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Ethical Enquiry into the Conditions under which Involuntary Commitment Can be Ethically Justified

From: Asian Bioethics Review
Volume 6, Issue 2, June 2014
pp. 174-186 | 10.1353/asb.2014.0013

In lieu of an abstract, here is a brief excerpt of the content:

This article first describes the phenomenon, called beijingshenbing in Chinese in which the victims are involuntarily committed in a psychiatric hospital for non-medical reasons, and then addresses ethical issues in the diagnosis of mental illness, in the criteria and procedures for civil involuntary commitment, and in the application of informed consent in the context of psychiatry with the belief that adequate discussion on these ethical issues will result in an appropriate approach to preventing the phenomenon in China.

Background

According to the 2009 report by the Center for Mental Health, China’s Center for Disease Prevention and Control, the number of patients with various types of mental disorders in mainland China was over 100 million, and among them, more than 16 million patients with severe mental disorders. However, the health resources allocated to mental health are very scarce. At the end of 2005, there were only 572 psychiatric hospitals with 132,000 beds, an average 1.04 beds per 10,000 people, fewer than the average 4.3 beds per 10,000 in the world. Among 16 million patients with severe mental disorders, 30% needed to be hospitalised, which is about 4.8 million patients. Many mental patients who should have been treated as inpatients were never adequately treated.

Ironically, since 2007, a number of cases revealing the misuse or abuse of psychiatry has been widely reported in the mainland media, provoking widespread debate. The term beijingshenbing was coined; it refers to a phenomenon in which some people are diagnosed and coercively treated as mental patients against their will and involuntarily committed in psychiatric hospitals for non-medical reasons. Many mentally normal people who should not have been hospitalised were involuntarily committed in mental hospitals. As a result, the right to healthcare of mental patients and the basic human right of mentally normal citizens are both under the threat of infringement.

The case of X is typical. X is a farmer in Dongwang Village, Daliu Township, Yuanhui District, Luohe City, Henan Province. From 1997 to 2003, he constantly tried to petition and to sue the Township government (shangfang) for its mistreatment of a disabled woman, Z, living in the same village. In October 2003, the party committee and government of this Township had him sent to the mental hospital of Luohe City without notifying his family. He was diagnosed as having "litigious paranoia" by Dr. Y, the psychiatrist, who used the 4th edition of the Textbook of Psychiatry published by the People’s Health Press as the basis for his diagnosis. Y said: "X’s symptoms are the same as that described in the Textbook." Later, when his family learned of his hospitalisation, they asked the mental hospital to discharge him but were refused. The Deputy-Director of the hospital said immediately: "You have no right to take him home. It is only the Township government, which sent him here, which has the power to discharge him." In the end, X was confined to the mental hospital for six and half years. During this period, he was given electronic shock treatment six times, tried to escape twice and attempted suicide many times. After X’s case was reported, it caused public outrage. In April 2010, the Yuanhui District party committee and government decided to dismiss three officials from their position because they misused their power to fabricate the certificate to prove X was suffering from a mental disorder. They were: the Vice-Chief of the Supervisory Bureau of the District government, the Chief of Complaint Letters and Request Handling Office of the District government, and the Director of Township of the Family Planning Service Center. Nothing was decided about the mental hospital. On 25 April 2010, X was taken home by his family members (Wang and Yang 2010).

This case and many others raise the question: Under what conditions can involuntary commitment be ethically justified? To address this question, we have to look into the ethical issues in the diagnosis of mental illness, in the criteria and procedures for civil involuntary commitment, and in the application of informed consent in the context of psychiatry.

Ethical Issues in the Diagnosis of Mental Illness

It is self-evident that the patient...



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