Szmukler George
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
World Psychiatry. 2019 Feb;18(1):34-41. doi: 10.1002/wps.20584.
The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) is the most up-to-date international legal instrument concerning the rights of persons with disabilities. Such persons are taken to include those with serious mental disorders. According to an authoritative interpretation of a crucial Article (Article 12 - Equal recognition before the law) by the UN CRPD Committee, involuntary detention and treatment of people with mental health disabilities are prohibited under the Convention. Both conventional mental health law and "capacity-based" law are deemed to violate the Convention. However, some other UN bodies are not in full agreement (for example, the UN Human Rights Committee and the Subcommittee on Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment), while others are less explicitly absolutist (for example, the Human Rights Council). Furthermore, strong criticisms of the position of the CRPD Committee have been mounted from a number of academic quarters. These criticisms center on whether the role of a person's ability to make a decision can be ignored, no matter the circumstances. Much of the above debate turns on the concept of "legal capacity" and the now often-repeated precept that one must always respect the "will and preferences" of the person with a disability. However, "will and preferences" remains undefined. In this paper, I offer an analysis of "will and preferences" that can clarify interventions that may be acceptable or non-acceptable under the terms of the UN Convention.
联合国《残疾人权利公约》是关于残疾人权利的最新国际法律文书。这类人包括患有严重精神障碍的人。根据联合国《残疾人权利公约》委员会对一项关键条款(第十二条——在法律面前获得平等承认)的权威解释,该公约禁止对有精神健康残疾的人进行非自愿拘留和治疗。传统的精神卫生法和“基于能力”的法律都被认为违反了该公约。然而,联合国的其他一些机构并不完全认同(例如,联合国人权事务委员会以及防范酷刑和其他残忍、不人道或有辱人格的待遇或处罚小组委员会),而其他一些机构则没有那么绝对(例如,人权理事会)。此外,一些学术领域对《残疾人权利公约》委员会的立场提出了强烈批评。这些批评集中在一个人的决策能力的作用是否可以在任何情况下都被忽视。上述大部分辩论都围绕着“法律行为能力”的概念以及现在经常被重复的原则,即必须始终尊重残疾人的“意愿和偏好”。然而,“意愿和偏好”仍然没有明确的定义。在本文中,我对“意愿和偏好”进行分析,以阐明根据联合国公约的条款可能被接受或不被接受的干预措施。