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保护权利和建设能力:从《残疾人权利公约》看全球精神卫生政策面临的挑战。

Protecting rights and building capacities: challenges to global mental health policy in light of the convention on the rights of persons with disabilities.

机构信息

Dalhousie University Schulich School of Law.

出版信息

J Law Med Ethics. 2013 Spring;41(1):48-73. doi: 10.1111/jlme.12005.

Abstract

The World Health Organization (WHO) has identified mental health as a priority for global health promotion and international development to be targeted through promulgation of evidence-based medical practices, health systems reform, and respect for human rights. Yet these overlapping strategies are marked by tensions as the historical primacy of expert-led initiatives is increasingly subject to challenge by new social movements - in particular, disabled persons' organizations (DPOs). These tensions come into focus upon situating the WHO's mental health policy initiatives in light of certain controversies arising under the Convention on the Rights of Persons with Disabilities (CRPD), particularly as it applies to persons with mental (psychosocial) disabilities. I examine two such controversies - concerning, respectively, the legitimacy of involuntary psychiatric interventions and the legitimacy of regimes of substitute decision-making. These controversies illustrate the radical challenges to global and domestic mental health policy that have gained new momentum through the participation of DPOs in the CRPD process. At the same time, they illustrate the need for ongoing, inclusive forums for deliberation at the nexus of mental health policy and human rights, aimed at enabling human flourishing within a framework of respect for diversity.

摘要

世界卫生组织(WHO)已将精神健康确定为全球健康促进和国际发展的优先事项,通过推广基于证据的医疗实践、卫生系统改革和尊重人权来实现。然而,这些重叠的策略存在紧张关系,因为专家主导的举措的历史首要地位越来越受到新社会运动的挑战,特别是残疾人组织(DPO)。当我们根据《残疾人权利公约》(CRPD)下出现的某些争议来审视世卫组织的精神卫生政策倡议时,这些紧张关系就会变得明显,特别是在适用于精神(心理社会)残疾人士的方面。我研究了两个这样的争议,分别涉及非自愿精神干预的合法性和替代决策制度的合法性。这些争议说明了通过 DPO 参与 CRPD 进程,对全球和国内精神卫生政策产生的激进挑战。同时,它们也说明了需要在精神卫生政策和人权的交叉点上持续进行包容性的审议论坛,以便在尊重多样性的框架内实现人类的繁荣。

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