Bell D
Victorian Institute of Forensic Mental Health, Victoria, Australia.
Aust N Z J Psychiatry. 1999 Oct;33(5):723-8. doi: 10.1080/j.1440-1614.1999.00635.x.
The aim of this paper is to discuss ethical issues that arise in the care of suicidal patients within a prison context. Such a discussion provides a suitable framework for exploration of the broader question of how coercion may be exercised by psychiatrists in a morally justifiable, as opposed to abusive, manner.
Literature relevant to the abuse of psychiatric power is reviewed. The means for immediate containment of highly suicidal patients in certain prison contexts is described and the paucity of relevant empirical research literature relating to this is identified. A framework is proposed to assist clinicians in making an ethical evaluation of coercive interventions that is applicable not only in the prevention of prisoner suicide, but also in the practice of psychiatry as a whole.
Due regard for the moral dimensions of the relationship between psychiatrist and prisoner has the potential to radically transform the way the exercise of power is subjectively experienced by each of them.
Coercion can be exercised by psychiatrists within an ethical framework which is not abusive. There will always be a risk that coercion will become an unhealthy habit of life within which the psychiatrist feels too comfortable.
本文旨在探讨在监狱环境中照顾自杀患者时出现的伦理问题。这样的讨论为探讨一个更广泛的问题提供了一个合适的框架，即精神科医生如何以道德上合理而非滥用权力的方式实施强制手段。
回顾与精神科权力滥用相关的文献。描述了在某些监狱环境中立即控制高度自杀患者的方法，并指出了与之相关的实证研究文献的匮乏。提出了一个框架，以协助临床医生对强制性干预措施进行伦理评估，该框架不仅适用于预防囚犯自杀，也适用于整个精神科实践。
对精神科医生与囚犯之间关系的道德层面给予应有的关注，有可能从根本上改变双方对权力行使的主观体验方式。
精神科医生可以在一个非滥用权力的伦理框架内实施强制手段。但始终存在一种风险，即强制手段可能会成为一种不健康的生活习惯，让精神科医生感到过于安逸。
