精神障碍患者非自愿医疗制度的法律问题研究——以北京市部分精神病医院为例

Study on the legal issues of involuntary medical system for patients with mental disorder——Taking some psychiatric hospitals in Beijing as an example

我国《精神卫生法》明确规定,精神障碍患者的住院医疗实行自愿原则。诊断结论、病情评估表明,就诊者为严重精神障碍患者并有"(一)已经发生伤害自身的行为,或者有伤害自身的危险的;(二)已经发生危害他人安全的行为,或者有危害他人安全的危险的",应当对这类患者实施住院治疗。在非自愿医疗程序运行过程中,由于部分规范性条文过于概括与模糊,在对于患者的危险性的判断程序上仍存在各种问题亟待解决。本文运用法学研究方法以精神卫生法典型案例及北京市部分精神病医院数据为基础,对"危险性"判断具有模糊性、"危险性"和判断没有明确具体评估人员进行深入分析,对于"危险性"概念给出了定义,对于决定患者是否"危险"的因素,可以从"对已经发生的危害行为的评价";"对可能发生的危害的标准,即危害的紧迫性和可能性"这两方面进行细化。同时应当成立非自愿医疗程序专门审查法庭,法律应当明确医疗机构的定位以及医疗鉴定的性质,最终由专门的法庭通过合理程序决定患者是否需要进行非自愿住院医疗,以期最大程度平衡并保护患者利益、他人利益和公共利益。

China’s"Mental Health Law"clearly stipulates that the hospitalization of patients with mental disorders implements the voluntary principle.The diagnosis conclusion and the disease evaluation indicate that the patient is a severely mentally ill person and"1.has already harmed his own behavior,or has the risk of harming himself;2.has already committed acts that endanger the safety of others,or has harmed the safety of others".Dangerous hospitalization should be performed on such patients.During the operation of the involuntary medical procedure,due to the over-generalization and ambiguity of some normative provisions,various problems still exist in the judgment procedure for the patient′s risk.Based on the typical case of mental health law and the data of some psychiatric hospitals in Beijing,this paper used the method of jurisprudence to solve two problems:The"dangerous"judgment is ambiguous and the"dangerous"judgment is not clear to the specific assessor.The authors gave a definition of the concept of"hazard",the factors that determine whether a patient is danger can be refined from"evaluation of the hazard behavior that has occurred"and"the criteria for the hazard that may occur,ie the urgency and possibility of hazard".At the same time,the author believed that an involuntary medical procedure should be established to specifically review the court.The law should clarify the positioning of the medical institution and the nature of the medical appraisal.Finally,a special court will determine whether the patient needs involuntary medical treatment through reasonable procedures to maximize the balance and protect the patients’ interest,the interests of others and the public interest.