Farhad R. Udwadia, MBE, is affiliated with Neuroethics Canada, Division of Neurology, Department of Medicine, at the University of British Columbia in Vancouver, and completed this work while at the Center for Bioethics at Harvard Medical School. Judy Illes, C.M., Ph.D., is affiliated with Neuroethics Canada, Division of Neurology, Department of Medicine, at the University of British Columbia in Vancouver.
J Law Med Ethics. 2020 Dec;48(4):735-740. doi: 10.1177/1073110520979383.
Supply-side interventions such as prescription drug monitoring programs, "pill mill" laws, and dispensing limits have done little to quell the burgeoning opioid crisis. An increasingly popular demand-side alternative to these measures - now adopted by 38 jurisdictions in the USA and 7 provinces in Canada - is court-mandated involuntary commitment and treatment. In Massachusetts, for example, Part I, Chapter 123, Section 35 of the state's General Laws allows physicians, spouses, relatives, and police officers to petition a court to involuntarily commit and treat a person whose alcohol or drug abuse poses a likelihood of serious harm. This paper explores the ethical underpinnings of this law as a case study for others. First, we highlight the procedural and substantive standards of Section 35 and evaluate the application of the law in practice, including the frequency with which it has been invoked and outcomes. We then use this background to inform an ethical critique of the law. Specifically, we argue that the infringement of autonomy and privacy associated with involuntary intervention under Section 35 is not currently justified on the grounds of a lack of evidenced benefits and a risk of significant of harm. Further ethical concerns also arise from a lack of standard of care provided under the Section 35 pathway. Based on this analysis, we advance four recommendations for change to mitigate these ethical shortcomings.
供应方干预措施，如处方药物监测计划、“制毒药房”法律和配药限制，对缓解日益严重的阿片类药物危机几乎没有起到作用。作为这些措施的替代方案，需求方干预措施越来越受到欢迎，目前美国有 38 个司法管辖区和加拿大的 7 个省份已采取这种措施，即法院强制实施非自愿住院和治疗。以马萨诸塞州为例，该州《一般法》第 123 章第 35 节第 1 部分允许医生、配偶、亲属和警察向法院申请强制住院和治疗滥用酒精或药物且可能造成严重伤害的人。本文将该法律作为案例研究，探讨其伦理基础。首先，我们强调第 35 节的程序和实质性标准，并评估该法律在实践中的应用，包括其被援引的频率和结果。然后，我们利用这一背景对该法律进行伦理批判。具体而言，我们认为，根据缺乏证据支持的利益和存在重大伤害风险这两点，第 35 节规定的非自愿干预侵犯了自主权和隐私，这一理由目前还不够充分。此外，由于第 35 节规定的护理标准缺乏，还引发了其他一些伦理问题。基于这一分析，我们提出了四项改革建议，以减轻这些伦理缺陷。
