International Journal of Law and Psychiatry最新文献_第2页

Analysing risk factors for involuntary admission from an intersectional perspective: A latent class analysis 从交叉视角分析非自愿入院的风险因素：潜在类别分析

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-01-23 DOI: 10.1016/j.ijlp.2026.102191

Jona Carlet, Florian Hotzy, Anke Maatz, Philipp Homan, Mario Müller

Background

Involuntary admission (IA) is a contentious practice in mental healthcare, justified only to prevent harm to self or others. Previous studies have identified individual sociodemographic characteristics as risk factors for IA. Intersectional theories argue that such approaches overlook the complexities of social identities and related health inequalities. Intersectionality stresses the interconnected nature of social identities, such as race or class, and analyses how these overlapping factors create unique experiences of marginalisation and discrimination. This study aimed to adopt an intersectional framework to identify subgroups with specific sociodemographic characteristics and assess their risk for IA. We hypothesized that groups facing multiple forms of marginalisation would be strongly associated with higher risk for IA.

Methods

We analysed data from 16,024 cases at the Psychiatric University Clinic Zurich, Switzerland, between 2017 and 2020 using Latent Class Analysis to identify subgroups with distinct sociodemographic characteristics. Variables included sex, age, nationality, residence status, educational attainment, employment status, and language proficiency. Classes were validated against clinical factors including IA.

Results

Four distinct classes emerged. The class most strongly associated with IA was characterized by unemployment, social welfare dependency, non-European citizenship, temporary residency or refugee status, and low educational attainment. In contrast, classes with Swiss nationality, permanent residency, and employment were significantly less likely to experience IA.

Conclusion

Adopting an intersectional framework, our findings suggest that individuals facing multiple marginalised identities are at higher risk for IA, indicating possible barriers to voluntary and early treatment. Further research is needed to explore and address these barriers.

背景：非自愿入院（IA）在精神卫生保健中是一个有争议的做法，只有为了防止伤害自己或他人才有理由。先前的研究已经确定了个体社会人口学特征是IA的危险因素。交叉理论认为，这种方法忽视了社会身份和相关健康不平等的复杂性。交叉性强调社会身份的相互联系本质，如种族或阶级，并分析这些重叠因素如何创造边缘化和歧视的独特经历。本研究旨在采用交叉框架来识别具有特定社会人口学特征的亚组，并评估他们患IA的风险。我们假设面临多种形式边缘化的群体与IA的高风险密切相关。方法：我们分析了2017年至2020年间瑞士苏黎世精神病学大学诊所16024例病例的数据，使用潜在类别分析来确定具有不同社会人口学特征的亚组。变量包括性别、年龄、国籍、居住状况、教育程度、就业状况和语言能力。根据包括IA在内的临床因素对班级进行验证。结果出现了四个不同的类别。与IA联系最密切的阶层的特点是失业、依赖社会福利、非欧洲公民身份、临时居留权或难民身份以及受教育程度低。相比之下，拥有瑞士国籍、永久居留权和就业的班级明显不太可能经历IA。结论采用交叉框架，我们的研究结果表明，面临多个边缘化身份的个体患IA的风险更高，这表明可能存在自愿和早期治疗的障碍。需要进一步的研究来探索和解决这些障碍。

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引用次数: 0

Prescription patterns of benzodiazepines and Z-drugs in Berlin prisons 柏林监狱苯二氮卓类药物和z型药物的处方模式。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-01-21 DOI: 10.1016/j.ijlp.2026.102189

Nicolas Schwarzer , Julia Krebs , Norbert Konrad , Marc Lehmann , Annette Opitz-Welke

Background

Benzodiazepines and Z-drugs are commonly prescribed medications in psychiatric treatment. Prisoners are a unique patient population due to their elevated prevalence of substance abuse and psychiatric morbidity. Given the limited data about the medical treatment for prisoners, this study aims to provide an initial exploratory overview of the prescription patterns of benzodiazepines and Z-drugs in Berlin prisons.

Materials and methods

A data set was compiled by extracting information from the documentation systems of all seven Berlin prisons. All inmates with a prescription for benzodiazepines or Z-drugs as of the cut-off date were included. Demographic characteristics, arrest circumstances, and medical histories were considered. Supplementary information on the overall prison population was obtained from officially published sources.

Results

As of August 31, 2022, the point prevalence of benzodiazepine and Z-drug prescriptions among Berlin prisoners was 3.9% (n = 136). The duration of 46 (33.8%) prescriptions exceeded six weeks. The prescription rate in female prisoners (6.8%, n = 13/190) was significantly higher than in male prisoners (4.1%, n = 123/3299). The prescription rate in default imprisoned individuals (16.5%, n = 62/376) was significantly higher compared to in convicted and remand detainees (2.1%, n = 71/3095).

Conclusion

Benzodiazepines and Z-drugs were prescribed less frequently in Berlin prisons than in general outpatient care. Approximately 1/3 of all prescriptions exceeded the recommended maximum duration. Prescription rates in prison were higher among female inmates. Rates among remand detainees did not exceed those of convicted prisoners. Default imprisonment was identified as a factor influencing prescription practices, likely due to its strong association with homelessness and alcohol abuse.

背景：苯二氮卓类药物和z -药物是精神病治疗中常用的处方药。囚犯是一个独特的病人群体，因为他们滥用药物和精神疾病的发病率很高。鉴于囚犯医疗数据有限，本研究旨在对柏林监狱苯二氮卓类药物和z型药物的处方模式进行初步探索性概述。材料和方法：通过从柏林所有七所监狱的文件系统中提取资料汇编了一套数据。截至截止日期，所有持有苯二氮卓类药物或z类药物处方的囚犯都包括在内。考虑了人口特征、逮捕情况和病史。关于监狱人口总数的补充资料来自正式公布的来源。结果：截至2022年8月31日，柏林囚犯苯二氮卓类药物和z -药物处方的点患病率为3.9% （n = 136）。处方持续时间超过6周的有46张（33.8%）。女性囚犯的处方率（6.8%,n = 13/190）显著高于男性囚犯（4.1%,n = 123/3299）。违约在押人员的处方率（16.5%,n = 62/376）显著高于已定罪和还押在押人员的处方率（2.1%,n = 71/3095）。结论：柏林监狱使用苯二氮卓类药物和z类药物的频率低于普通门诊。大约三分之一的处方超过了建议的最大持续时间。监狱中女性囚犯的处方率更高。还押囚犯的比率并不超过已定罪囚犯。默认监禁被确定为影响处方做法的一个因素，可能是因为它与无家可归和酗酒密切相关。

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引用次数: 0

Forensic mental health services in selected Sub Saharan African countries: A scoping review 选定撒哈拉以南非洲国家的法医精神卫生服务：范围审查。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-01-20 DOI: 10.1016/j.ijlp.2026.102187

Chrispen Madondo , Walter Mangezi , Roy W. Batterham , Marc G. Van der Putten

Purpose

This study synthesised the literature on forensic mental health services for offenders with mental health and substance use conditions in selected Sub-Saharan African countries to guide planned action research on a diversion program.

Methods

A scoping review methodology was applied, using a Boolean search strategy in retrieving publications from relevant databases and search engines. Selection of literature was facilitated by PRISMA-ScR.

Results

Following forensic mental health services: psychiatric hospital-based, court-based, prison-based, community-based services and diversion programs. Forensic mental health services in the selected countries are fragmented. Poor multisectoral coordination, and limited of human, financial and infrastructural resources attributed to this fragmentation.

Conclusions

Where adoption of a diversion program is considered, it is important to focus on aligning interventions to local needs, priorities, capacities and resources to inform the application of international policy recommendations.

目的：本研究综合了选定的撒哈拉以南非洲国家对有精神健康和物质使用状况的罪犯提供法医精神卫生服务的文献，以指导有关转移方案的计划行动研究。方法：应用范围审查方法，使用布尔搜索策略从相关数据库和搜索引擎检索出版物。文献的选择由PRISMA-ScR辅助。结果：下列法医精神卫生服务：以精神病院为基础、以法院为基础、以监狱为基础、以社区为基础的服务和转移方案。所选国家的法医精神卫生服务是分散的。多部门协调不力，人力、财政和基础设施资源有限。结论：在考虑采用转移方案时，重要的是将干预措施与当地需求、优先事项、能力和资源相结合，以便为国际政策建议的应用提供信息。

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引用次数: 0

Forensic mental health research: The potential of Danish national registers 法医心理健康研究：丹麦国家登记册的潜力

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-01-08 DOI: 10.1016/j.ijlp.2026.102188

Christian Jentz , Harry Kennedy , Lisbeth Uhrskov Sørensen

Forensic psychiatric research faces persistent methodological and ethical challenges, limiting the development of robust evidence to inform practice and policy. This article examines these barriers in the Danish context, highlighting the underutilized potential of national register data to overcome current limitations. Despite Denmark having a relatively large forensic psychiatric patient population and comprehensive national health registers, critical obstacles remain, including inconsistent patient identifiers, fragmented service delivery, and restrictive ethical frameworks that impede patient inclusion in research. The authors argue for greater methodological rigor, improved identification strategies, and clearer ethical guidelines, proposing that leveraging existing register-based data could significantly enhance the scope and quality of forensic mental health research. Addressing these barriers would help fill crucial knowledge gaps and support more evidence-based interventions for this vulnerable population.

法医精神病学研究面临着持续的方法和伦理挑战，限制了为实践和政策提供有力证据的发展。本文在丹麦的背景下考察了这些障碍，强调了未充分利用国家登记数据的潜力，以克服目前的限制。尽管丹麦拥有相对较大的法医精神病患者人口和全面的国家健康登记，但仍然存在重大障碍，包括患者标识不一致、服务提供不完整以及限制性伦理框架阻碍患者参与研究。作者主张更严格的方法、改进的识别策略和更明确的伦理准则，并提出利用现有的基于登记册的数据可以显著提高法医心理健康研究的范围和质量。解决这些障碍将有助于填补关键的知识空白，并支持为这一弱势群体提供更多基于证据的干预措施。

引用次数: 0

Is anti-ligature an automatic requirement for suicide prevention?: Assessing legal obligations in alternative mental health crisis services 反结扎是预防自杀的必然要求吗？评估替代性心理健康危机服务中的法律义务

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-01-07 DOI: 10.1016/j.ijlp.2025.102182

Joshua Finn , Piers Gooding , Lisa Brophy , Deb Carlon , Chris Maylea

Around the world, peer-run, bed-based services that offer voluntary support to people experiencing mental health crisis are emerging as alternatives to hospital-based mental healthcare. In Victoria, Australia, where these ‘alternative crisis services’ are expanding, a key legal question has arisen: must non-coercive settings adopt the suicide prevention architectural design (or ‘anti-ligature design’) mandated in psychiatric wards under negligence and occupational health and safety laws?

This article answers that question through a three-stage study: (1) a doctrinal analysis of Victorian case law and statutes that shape duties to prevent suicide; (2) a narrative review of evidence on anti-ligature measures in hospital environments; and (3) thematic analysis of interviews with clinicians, designers, peer leaders and legal experts (n = 12).

The findings indicate that empirical evidence only associates anti-ligature design with reduced suicide rates when paired with search, detention and close observation powers, which are absent from alternative crisis services. There was no evidence identified that anti-ligature design will reduce suicide in settings which do not also implement these practices.

This absence of data does not justify retreat to institutional templates, especially considering key differences in the care models that differentiate alternative crisis services from traditional hospital-based offerings. Interviewees warned that conspicuous anti-ligature hardware can undermine the therapeutic value of alternative crisis services, and merely displace, rather than prevent, suicidal behaviour. Wholesale transplantation of hospital anti-ligature standards into alternative crisis services is therefore unlikely to satisfy the ‘reasonableness’ test and may contravene the therapeutic mandate of services. Instead, this study calls for regulators to endorse context-specific standards for mental health service design, some of which may require further empirical research on rights-based, peer-led safety strategies.

在世界各地，为经历精神健康危机的人提供自愿支持的同行经营的床位服务正在成为医院精神保健的替代方案。在澳大利亚的维多利亚州，这些“另类危机服务”正在扩大，一个关键的法律问题出现了：非强制性环境是否必须采用疏忽和职业健康安全法规定的精神病院的自杀预防建筑设计（或“反捆绑设计”）？本文通过三个阶段的研究来回答这个问题：(1)对维多利亚判例法和制定防止自杀责任的法规进行理论分析；(2)对医院环境中抗结扎措施的证据进行述评；(3)对临床医生、设计师、同行领导和法律专家的访谈进行专题分析（n = 12）。研究结果表明，经验证据表明，只有在与搜查、拘留和密切观察权力相结合的情况下，反捆绑设计才能降低自杀率，而这些在其他危机服务中是不存在的。没有证据表明，在没有实施这些做法的环境中，反捆绑设计将减少自杀。数据的缺乏并不能成为退回到机构模板的理由，特别是考虑到区分替代性危机服务与传统医院服务的护理模式的关键差异。受访者警告说，引人注目的反捆绑硬件会破坏替代性危机服务的治疗价值，而且只会取代而不是预防自杀行为。因此，将医院反结扎标准大规模移植到替代危机服务中不太可能满足“合理性”测试，并可能违反服务的治疗任务。相反，这项研究呼吁监管机构认可心理健康服务设计的具体环境标准，其中一些标准可能需要对基于权利的、同行主导的安全策略进行进一步的实证研究。

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引用次数: 0

Suicidal ideation amongst incarcerated populations: An examination of contributing factors amongst male inmates in Southwest Nigeria 被监禁人群中的自杀意念：尼日利亚西南部男性囚犯中影响因素的调查

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-12-26 DOI: 10.1016/j.ijlp.2025.102186

Gift Onwuadiamu , Godwin Egbe

Mental health issues are a significant concern in prisons worldwide. Research shows that the prevalence of mental health problems is much higher among prison populations compared to other groups. One common mental health issue found among prison population is suicidal behaviors. This study uses data collected from a sample of male inmate in a maximum-security prison, in southwestern Nigeria to examine risks factors that predisposes suicidal ideation amongst male inmates in the correctional facility. Initial findings indicate that time spent in prison is a marginally significant predictor of suicidal ideation. Findings also showed that unwanted physical and sexual prior experiences significantly and negatively contributed to suicidal ideation, and hopelessness also played a significant role in suicidal ideation, controlling for other factors including age, religion, educational qualification, convictions, etc. This study has implications for policy in advancing mental health intervention in the criminal justice system and the need for pre and post mental health evaluation in prison.

心理健康问题是全世界监狱中的一个重大问题。研究表明，与其他群体相比，监狱人口中心理健康问题的患病率要高得多。在监狱人群中发现的一个常见的心理健康问题是自杀行为。本研究使用从尼日利亚西南部一所最高安全级别监狱的男性囚犯样本中收集的数据，以检查教养设施中男性囚犯易产生自杀念头的风险因素。初步调查结果表明，在监狱中度过的时间是自杀意念的一个略微显著的预测因素。研究结果还显示，不良的身体和性经历对自杀意念有显著的负向影响，而绝望在控制年龄、宗教、教育程度、信仰等其他因素的情况下，对自杀意念也有显著的影响。本研究对促进刑事司法系统中心理健康干预的政策以及对监狱中心理健康前后评估的需求具有启示意义。

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引用次数: 0

Ethical, clinical, and legal challenges of mental health care in prisons: between constraints and clinical integrity 监狱精神卫生保健的伦理、临床和法律挑战：在约束与临床诚信之间。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-12-08 DOI: 10.1016/j.ijlp.2025.102165

Bruna Paulino Alves , Mariana Pinto da Costa , Thomas Pollmächer , Meryam Schouler-Ocak , Luis Madeira

Background

Prison populations experience disproportionately high rates of mental disorders and suicidality, often receiving inadequate care in settings primarily designed for punishment rather than treatment. Prisons, increasingly serving as de facto psychiatric institutions, present distinct ethical, legal, and clinical challenges for mental health professionals.

Objectives

This paper explores the ethical dilemmas in correctional mental health care, focusing on confidentiality, the principle of equivalence of care, and the dual role of clinicians. It critically examines clinical practices such as suicide prevention, psychopharmacological treatment, management of violence, and end-of-life decisions, and offers recommendations for ethical care in prison environments.

Methods

A comprehensive literature review was conducted using PubMed and major journals in psychiatry and bioethics, supplemented by policy documents from WHO, UN, and WPA. Guided by expert consultation, the thematic analysis included 97 articles and 6 book chapters. Expert feedback from the EPA ethics committee informed the final recommendations.

Results

Key findings highlight tensions between institutional control and therapeutic ethics, especially regarding confidentiality breaches, consent, and coercive practices. Structural factors—Overcrowding, under-resourcing, and stigmatization—Compromise the feasibility of equivalence of care. Ethical concerns intensify around suicide, substance use, neurocorrections, solitary confinement, and the death penalty.

Conclusion

Correctional mental health care requires ethically robust, rights-based approaches responsive to both clinical needs and institutional constraints. Implementing context-sensitive guidelines, improving training, ensuring continuity of care, and upholding patient autonomy are critical for safeguarding dignity and therapeutic integrity within prisons.

背景：监狱人口的精神障碍和自杀率高得不成比例，在主要用于惩罚而不是治疗的环境中，往往得不到适当的照顾。监狱越来越多地成为事实上的精神病院，给精神卫生专业人员带来了明显的道德、法律和临床挑战。目的：探讨惩教精神卫生保健中的伦理困境，重点关注保密、护理对等原则和临床医生的双重角色。它严格审查临床实践，如自杀预防、精神药物治疗、暴力管理和临终决定，并为监狱环境中的道德护理提供建议。方法：采用PubMed和主要的精神病学和生物伦理学期刊，辅以WHO、UN和WPA的政策文件，进行全面的文献综述。在专家咨询的指导下，专题分析包括97篇文章和6本书章节。来自EPA伦理委员会的专家反馈为最终建议提供了依据。结果：主要发现强调了机构控制和治疗伦理之间的紧张关系，特别是在违反保密规定、同意和强制做法方面。结构性因素——过度拥挤、资源不足和污名化——损害了同等护理的可行性。关于自杀、药物使用、神经矫正、单独监禁和死刑的伦理担忧加剧。结论：惩教精神卫生保健需要道德健全、基于权利的方法，以应对临床需求和体制限制。实施对具体情况敏感的指导方针、改进培训、确保护理的连续性和维护病人的自主权，对于维护监狱内的尊严和治疗的完整性至关重要。

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引用次数: 0

Informal coercion towards discharge: The entanglement of formal and informal coercion in social resource introduction 非正式强制走向释放：社会资源引入中正式强制与非正式强制的纠缠

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-12-06 DOI: 10.1016/j.ijlp.2025.102183

Hiroyasu Ino , Akira Akabayashi , Yoshiyuki Takimoto , Eisuke Nakazawa

Background

Coercion is a central issue in psychiatric practice, and understanding its nature is essential for developing effective coercion reduction strategies. However, the epidemiology and impact of informal coercion during a single hospitalization, as well as its relationship with formal coercion, remain unclear. This study aimed to estimate the prevalence and characteristics of informal coercion during a single hospitalization; to assess whether informal coercion was associated with the intended effect of introducing social resources; and to identify risk factors associated with its use, particularly formal coercion.

Method

This retrospective cohort study was conducted at an urban psychiatric emergency hospital. A total of 659 individuals with acute schizophrenia were examined for experiences of informal coercion in the context of social resource introduction. A quasi-experimental design using inverse probability of treatment weighting and modified Poisson regression was employed.

Results

Approximately 22 % of participants experienced informal coercion. Specifically, 9.1 % were subjected to threats, 4.7 % to inducements, and 11 % to persuasion. Threats and inducements increased the likelihood of social resource introduction but were also associated with limitations of the participants' choices regarding discharge and post-discharge life decisions. Involuntary admission was the strongest predictor of informal coercion, and condition for discharge is the most prevalent gain implied in threats.

Conclusion

Informal coercion towards discharge was a structurally embedded practice linked to formal coercion. Two forms of informal coercion were identified: extra-legally constructed medical authority and informal legal transplantation. Reducing informal coercion requires limiting formal coercion, clarifying discharge criteria in law, and expanding non-coercive social resources.

胁迫是精神病学实践中的一个核心问题，了解其本质对于制定有效的胁迫减少策略至关重要。然而，在一次住院期间，非正式胁迫的流行病学和影响，以及它与正式胁迫的关系，仍然不清楚。本研究旨在估计一次住院期间非正式胁迫的发生率和特征；评估非正式强制是否与引入社会资源的预期效果有关；并确定与使用相关的风险因素，特别是正式胁迫。方法回顾性队列研究在某城市精神科急诊医院进行。对659例急性精神分裂症患者进行了社会资源引入背景下的非正式胁迫体验调查。采用处理加权逆概率和修正泊松回归的准实验设计。结果大约22%的参与者经历过非正式胁迫。具体来说，9.1%的人受到威胁，4.7%的人受到引诱，11%的人受到劝说。威胁和诱因增加了社会资源引入的可能性，但也与参与者在出院和出院后生活决策方面的选择限制有关。非自愿入院是非正式胁迫的最强预测指标，而释放条件是威胁中隐含的最普遍的收益。结论非正式胁迫是一种与正式胁迫相关联的结构性嵌入实践。确定了两种形式的非正式胁迫：法外建构的医疗权威和非正式的法律移植。减少非正式强制需要限制正式强制，明确法律上的解除标准，扩大非强制性社会资源。

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引用次数: 0

Involuntary patients awareness of their entitlement to appeal an admission and existence of the mental health review board in South Africa 非自愿病人意识到他们有权对南非精神健康审查委员会的接纳和存在提出上诉。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-12-02 DOI: 10.1016/j.ijlp.2025.102184

Shamima Saloojee, Zinhle Shozi, Vuyokazi Ntlantsana, Sibongile Mashapu

Background

South Africa's mental health law is person-centred, has a strong human rights emphasis, and includes the appointment of mental health review boards (MHRB) to provide oversight and consider appeals against involuntary admissions. Owing to the low number of appeals, this study aimed to determine the proportion of involuntary patients who were aware of their right to appeal at two public sector psychiatric hospitals in KwaZulu Natal Province.

Method

A group of conveniently selected involuntary patients was interviewed in a descriptive study that entailed the collection of quantitative data through the administration of a study-specific questionnaire, and the Birchwood Insight Scale from June 2020 to December 2020.

Results

Of the 131 participants, most were unemployed (72.5 %) and had at least a high school level of education (61.06 %). The majority were diagnosed with a psychotic disorder (79.4 %), with a median duration of admission of 17.00 days (IQR 9.00, 69.00), and 63.4 % had good insight into their illness. Not a single patient appealed the current involuntary admission, and only one patient appealed a previous admission.

Only 11.5 % of the participants were aware that they had the right to appeal their admission, and 8.4 % were aware of the existence of the MHRB.

Conclusion

Most patients were unaware of their legal right to appeal and of the MHRB, highlighting the challenges in implementing the letter and practice of the law in underresourced settings without the necessary pre-conditions to fully realise its spirit.

背景：南非的精神卫生法以人为本，非常强调人权，其中包括任命精神健康审查委员会（MHRB）监督和审议针对非自愿收容的上诉。由于上诉数量少，这项研究旨在确定在夸祖鲁-纳塔尔省两家公立精神病医院了解自己有权上诉的非自愿病人的比例。方法：在一项描述性研究中，对一组方便选择的非自愿患者进行访谈，该研究需要通过管理研究特定问卷和Birchwood Insight Scale收集定量数据，时间为2020年6月至2020年12月。结果：在131名参与者中，大多数人失业（72.5%），至少有高中教育水平（61.06%）。大多数被诊断为精神障碍（79.4%），中位住院时间为17.00天（IQR 9.00, 69.00）， 63.4%对自己的疾病有很好的了解。没有一个病人对目前的非自愿入院提出上诉，只有一个病人对以前的入院提出上诉。只有11.5%的参与者知道他们有权对自己的录取提出上诉，8.4%的参与者知道MHRB的存在。结论：大多数患者不知道他们的合法上诉权利和MHRB，突出了在资源不足的环境中实施法律条文和实践的挑战，没有必要的先决条件来充分实现其精神。

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引用次数: 0

Addressing the false dichotomy between autonomy and preservation of life: Clinical, legal, and ethical considerations in severe and longstanding anorexia nervosa 解决自主和保存生命之间的错误二分法：严重和长期神经性厌食症的临床，法律和伦理考虑

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-11-29 DOI: 10.1016/j.ijlp.2025.102179

Agnes Ayton , Ali Ibrahim , Marco Solmi , Cynthia M. Bulik , Eric F. van Furth , Philip S. Mehler , Maryrose Bauschka , Angela S. Guarda

Anorexia nervosa (AN) is a serious metabo-psychiatric disorder. Despite a mortality rate approximately five times higher than that of age-matched controls, most deaths result from delayed recognition, fragmented care, and limited access to integrated, evidence-based treatment. Refusal of life-sustaining nutrition in severe or longstanding AN presents profound ethical and legal dilemmas, challenging the balance between autonomy, protection, and the duty to preserve life.

This paper provides a critical narrative and normative review of how clinical uncertainty, systemic failure, and legal interpretation influence decision-making in treatment refusal. It examines capacity, futility, and best-interests determinations within mental health and capacity law in England and Wales, with comparative reference to other high-income countries.

The review finds that unvalidated constructs such as “severe and enduring” and end-of-life framing of AN lack empirical and legal foundation. Their adoption risks normalising treatment withdrawal and assisted dying in a treatable psychiatric disorder that predominantly affects women. Ethical analysis grounded in autonomy, beneficence, non-maleficence, and justice demonstrates that autonomy should be supported rather than presumed absolute when reasoning is impaired by malnutrition or psychopathology.

The paper concludes that aligning clinical and legal practice with the Convention on the Rights of Persons with Disabilities would strengthen supported decision-making, safeguard the right to life, and promote parity between psychiatric and physical healthcare. A shift toward the prevention of avoidable deaths, rather than acceptance of inevitability, is urgently required.

神经性厌食症是一种严重的代谢性精神疾病。尽管死亡率大约是同龄对照组的五倍，但大多数死亡是由于认识迟缓、护理不完整以及获得综合循证治疗的机会有限造成的。在严重或长期AN中拒绝维持生命的营养会带来深刻的伦理和法律困境，挑战自治，保护和保护生命的责任之间的平衡。本文提供了临床不确定性、系统失败和法律解释如何影响治疗拒绝决策的关键叙述和规范审查。它审查了英格兰和威尔士精神健康和行为能力法中的能力、无效和最大利益确定，并与其他高收入国家进行比较。审查发现，诸如“严重和持久”和生命终结框架等未经验证的构念缺乏经验和法律基础。他们的收养有可能使治疗中断正常化，并协助死亡于一种主要影响妇女的可治疗的精神疾病。基于自主性、仁慈性、非恶意性和正义的伦理分析表明，当推理因营养不良或精神病理而受损时，应该支持自主性，而不是假定自主性是绝对的。本文的结论是，将临床和法律实践与《残疾人权利公约》相结合，将加强支持性决策，保障生命权，并促进精神保健和身体保健的平等。迫切需要转向预防可避免的死亡，而不是接受不可避免的死亡。

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