scholarly journals The use of community treatment orders in competent patients is not justified

2017 ◽  
Vol 210 (5) ◽  
pp. 311-312 ◽  
Author(s):  
Giles Newton-Howes ◽  
Christopher James Ryan
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Empirical Evidence ◽  
Community Treatment ◽  
Necessary Condition ◽  
Community Treatment Orders ◽  
Decision Making Capacity

SummaryEmpirical evidence for the effectiveness of community treatment orders (CTOs) is at best mixed. We examine CTOs through the prism of human rights and discrimination, bearing the evidence in mind, and argue that a necessary condition for their use is that a person lacks decision-making capacity.

scholarly journals Who’s Talking About Us Without Us? A Survivor Research Interjection into an Academic Psychiatry Debate on Compulsory Community Treatment Orders in Ireland

Laws ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 33 ◽  
Author(s):  
Liz Brosnan
Keyword(s):  
Human Rights ◽  
Academic Psychiatry ◽  
United Nations ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Critical Questions ◽  
Critical Issues ◽  
Compulsory Community Treatment ◽  
United Nations Convention ◽  
The United Nations

This paper presents a user/survivor researcher perspective to the debate among psychiatrists on the suggested introduction of Community Treatment Orders in Ireland. Critical questions are raised about evidence and the construction of psychiatric knowledge. Important questions include: How is this evidence created? What and whose knowledge have not been considered? Some critical issues around coercion, ‘insight’, and attributions of ‘lack of capacity’ are briefly considered. Further legal considerations are then introduced based on the United Nations Convention on the Rights of Persons with Disability. The paper concludes with a human rights-based appeal to reject the introduction of coercive community treatment in Ireland.

scholarly journals Do Community Treatment Orders in Psychiatry Stand Up to Principalism: Considerations Reflected through the Prism of the Convention on the Rights of Persons with Disabilities

2019 ◽  
Vol 47 (1) ◽  
pp. 126-133 ◽  
Author(s):  
Giles Newton-Howes
Keyword(s):  
Decision Making ◽  
Psychiatric Treatment ◽  
Community Treatment ◽  
Psychiatric Practice ◽  
Individual Autonomy ◽  
Ethical Considerations ◽  
Community Treatment Orders ◽  
Persons With Disabilities ◽  
Medical Interventions ◽  
Modern Context

Compulsory psychiatric treatment is the norm in many Western countries, despite the increasingly individualistic and autonomous approach to medical interventions. Community Treatment Orders (CTOs) are the singular best example of this, requiring community patients to accept a variety of interventions, both pharmacological and social, despite their explicit wish not to do so. The epidemiological, medical/treatment and legal intricacies of CTOs have been examined in detail, however the ethical considerations are less commonly considered. Principlism, the normative ethical code based on the principles of autonomy, beneficence, non-maleficence and justice, underpins modern medical ethics. Conflict exists between patient centred commentary that reflects individual autonomy in decision making and the need for supported decision making, as described in the Convention on the Rights of Persons with Disabilities (CRPD) and the increasing use of such coercive measures, which undermines this principle. What appears to have been lost is the analysis of whether CTOs, or any coercive measure in psychiatric practice measures up against these ethical principles. We consider whether CTOs, as an exemplar of coercive psychiatric practice, measures up against the tenets of principalism in the modern context in order to further this debate.

Emergencies, general medicine, ‘community treatment orders’, and ‘psychiatric advance statements’

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Decision Making ◽  
Psychiatric Treatment ◽  
Good Practice ◽  
General Medicine ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Best Interests ◽  
Important Place ◽  
Decision Making Capacity ◽  
Advance Statements

The implications of the Fusion Law for general medicine, especially inpatient care when non-consensual and involuntary treatment is being considered, are examined in this chapter. The new burdens posed by regulation can be minimized by making requirements essentially parallel ‘good practice’. Involuntary psychiatric treatment in the community under the ‘decision-making capability–best interests (will and preferences)’ principles of the Fusion Law would be substantially different from the way it is commonly instituted today. The Fusion Law offers an important place for ‘advance statements’ and ‘advance directives’, supporting respect for a patient’s beliefs and values (or ‘will and preferences’). Illnesses that impair decision-making capacity, but that are relapsing-remitting—such as the majority of mental illnesses—are good candidates for such advance planning, yet such measures have rarely been employed to date.

scholarly journals Community Treatment Orders and Supported Decision-Making

2019 ◽  
Vol 10 ◽  
Author(s):  
Lisa Brophy ◽  
Renata Kokanovic ◽  
Jacinthe Flore ◽  
Bernadette McSherry ◽  
Helen Herrman
Keyword(s):  
Decision Making ◽  
Community Treatment ◽  
Community Treatment Orders

scholarly journals 6 The Intersection of Human Rights and Decision Making Capacity Legislation with Person Centred Approaches

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Amanda Phelan ◽  
Patricia Rickard Clarke
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
United Kingdom ◽  
Social Care ◽  
Self Determination ◽  
Cognitive Capacity ◽  
Risky Decision ◽  
Support Person ◽  
Decision Making Capacity ◽  
Health And Social Care

Abstract Background A major focus on decision making capacity (as opposed to cognitive capacity and competence) legislation in many Western countries is the integration of a human rights approach focused on self-determination and autonomy. This paper examines modern day concepts of personhood and person centred care and presents Irish and United Kingdom legal commentaries which focus on health services’ and society's approaches to risky decision making. Integrating human rights into decision making capacity legislation has been central in contemporary discourses on health and welfare. Methods A literature review was undertaken charting the emergence of personhood, person centred care and human rights. Case studies of influential legal commentaries in Ireland and the United Kingdom where decision-making capacity was addressed were mapped to person centred care principles. Results Findings point to a convergence of discourses of human rights in contemporary approaches to health and social care as well as the evolution of legislation to support person centredness in fostering safeguarding and promoting autonomy and self-determination. Specific legal commentaries point to the need of health and social care to be mindful of paternalism and to conceptualise the concept of ‘risk’ with a particular emphasis on the inclusion and defence of the voice of the older or vulnerable person. Conclusion The intrinsic worth of each human is articulated through an implicit and explicit vindication of their human rights. The emergence of the third generation of human rights has argued the value of self-determination and autonomy, articulated through robust national legislation on decision-making capacity based on the core principles of person centred care approaches. This move from paternalism is imperative and is imbued in contemporary legislation and legal commentaries, which has noted the need for revisions in health and social care case management perspectives.

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