精神疾病患者非自愿住院的伦理学研究

精神科临床实践中 ,因精神疾病患者的特点应用“知情同意”准则有其特殊性。作者对非自愿住院的伦理学一些基本问题进行了探讨 ,认为生命价值原则、有利原则、无伤原则、病人利益至上兼顾社会公益是精神科临床工作中应遵循的伦理学基本原则。

精神障碍者非自愿住院的立法缺陷及完善策略分析

非自愿住院治疗是避免社会危害和保障精神障碍者健康利益而采取的一种治疗方法。笔者分析了非自愿住院的立法缺陷,明确了完善精神障碍者非自愿住院治疗立法内容,提出加快精神卫生立法,保障精神障碍者的住院选择权,规定具体的条件,设置严格、规范的非自愿住院治疗程序,健全完善监督审查机制等策略。

Ethical consideration on use of seclusion in mental health services

Seclusion was widely used in mental health service,which had caused various negative effects on patients and nurses.In China,the clinical use of seclusion was gradually increasing,which had led to ethical dilemma and had gained public concern.This article aimed to synthesize the ethical issue according to the principle of autonomy,justice,beneficence,and non-maleficence.Given that nursing workforce was limited and work burden among psychiatric nurses was heavy,seclusion was one of coercive interventions managing aggressive behavior.In relation to cope with ethical dilemma,it was proposed to improve therapeutic environment,and to apply de-escalation technique.Additionally,reducing clinical use and adverse effects of seclusion was also important,this goal would be achieved by building appropriate patient-nurse relationship,increasing staff engagement,and promoting guideline of seclusion.

加拿大的非自愿住院制度及其启示

作为联邦制国家的加拿大没有统一的精神卫生法;其各省的精神卫生法尽管存在一定的差异,但多数省的非自愿住院制度基本趋于一致,且多数省对于患者的非自愿入院都没有采取西方国家盛行的司法审查制度,而是建立了独具特色的精神卫生审查委员会制度作为事后救济途径。非自愿住院的实体条件、多样化的非自愿住院类型、便捷高效的事后救济机制等,对我国不乏借鉴意义。

民政系统精神病院的医患纠纷及处理对策探析

针对精神病院医患纠纷中存在的部分患者知情同意落实困难、一些患者的角色被强化、医疗资源使用不平衡,影响患者公平就医等伦理问题,提出防范风险,减少纠纷的对策:医务人员应正确理解医学伦理与法律、法规的关系;坚持医疗最优化、尊重、知情同意、慎独的原则;重视精神病患者的特殊心理需要,提高病床周转率;提高公众对精神疾病的知晓度。