Zemishlany Zvi
Harefuah. 2007 Aug;146(8):602-4, 646.
Involuntary or compulsory hospitalization and treatment of mentally ill patients is one of the most distressing societal needs. The decision to hospitalize or treat an individual involuntarily must balance between three ethical issues: the patient's right to receive medical care, the patient's personal rights to liberty and dignity, and the protection of the public. The psychiatrist is concerned with the need for medical treatment, while the courts follow the letter of the law in order to ensure protection of the individual's rights, as well as those of the public. The interaction between the psychiatric (or medical) discipline and the judicial discipline comprises inherent difficulties, due to these differences in focus of concern and due to the differences in the language they use. In the civil compulsory hospitalization, it is the definition and prediction of dangerousness that comprises a potential discourse and misunderstanding between the psychiatric and the judicial system. It seems that both systems, as well as the patients, may benefit if the initial decision to hospitalize involuntarily is taken by the medical representatives (the District Psychiatrist, Hospital Director, three physicians, etc.) as an emergency procedure. The decision to continue the involuntary hospitalization should be taken by a judicial representative (or a committee), based on the psychiatric evaluation, within 72 hours instead of the 14 days as is currently stated in the Mental Health Law. The less restrictive alternative to hospitalization, compulsory outpatient treatment, is still controversial. This is an order "with no bite" and its implementation is determined, in effect, by the patient's goodwill and cooperation. There are no legal or other consequences for patients who do not comply with the outpatient treatment order. This is true for both civil and criminal outpatient orders. Without legal sanctions this model of outpatient treatment is not really "compulsory" and does not achieve its preventive goals.
对精神病患者进行非自愿或强制住院及治疗是最令人苦恼的社会需求之一。非自愿地将某人住院或治疗的决定必须在三个伦理问题之间取得平衡：患者接受医疗护理的权利、患者的人身自由和尊严权利以及对公众的保护。精神科医生关注医疗治疗的必要性，而法院则遵循法律条文以确保保护个人权利以及公众权利。由于关注重点的这些差异以及所使用语言的不同，精神科（或医学）学科与司法学科之间的互动存在内在困难。在民事强制住院方面，危险性的定义和预测构成了精神科系统与司法系统之间潜在的话语和误解。似乎如果非自愿住院的初步决定由医疗代表（地区精神科医生、医院院长、三名医生等）作为紧急程序做出，那么这两个系统以及患者可能都会受益。继续非自愿住院的决定应由司法代表（或委员会）根据精神科评估在72小时内做出，而不是像《精神卫生法》目前规定的14天。对住院限制较小的替代方案，即强制门诊治疗，仍然存在争议。这是一项“没有约束力”的命令，其实施实际上取决于患者的善意和合作。对于不遵守门诊治疗命令的患者没有法律或其他后果。民事和刑事门诊命令都是如此。没有法律制裁，这种门诊治疗模式就不是真正的“强制”，也无法实现其预防目标。
