier\/\">Bilan 2018 sur l&#8217;euthanasie au Qu\u00e9bec\u00a0<\/a>\u00bb<\/p>\n<p><a href=\"https:\/\/www.cbc.ca\/news\/opinion\/physician-referrals-1.4991723\"><strong>Physicians in Canada should be moral actors, not robotic bureaucrats<\/strong><\/a><strong>:<\/strong> Doctors should not be obliged to write referrals for procedures they find morally objectionable.<\/p>\n<p><strong>An article by Marie-\u00c8ve Veilleux, <\/strong>on the obstacles that cause suffering for people with disabilities. Original article available in French only: <a href=\"https:\/\/www.ledevoir.com\/opinion\/idees\/546012\/aide-medicale-a-mourir-ce-qui-fait-souffrir-les-personnes-handicapees\">Ce qui fait souffrir les personnes handicap\u00e9es<\/a><\/p>\n<p><strong>Investing in mental health to live with dignity.<\/strong> Original article in French only\u00a0: <a href=\"https:\/\/www.ledevoir.com\/opinion\/idees\/545938\/investir-en-sante-mentale-pour-vivre-dans-la-dignite\">Investir en sant\u00e9 mentale pour vivre dans la dignit\u00e9<\/a><\/p>\n<p><strong>Mario Dumont, <\/strong>who supported \u201cmedical aid in dying\u201d, reflects on what Gladu and Truchon are asking for&#8230; maybe it\u2019s aid in suicide, not \u201caid in dying\u201d. Original article available in French only: <a href=\"https:\/\/www.journaldequebec.com\/2019\/01\/19\/il-faudra-dire-suicide-assiste\">Il faudra dire \u00ab suicide assist\u00e9 \u00bb<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">Resources<\/span><\/b><\/p>\n<p><a href=\"http:\/\/www.virtualhospice.ca\/Assets\/too-little-too-late%20-%20vulnerable%20Canadians%20-%20Nov%202018_20181106121227.pdf\"><strong>TOO LITTLE, TOO LATE:<\/strong> How we fail vulnerable Canadians as they die and what to do about it<\/a>.\u00a0November 2018. Final Project Report for the Equitable Access to Care Study in Victoria, British Columbia.<\/p>\n<p><strong>NOVA Montreal<\/strong> launches the new <a href=\"https:\/\/palli-science.com\/sites\/default\/files\/pdf\/croix-bleue-mentorat.pdf\">Blue Cross Palliative Care Nursing mentoring program<\/a> for home care nurses working in CLSCs in Quebec.<\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">Events:<\/span><\/b><strong>\u00a0<\/strong><\/p>\n<p>Dr. Catherine Ferrier will speak about <a href=\"https:\/\/st-luke.ca\/upload\/2018-2019CAFE_Flyer.pdf\">Euthanasia in Quebec and Canada<\/a> on Wednesday, February 27 at 7 p.m. at St. Luke\u2019s Parish, 106A Anselme-Lavigne, Dollard des Ormeaux Qc, H9A 1N8.<\/p>\n<p>&nbsp;<\/p>\n<p><b><span style=\"color: #a60808; font-size: 22px; font-family: georgia;\">In the literature\u00a0<\/span><\/b><\/p>\n<p><strong><em>Nature Communications<\/em><\/strong><em>\u00a0<strong>(2019) 10:207<\/strong><\/em> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6331593\/pdf\/41467_2018_Article_8170.pdf\">Suicide among cancer patients<\/a>. Zaorsky, N.G., Zhang, Y., Tuanquin, L., et al.<\/p>\n<p><strong><em>Current Opinion in Anaesthesiology\u00a0Dec 2018 <\/em><\/strong>\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30531611\">Withholding or withdrawing<\/a> life support versus physician-assisted death: a distinction with a difference? McClelland, W. and\u00a0Goligher, E.C.<\/p>\n<p><strong><em>New England Journal of Medicine Jan 2019; 380:211-213<\/em><\/strong>\u00a0 <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp1810018\" data-cke-saved-href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp1810018\">Perspective: Better Words for Better Deaths<\/a>.\u00a0DeForest, A.<\/p>\n<p><strong><em>New England Journal of Medicine, ;January 2019; 380:311-313\u00a0 <\/em><\/strong>Perspective: <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp1808910\">When a Patient Dies by Suicide \u2014 The Physician\u2019s Silent Sorrow<\/a> Miller, D.<\/p>\n<p>&nbsp;<\/p>\n<p><em>If you come across articles that could be of interest to colleagues in the Alliance please send the reference to <a href=\"mailto:info@collectifmedecins.org\">info@collectifmedecins.org<\/a>.<\/em><\/p>\n<div>\n<hr \/>\n<p><strong>SUPPORT OUR EFFORTS<\/strong>\u00a0so that we can continue to speak on your behalf:<\/p>\n<\/div>\n<form action=\"https:\/\/www.paypal.com\/cgi-bin\/webscr\" method=\"post\" target=\"_top\"><input contenteditable=\"false\" name=\"cmd\" type=\"hidden\" value=\"_s-xclick\" data-cke-saved-name=\"cmd\" data-cke-editable=\"1\" \/> <input contenteditable=\"false\" name=\"hosted_button_id\" type=\"hidden\" value=\"PMSKFWV5BW9BC\" data-cke-saved-name=\"hosted_button_id\" data-cke-editable=\"1\" \/> <input contenteditable=\"false\" alt=\"PayPal - The safer, easier way to pay online!\" name=\"submit\" src=\"https:\/\/www.paypalobjects.com\/en_US\/i\/btn\/btn_donateCC_LG.gif\" type=\"image\" data-cke-saved-name=\"submit\" data-cke-saved-src=\"https:\/\/www.paypalobjects.com\/en_US\/i\/btn\/btn_donateCC_LG.gif\" data-cke-editable=\"1\" \/> <img decoding=\"async\" src=\"https:\/\/www.paypalobjects.com\/en_US\/i\/scr\/pixel.gif\" alt=\"\" width=\"1\" height=\"1\" border=\"0\" data-cke-saved-src=\"https:\/\/www.paypalobjects.com\/en_US\/i\/scr\/pixel.gif\" \/><\/form>\n<p><strong>Increase our media impact:<\/strong><\/p>\n<ul>\n<li>Invite your entourage to <a href=\"http:\/\/collectifmedecins.org\/en\/declaration\/\" target=\"_blank\" rel=\"noopener\" data-cke-saved-href=\"http:\/\/collectifmedecins.org\/en\/declaration\/\">become a supporter of the <em>Physicians&#8217; Alliance<\/em> &gt;&gt;<\/a><\/li>\n<li>Invite your entourage to <a href=\"http:\/\/twitter.com\/collectifmed\" target=\"_blank\" rel=\"noopener\" data-cke-saved-href=\"http:\/\/twitter.com\/collectifmed\">follow us on Twitter &gt;&gt;<\/a><\/li>\n<li>Invite your entourage to <a href=\"https:\/\/www.facebook.com\/collectifmed\" target=\"_blank\" rel=\"noopener\" data-cke-saved-href=\"https:\/\/www.facebook.com\/collectifmed\">like our Facebook page &gt;&gt;<\/a><\/li>\n<li>Invite your entourage to <a href=\"http:\/\/www.youtube.com\/channel\/UCkkxS2RNnJeT4r5-i0DXB7Q\" target=\"_blank\" rel=\"noopener\" data-cke-saved-href=\"http:\/\/www.youtube.com\/channel\/UCkkxS2RNnJeT4r5-i0DXB7Q\">subscribe to our Youtube channel &gt;&gt;<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include people with dementia (by advance directive), \u201cmature\u201d minors (with or without parental consent or knowledge) and those for whom psychiatric illness is the sole underlying condition. Unfortunately, by virtue of a [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_oasis_is_in_workflow":0,"_oasis_original":0,"footnotes":""},"categories":[211,185],"tags":[],"class_list":["post-4703","post","type-post","status-publish","format-standard","hentry","category-alliance-communication","category-newsletters"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Truchon, Gladu and the euthanasia of people who are not terminally ill : February 2019 newsletter of the Physicians&#039; Alliance against Euthanasia - Physicians\u2019 Alliance against Euthanasia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/collectifmedecins.org\/en\/truchon-gladu-and-the-euthanasia-of-people-who-are-not-terminally-ill-february-2019-newsletter-of-the-physicians-alliance-against-euthanasia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Truchon, Gladu and the euthanasia of people who are not terminally ill : February 2019 newsletter of the Physicians&#039; Alliance against Euthanasia - Physicians\u2019 Alliance against Euthanasia\" \/>\n<meta property=\"og:description\" content=\"In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include people with dementia (by advance directive), \u201cmature\u201d minors (with or without parental consent or knowledge) and those for whom psychiatric illness is the sole underlying condition. 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