Appelbaum P S
Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655, USA.
J Am Acad Psychiatry Law. 1997;25(2):135-47.
To what extent have developments in commitment law around the world paralleled trends in the United States in the last three decades? Although the American emphasis on dangerousness criteria and strigent procedural rights has been echoed in a number of other countries, it has not dominated reform in most nations. The leading alternative has been the 1983 Mental Health Act in England and Wales, with its focus on the "health and safety" of the patient, as well as protection of other persons, and its avoidance of judicial hearings. How have these reforms fared? Extensive data from the United States, and more limited data from other countries, suggest that reforms in general are resisted when they are seen as shifting the focus away from patients' treatment needs. When law fails to reflect widely held moral sentiments, it is molded in practice to conform more closely to those sentiments. It is helpful to recognize that a variety of approaches to mental health law are consistent with reasonable protection of civil liberties in a democratic society. Greater attention to practices in other countries may help reformers expand the menu of options in policy debates.
在过去三十年里，世界各国在强制收治法律方面的发展在多大程度上与美国的趋势并行？尽管美国对危险性标准和严格程序权利的强调在其他一些国家得到了呼应，但在大多数国家，它并未主导改革。主要的替代方案是1983年英格兰和威尔士的《精神健康法》，其重点是患者的“健康和安全”以及对其他人的保护，并且避免司法听证。这些改革的成效如何？来自美国的大量数据以及来自其他国家的有限数据表明，当改革被视为将重点从患者的治疗需求上转移时，总体上会遭到抵制。当法律未能反映广泛持有的道德观念时，它在实践中会被塑造得更符合这些观念。认识到各种精神健康法律方法与民主社会中对公民自由的合理保护是一致的，这很有帮助。更多地关注其他国家的做法可能有助于改革者在政策辩论中扩大选择范围。
