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权宜之计而非束缚:根据《残疾人权利公约》,在完全禁止精神科强制之前,临时精神卫生立法的理由。

A Key, Not a Straitjacket: The Case for Interim Mental Health Legislation Pending Complete Prohibition of Psychiatric Coercion in Accordance with the Convention on the Rights of Persons with Disabilities.

机构信息

London Barrister and a noted authority on human rights, mental health, mental capacity, and disability law.

出版信息

Health Hum Rights. 2020 Jun;22(1):163-178.

Abstract

The practice of coercion on the basis of psychosocial disability is plainly discriminatory. This has resulted in a demand from the Committee on the Rights of Persons with Disabilities (the CRPD Committee) for a paradigm shift away from the traditional biomedical model and a global ban on compulsion in the psychiatric context. However, that has not occurred. This paper considers conflicting pronouncements of the CRPD Committee and other United Nations bodies. Assuming the former's interpretations of the Convention on the Rights of Persons with Disability (CRPD) are accurate, involuntary psychiatric detention and enforced treatment on the basis of psychosocial disability are discriminatory and unlawful practices. However, dedicated mental health legislation both permits discrimination and protects and enhances rights. This paper proposes a practical way out of the present impasse: the global introduction of interim "holding" legislation lacking full compliance with the CRPD. While imperfect, such a framework would facilitate a move toward a complete ban on psychiatric coercion. The paper outlines four essential ingredients that any interim legislation ought to contain, including clear timebound targets for full CRPD implementation. It concludes by urging the CRPD Committee to take the unprecedented step of issuing a general comment providing reluctant "permission" for the progressive realization of respect for articles 12 and 14 of the CRPD.

摘要

基于心理社会残疾而实施的强制行为显然具有歧视性。这导致残疾人权利委员会(残疾人权利委员会)要求彻底改变传统的生物医学模式,并在精神科环境中全面禁止强制。然而,这种情况并未发生。本文探讨了残疾人权利委员会和其他联合国机构之间相互矛盾的声明。假设前者对《残疾人权利公约》(《公约》)的解释是准确的,那么基于心理社会残疾的非自愿精神科拘留和强制治疗是歧视性和非法的做法。然而,专门的精神卫生立法既允许歧视,又保护和增强权利。本文提出了一种摆脱目前僵局的切实可行的方法:在全球范围内引入临时“拘留”立法,该立法不完全符合《公约》。虽然不完美,但这样的框架将有助于全面禁止精神科强制。本文概述了任何临时立法都应包含的四个基本要素,包括完全遵守《公约》的明确时间目标。最后,它敦促残疾人权利委员会采取前所未有的步骤,发表一项一般性意见,为逐步实现对《公约》第十二条和第十四条的尊重提供不情愿的“许可”。

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Epidemiol Psychiatr Sci. 2019 Dec;28(6):605-612. doi: 10.1017/S2045796019000350. Epub 2019 Jul 9.
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Surveying the Geneva impasse: Coercive care and human rights.审视日内瓦僵局:强制性护理与人权。
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