Lin Chih-Yuan
Department of psychiatry at Yu-Li Veterans Hospital in Hua-Lien, Taiwan. Send correspondence to Dr. Lin at 91 Shih-Shih Street, Yu-Li, Hualien 981, Taiwan.
Psychiatr Serv. 2003 Jun;54(6):866-70. doi: 10.1176/appi.ps.54.6.866.
Although there have been critiques about the application of the "least restrictive alternative" to mental health policies in the past three decades, no critical analysis of the ethical logic of this principle has been put forward. The author explores three main ethical theories-liberalism, utilitarianism, and communitarianism-and explains how liberalism and subjective utilitarianism, which evidently uphold the least restrictive alternative in the name of individual rights and preference for liberty, effectively disenfranchise patients and members of their family. Contrarily, objective utilitarianism, with its highlight on cost-effectiveness analysis, would actually lay solid ground for mental health policies that attend not simply to ideological belief but rather to the question of which treatments can most cost-effectively meet the complex needs of patients. In addition, under communitarianism the evidence derived from cost-effectiveness analysis can be used to reinterpret the traditional value in mental health policies and thereby lead to the policy in favor of the most cost-effective alternative.
尽管在过去三十年里，有人对“限制最少的替代方案”在心理健康政策中的应用提出了批评，但尚未有人对这一原则的伦理逻辑进行批判性分析。作者探讨了三种主要的伦理理论——自由主义、功利主义和社群主义——并解释了自由主义和主观功利主义如何以个人权利和对自由的偏好之名明显支持限制最少的替代方案，却实际上剥夺了患者及其家庭成员的权利。相反，强调成本效益分析的客观功利主义，实际上将为心理健康政策奠定坚实基础，这些政策不仅关注意识形态信仰，更关注哪种治疗方法能够最具成本效益地满足患者的复杂需求。此外，在社群主义之下，源自成本效益分析的证据可用于重新诠释心理健康政策中的传统价值观，从而得出支持最具成本效益替代方案的政策。
