Testa Megan, West Sara G
Dr. Testa is from University Hospitals Case Medical Center, Cleveland, Ohio.
Psychiatry (Edgmont). 2010 Oct;7(10):30-40.
This article reviews the academic literature on the psychiatric practice of civil commitment. It provides an overview of the history of involuntary psychiatric hospitalization in the United States-from the creation of the first asylum and the era of institutionalization to the movement of deinstitutionalization. The ethical conflict that the practice of involuntary hospitalization presents for providers, namely the conflict between the ethical duties of beneficence and respect for patient autonomy, is presented. The evolution of the United States commitment standards, from being based on a right to treatment for patients with mental illness to being based on dangerousness, as well as the implications that the changes in commitment criteria has had on patients and society, are discussed. Involuntary hospitalization of patient populations that present unique challenges for psychiatry (e.g., not guilty by reason of insanity acquittees, sex offenders, and individuals with eating disorders, substance use disorders, and personality disorders) is discussed. Finally, an overview of outpatient commitment is provided. By reading this article, one will learn the history of involuntary psychiatric hospitalization in the United States and gain an understanding of the ethical issues that make civil commitment one of the most controversial practices in modern psychiatry.
本文回顾了关于民事强制住院精神科实践的学术文献。它概述了美国非自愿精神科住院治疗的历史——从第一家精神病院的创建和机构化时代到去机构化运动。文中介绍了非自愿住院治疗实践给医护人员带来的伦理冲突，即行善的伦理责任与尊重患者自主权之间的冲突。讨论了美国强制住院标准的演变，从基于精神疾病患者的治疗权到基于危险性，以及强制住院标准的变化对患者和社会的影响。文中还讨论了给精神病学带来独特挑战的患者群体（例如，因精神错乱而被判无罪者、性犯罪者以及患有饮食失调、物质使用障碍和人格障碍的个体）的非自愿住院治疗。最后，提供了门诊强制治疗的概述。通过阅读本文，读者将了解美国非自愿精神科住院治疗的历史，并理解那些使民事强制住院成为现代精神病学中最具争议性实践之一的伦理问题。
