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23 March 1994
Doc. 7048
1403-21/3/94-4-E
OPINION
on psychiatry and human rights1
(Rapporteur: Mr EISMA,
Netherlands)
The idea for this excellent report — on which the Rapporteur is to be congratulated — predicted the fall of the Berlin Wall and the Council of Europe's subsequent expansion. Its appearance before the Assembly comes at a very appropriate time.
While the transition to democracy of the countries of central and eastern Europe necessarily involves a detailed examination of changes in the psychiatric field and the conditions of the mentally ill, their counterparts in western Europe are not exempt from such a process. Past abuses provide lessons for us all.
The reports published by the Council of Europe's Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment have also highlighted the fact that the situation in secure psychiatric hospitals in a number of the Council of Europe's founder countries is certainly open to criticism.
It should be stressed that the committee's priority is to inspect prisons and the fate of individuals deprived of their liberty as a result of a decision of a public authority; moreover, according to its own criteria its visits do not always necessarily include psychiatric establishments.
The Rapporteur's proposal in the final sub-paragraph of paragraph 7.ii.f. of the draft recommendation regarding the establishment of a system of regular inspections of such establishments, should therefore be supported and further strengthened by deleting the words "if necessary" (éventuellement). Such an inspection system is necessary for safeguarding human rights.
Modern society considers those detained in psychiatric hospitals to be ill, but the illness is above all a legal status, which is distinguished by the deprivation of liberty, and which in the past was not accompanied by any medical care. Fortunately, this is in principle no longer the case and it is to be hoped that current progress in the neurosciences, including neurobiology, will lead to the improved classification and treatment of psychiatric illnesses.
The draft recommendation only deals with deprivation of liberty for mentally ill people in the context of admission without the individual's consent (see paragraph 7.i.). There are certain problems with the wording of the French text, which are the subject of a proposed amendment (in the French text only, use the wording placement non volontaire instead of internement). The English version is not affected.
Clearly, only judges should be authorised to order compulsory admissions, as the Rapporteur recommends (see paragraph 7.i.b.). However, to avoid any risk of abuse, it should also be stated that the need for such a placement should be automatically and regularly reviewed. This could be the third proposed amendment to the draft recommendation.
As Rapporteur of the Social Affairs Committee, I wish to make at least a passing reference to the treatment of two groups in the population — elderly people and young people.
The special safeguards relating to their placement and treatment in psychiatric institutions could be and should be the subject of a separate report. Here, I would simply propose that reference be made, in the second sub-paragraph of paragraph 7.iii.c., to the risk of abuse of pharmaceutical means of restraint and to the need to safeguard the individuals' rights to procreate.
Finally, bearing in mind the re-emergence of ghosts from the past, it should be expressly stated that the principle established by the Nuremberg trials is that all human experiments require the freely given consent of those taking part. This applies equally to the mental health field. While there may be a requirement under certain circumstances to treat a dangerous patient immediately without seeking his advice, research must not, in principle, be carried out without the knowledge of the patient and against his will.
Proposed amendments
[A. French version only: in paragraph 7.i. replace the word "internement" by the word "placement"
Paragraph 7.i: "Procédure et conditions du placement
a. le placement non volontaire doit être exceptionnel ...." ]
B. English and French versions
At the end of paragraph 7.i.b., add the following:
"Provision must be made for the placement decision to be regularly and automatically reviewed. Principles established in the Council of Europe's forthcoming Convention on Bioethics must be respected in all cases;"
At the beginning of paragraph 7.ii.f. delete the words "if necessary".
In paragraph 7.iii.c. after the words "no mechanical restraint should be used" add:
"The use of pharmaceutical means of restraint must be proportionate to the objective sought. There must be no permanent infringement of individuals' right to procreate."
In Paragraph 7.iii. add a new sub-paragraph d.:
"d. scientific research in field of mental health must not be undertaken without the patient's knowledge, or against his or her will or the will of his her representative, and must be conducted only in the patient's interest."
Reporting committee: Committee on Legal Affairs and Human Rights (Doc. 7040).
Committee for opinion: Social, Health and Family Affairs Committee.
Reference to committee: Doc. 5929 and Reference No. 1609 of 3 October 1988.
Opinion approved by the committee on 15 March 1994.
Secretaries to the committee: Mr Hartland and Ms Meunier.