Dawson J, Burns T, Rugkåsa J
Faculty of Law, University of Otago, Dunedin, New Zealand.
Med Law Rev. 2011 Winter;19(1):1-26. doi: 10.1093/medlaw/fwq030. Epub 2011 Feb 2.
This article debates and defends the lawfulness of a randomised controlled trial of compulsory outpatient treatment under the mental health legislation for England and Wales. The trial is designed to compare the outcomes for patients of their treatment under the new Community Treatment Order (CTO) regime with their treatment under the older leave scheme - the two main forms of compulsory care in the community now authorised by the revised Mental Health Act 1983. The methods for the trial involve the random allocation of some patients between the two schemes, when they are considered by their Responsible Clinicians to be eligible for some form of compulsory outpatient care. The main question we consider is the lawfulness of that aspect of the methods. Can a carefully selected group of patients be allocated at random between the two regimes to permit an evaluation to proceed? Or would that involve some departure from the decision-making criteria specified by law? We argue that a group of patients can be identified who meet - simultaneously - the tests for treatment under both the CTO and the leave schemes. Those patients could then be allocated lawfully to treatment under either scheme. This opens the door, we argue, to their random allocation between the two schemes for the purposes of the research. In reaching this conclusion, we explain the methods and aims of the trial and closely compare the respective features of the leave and CTO regimes.
本文对依据英格兰和威尔士精神健康立法进行的强制门诊治疗随机对照试验的合法性展开辩论并进行辩护。该试验旨在比较患者在新的社区治疗令（CTO）制度下接受治疗的结果与在旧的请假制度下接受治疗的结果，这两种制度是目前经修订的1983年《精神健康法》授权的社区强制护理的两种主要形式。试验方法包括，当责任 clinician 认为某些患者有资格接受某种形式的强制门诊护理时，将他们随机分配到这两种制度中。我们考虑的主要问题是该方法这一方面的合法性。能否将精心挑选的一组患者在这两种制度之间随机分配，以进行评估？或者这是否会涉及偏离法律规定的决策标准？我们认为，可以确定一组同时符合CTO和请假制度下治疗测试的患者。然后，可以合法地将这些患者分配到任何一种制度下接受治疗。我们认为，这为出于研究目的在这两种制度之间对他们进行随机分配打开了大门。在得出这一结论时，我们解释了试验的方法和目的，并仔细比较了请假制度和CTO制度各自的特点。
