阿片类物质使用障碍非自愿民事住院治疗的感知益处与危害
Perceived Benefits and Harms of Involuntary Civil Commitment for Opioid Use Disorder.
作者信息
Evans Elizabeth A, Harrington Calla, Roose Robert, Lemere Susan, Buchanan David
机构信息
Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics.
出版信息
J Law Med Ethics. 2020 Dec;48(4):718-734. doi: 10.1177/1073110520979382.
Involuntary civil commitment (ICC) to treatment for opioid use disorder (OUD) prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and "on-demand" treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way.
因阿片类物质使用障碍（OUD）而进行的非自愿民事住院治疗（ICC）可预防即将发生的药物过量，但也会限制自主权并引发其他伦理问题。利用卡斯公共卫生伦理框架，我们确定了ICC的益处和危害。益处包括：保护脆弱、服务不足的患者；减少法律后果；为家庭提供资源；以及“按需”获得治疗。危害包括：污名化和惩罚性经历；加剧家庭冲突和社会隔离；侵蚀患者的自决权；阿片类物质使用障碍药物供应有限或无供应；以及长期药物过量风险。为了合乎伦理地使用ICC，应认识到其涉及值得额外保护的脆弱患者；应作为最后的选择；采用自愿、人性化的程序；提供药物和其他循证治疗；与现有医疗系统整合；并在推广之前证明有效结果。对阿片类物质使用障碍治疗进行ICC存在重大潜在危害，如果不加以解决，可能会超过其益处。研究结果可为确保以符合伦理责任的方式使用ICC的创新提供参考。
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