Fistein Elizabeth C, Clare Isabel C H, Redley Marcus, Holland Anthony J
Education Division, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC) Cambridge, UK; Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Int J Law Psychiatry. 2016 May-Jun;46:50-7. doi: 10.1016/j.ijlp.2016.02.029. Epub 2016 Apr 6.
The use of detention for psychiatric treatment is widespread and sometimes necessary. International human rights law requires a legal framework to safeguard the rights to liberty and personal integrity by preventing arbitrary detention. However, research suggests that extra-legal factors may influence decisions to detain. This article presents observational and interview data to describe how decisions to detain are made in practice in one jurisdiction (England and Wales) where a tension between policy and practice has been described. The analysis shows that practitioners mould the law into 'practical criteria' that appear to form a set of operational criteria for identifying cases to which the principle of soft paternalism may be applied. Most practitioners also appear willing, albeit often reluctantly, to depart from their usual reliance on the principle of soft paternalism and authorise detention of people with the capacity to refuse treatment, in order to prevent serious harm. We propose a potential resolution for the tension between policy and practice: two separate legal frameworks to authorise detention, one with a suitable test of capacity, used to enact soft paternalism, and the other to provide legal justification for detention for psychiatric treatment of the small number of people who retain decision-making capacity but nonetheless choose to place others at risk by refusing treatment. This separation of detention powers into two systems, according to the principle that justifies the use of detention would be intellectually coherent, consistent with human rights instruments and, being consistent with the apparent moral sentiments of practitioners, less prone to idiosyncratic interpretations in practice.
将患者拘留以进行精神科治疗的做法很普遍，有时也是必要的。国际人权法要求建立一个法律框架，通过防止任意拘留来保障人身自由和人格尊严权。然而，研究表明，法律以外的因素可能会影响拘留决定。本文提供了观察数据和访谈数据，以描述在一个存在政策与实践矛盾的司法辖区（英格兰和威尔士），拘留决定在实际中是如何做出的。分析表明，从业者将法律塑造成“实际标准”，这些标准似乎构成了一套操作标准，用于确定可适用温和家长主义原则的案例。大多数从业者似乎也愿意，尽管往往很不情愿，背离他们通常对温和家长主义原则的依赖，批准对有能力拒绝治疗的人进行拘留，以防止严重伤害。我们针对政策与实践之间的矛盾提出了一个可能的解决方案：设立两个独立的法律框架来批准拘留，一个采用合适的行为能力测试，用于实施温和家长主义，另一个为少数保留决策能力但却因拒绝治疗而选择将他人置于危险境地的人接受精神科治疗的拘留提供法律依据。根据证明拘留合理性的原则，将拘留权分为两个系统，在理论上是连贯一致的，符合人权文书，并且与从业者明显的道德观念一致，在实践中不太容易产生特殊解释。
