South West London and St George's Mental Health NHS Trust, London, UK.
Institute of Medical and Biomedical Education, St George's University of London, London, UK.
J Med Ethics. 2019 Mar;45(3):173-177. doi: 10.1136/medethics-2018-104947. Epub 2018 Dec 4.
The approach to managing the involuntary detention of people suffering from psychiatric conditions can be divided into those with clinicians at the forefront of decision-making and those who rely heavily on the judiciary. The system in England and Wales takes a clinical approach where doctors have widespread powers to detain and treat patients involuntarily. A protection in this system is the right of the individual to challenge a decision to deprive them of their liberty or treat them against their will. This protection is provided by the First-tier Tribunal; however, the number of successful appeals is low. In this paper, the system of appeal in England and Wales is outlined. This is followed by a discussion of why so few patients successfully appeal their detention with the conclusion that the current system is flawed. A number of recommendations about how the system might be reformed are offered.
管理非自愿拘留精神病患者的方法可以分为以临床医生为决策核心和严重依赖司法机构的方法。英格兰和威尔士的系统采用临床方法,医生拥有广泛的权力来非自愿地拘留和治疗患者。该系统中的一项保护措施是个人有权质疑剥夺其自由或违背其意愿进行治疗的决定。这种保护是由第一审法院提供的;然而,成功上诉的人数却很少。本文概述了英格兰和威尔士的上诉系统。接着讨论了为什么只有少数患者成功地对他们的拘留提出上诉,并得出结论认为现行制度存在缺陷。本文提出了一些关于如何改革该系统的建议。