严重神经性厌食症患者拒绝治疗时非自愿住院的指征：日本医生和精神卫生保健审查委员会成员的一项调查

Indications for involuntary hospitalization for refusal of treatment in severe anorexia nervosa: a survey of physicians and mental health care review board members in Japan.

作者信息

Takimoto Yoshiyuki

机构信息

Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

Department of Psychosomatic Medicine and Stress Science, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

出版信息

J Eat Disord. 2022 Nov 21;10(1):176. doi: 10.1186/s40337-022-00703-w.

DOI:10.1186/s40337-022-00703-w

PMID:36415005

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9682757/

Abstract

BACKGROUND

When a patient with anorexia nervosa refuses treatment despite a physically critical condition, the therapist considers involuntary inpatient treatment under the Mental Health Law. However, ethical and practical problems arise from its application. In this study, a survey of treatment providers for eating disorders and psychiatric review board members was conducted regarding indications for involuntary hospitalization under the Mental Health Act for refusal of treatment for anorexia nervosa.

METHODS

A survey of 212 physicians affiliated with the Japanese Society for Eating Disorders and 180 members of Mental Health Care Review Boards across Japan was conducted using six vignette cases of patients with anorexia nervosa refusing treatment.

RESULTS

Regardless of the duration of illness or age of the patient, few physicians chose compulsory hospitalization with or without the consent of the family, while the largest number of physicians chose hospitalization for medical care and protection when there was family consent. Among committee members, only hospitalization for medical care and protection was determined to be appropriate when there was family consent. Both hospitalization for medical care and protection, and compulsory hospitalization were deemed appropriate in the absence of family consent. Committee members who adjudged refusal of treatment for anorexia nervosa as self-injurious behavior suggested that compulsory hospitalization was indicated.

CONCLUSIONS

When a patient with life-threatening anorexia nervosa refuses inpatient treatment, hospitalization for medical care and protection is actively chosen if the patient's family consents. Mental Health Care Review Board members considered this acceptable. However, if the family does not consent, the physicians did not choose compulsory hospitalization, and the psychiatric review board was divided on this. Consensus was not achieved in this regard.

摘要

背景

当神经性厌食症患者尽管身体状况危急却拒绝治疗时，治疗师会考虑依据《精神卫生法》进行非自愿住院治疗。然而，其应用引发了伦理和实际问题。在本研究中，针对饮食失调治疗提供者和精神科审查委员会成员就《精神卫生法》规定的因神经性厌食症拒绝治疗而进行非自愿住院治疗的指征展开了一项调查。

方法

使用6个神经性厌食症患者拒绝治疗的案例 vignette 对212名隶属于日本饮食失调协会的医生以及日本各地180名精神卫生保健审查委员会成员进行了调查。

结果

无论患者的病程长短或年龄大小，很少有医生选择在有或没有家属同意的情况下进行强制住院，而当有家属同意时，选择住院进行医疗护理和保护的医生数量最多。在委员会成员中，只有在有家属同意时，住院进行医疗护理和保护才被判定为合适。在没有家属同意的情况下，住院进行医疗护理和保护以及强制住院都被认为是合适的。将神经性厌食症拒绝治疗判定为自残行为的委员会成员建议进行强制住院。