精神障碍患者自愿诊疗权利的伦理研究

发布时间：2018-04-21 19:26

本文选题：精神障碍患者 + 自愿原则　；参考：《重庆医科大学》2015年硕士论文

【摘要】：精神障碍患者的自主权应当得到相应的尊重和保护,作为社会的弱势群体,精神障碍患者的思想和行为能力存有缺陷,无法完全对自身的健康与合法权益予以保护,“自愿原则”将精神障碍患者从历史“异端”拉进社会关爱中,并用法律予以规范,是法制与人权的进步。本文通过对维护病人利益原则、尊重自主权原则、知情同意权原则、维护公共利益原则、和公正原则这五大原则进行伦理精神分析,论述精神卫生法对精神障碍诊疗实行自愿原则的相关规定,提出“自愿原则”实施的伦理正当性,为衡平正义提供价值考量。本文分为前言,第一至第五部分及结语。第一部分：精神障碍患者自愿诊疗权利的基本理论。这一章的内容分为两个方面去论述。第一：精神障碍患者自愿诊疗权利产生的伦理涵义。首先说明伦理的含义和从伦理角度研究的必要性,再说明精神卫生法规定的精神障碍患者自愿诊疗的权利是否具有合法性与合理性价值是其正当性基础。第二：精神障碍患者自愿诊疗的法律规定。包括精神障碍患者自愿诊疗的具体规定和精神障碍患者非自愿诊疗的情形。自愿原则并不等于无限制的自由,基于正当性本质,不能完全否认强制诊疗。第二部分：其他国家和地区精神障碍患者自愿诊疗权利的伦理研究。本章内容分为四个方面去论述。第一：美国精神障碍患者自愿诊疗权利的伦理研究。首先简单介绍了美国的精神卫生立法发展,笔者尤其注重对于自愿诊疗方面的研究,发现美国在自愿入院制度中既规定了“危险性”标准又设置了司法介入程序。然后对比我国精神障碍患者自愿诊疗权利的规定,笔者认为我国精神卫生立法中采用的“危险性”标准,有效的防止强制住院的门槛过低造成“被精神病”泛滥,具备伦理的合理性要求。第二：英国精神障碍患者自愿诊疗权利的伦理研究。英国早在18世纪末,就开始进行了综合性立法以维护精神障碍患者的权益。对比我国对精神障碍患者自愿诊疗权利的保护,发现其中有很多值得借鉴之处,可以更好的体现伦理的正当性。第三：日本精神障碍患者自愿诊疗权利的伦理研究。日本在1988年就首次规定了“自愿入院”制度,提倡保障精神障碍患者自愿入院的权利,符合伦理上的合理性要求。由于日本在文化风俗等方面与我国有着许多相似的地方,因此日本精神卫生服务遇到的困境,也同样值得我们重视。第四：台湾地区精神障碍患者自愿诊疗权利的伦理研究。台湾地区的法律很多都是以国民党的法律规则为蓝本的,因此对于强制诊疗对象的范围及强制诊疗程序都存在很大的不同,值得学者进行深入的研究学习,探讨是否具备实施的伦理正当性。第三部分：法律干预精神障碍患者自愿诊疗权利的伦理正当性分析。本章内容分为三方面去论述。第一,精神障碍患者权利的伦理冲突。包括社会公众权利与精神障碍患者权利的直接冲突和精神障碍患者的健康权与自主权之间的冲突。精神卫生法的伦理使命就是在冲突中寻找平衡点,坚持国家利益、集体利益与个人利益平衡原则,不断完善精神卫生立法。第二：法律干预精神障碍患者自愿诊疗的伦理正当性。为了维系权利秩序,用法律的手段干预精神障碍患者的诊疗是社会发展的要求。精神障碍患者的平等权、精神障碍患者的自由自主权、精神障碍患者的医疗权都是精神卫生法所必须维系的权利,是他们所应当具有的权利。第三,法律干预精神障碍患者自愿诊疗权利缺失的危害。分别从对社会、对医学界和对精神障碍患者三个方面所造成的危害进行分析,再次强调法律干预精神障碍患者自愿诊疗权利的必要性。第四部分：精神障碍患者自愿诊疗权利所体现的伦理原则和伦理价值。本章内容分为两个部分。我国精神卫生立法中关于精神障碍患者自愿诊疗的规定体现了国际上关于精神卫生法的原则,包括第一,维护病人利益原则、尊重自主权原则。第二,知情同意权。第三,维护公共利益原则。第四,公正原则。精神障碍自愿诊疗权利也体现了促进精神卫生事业发展、规范诊疗制度、保障精神障碍患者和大多数人民群众利益的伦理价值。第五部分：完善精神障碍患者自愿诊疗权利。本章内容分为三个方面。第一：加强监护,保障当事人的权利。第二：明确详细标准,遵守无病推定原则。第三：强化监督机制,由独立的无利益第三方机构完成社会监管职能。
[Abstract]:The autonomy of the patients with mental disorders should be respected and protected accordingly. As a social vulnerable group, the mental and behavioral abilities of the mentally disabled persons are defective, and they can not completely protect their own health and legitimate rights and interests. "Voluntary principles" pull the mentally disabled from the historical "heresy" into social care and use them. The law is standardized, it is the progress of the legal system and human rights. By analyzing the five principles of the principle of safeguarding the interests of the patients, respecting the principle of autonomy, the principle of informed consent, the principle of maintaining public interest and the principle of justice, this paper discusses the relevant provisions of the voluntary principle of mental health law to the diagnosis and treatment of mental obstacle, and puts forward the "voluntary" principle. The ethical justification of the principle of "principle" provides value for equity. This article is divided into preface, the first to fifth parts and conclusion. The first part: the basic theory of the right of voluntary diagnosis and treatment for patients with mental disorders. The content of this chapter is divided into two aspects. First: the ethical meaning of the right of voluntary diagnosis and treatment for mental handicap patients. First, it explains the meaning of ethics and the necessity of studying from the ethical point of view, and then explains whether the rights of voluntary diagnosis and treatment of mental disorders prescribed by mental health law are legitimate and reasonable. Second: the legal provisions of voluntary diagnosis and treatment for patients with mental disorders, including the specific voluntary diagnosis and treatment of mental disorders. Non voluntary diagnosis and treatment of patients with mental disorders. Voluntary principle is not equal to unrestricted freedom. Based on the nature of legitimacy, it can not completely deny compulsory diagnosis and treatment. The second part: the ethical study of voluntary diagnosis and treatment in other countries and regions. This chapter is divided into four aspects. First: American spirit The ethical research on the rights of voluntary diagnosis and treatment for patients with obstacles. First, the development of mental health legislation in the United States is briefly introduced. I pay particular attention to the research on voluntary diagnosis and treatment. It is found that the United States has set up the "danger" standard in the voluntary admission system and the judicial intervention process. Then it compares the voluntary diagnosis of patients with mental disorders in our country. The provisions of the treatment rights, the author believes that the "dangerous" standard adopted in China's mental health legislation, effectively preventing the low threshold of compulsory hospitalization, resulting in the spread of "psychosis", has ethical rationality requirements. Second: the ethical study of the right of voluntary diagnosis and treatment for the British mental disorders. Comprehensive legislation to protect the rights and interests of patients with mental disorders. Compared to the protection of the rights of voluntary diagnosis and treatment of mental disorders in China, many of them have been found to be worthy of reference, which can better reflect the ethical legitimacy. Third: the ethical study of the right of voluntary diagnosis and treatment for patients with mental disorders in Japan. In 1988, Japan first stipulated that "Voluntary admission" system, advocating the right to protect mental disorders patients voluntarily admission, in line with the ethical requirements. Because of Japan's cultural customs and other aspects of our country have many similar places, so the difficulties encountered in the Japanese mental health service are also worth our attention. Fourth: the mental disorder patients in Taiwan region The ethical study of the rights of voluntary diagnosis and treatment. Many laws in the Taiwan region are based on the legal rules of the Kuomintang. Therefore, there are great differences in the scope and compulsory diagnosis and treatment procedures of the compulsory diagnosis and treatment. It is worth a thorough study and study of the ethical justification for the implementation of the compulsory diagnosis and treatment. The third part: the law The ethical analysis of the rights of voluntary diagnosis and treatment for patients with premental disorders. The contents of this chapter are divided into three aspects. First, the ethical conflict of the rights of patients with mental disorders. The conflict between the rights of the public and the mental disorders and the conflict between the right to health and the autonomy of the mental disorders. The mission is to find the balance point in the conflict, adhere to the national interests, the principle of the balance of collective interests and individual interests, and constantly improve the mental health legislation. Second: the legal intervention of the ethical legitimacy of voluntary diagnosis and treatment for patients with mental disorders. In order to maintain the right order, the diagnosis and treatment of the patients with pre mental barriers by law means the social development. The equal right of the mental disorder, the free self sovereignty of the mental disorder sufferer, the medical right of the mentally disabled patients are the rights that the mental health law must maintain and the right they should have. Third, the harm of the lack of the right of voluntary diagnosis and treatment of the mental disorder patients. The harm caused by the three aspects of the patient is analyzed, and the necessity of legal intervention for the right of voluntary diagnosis and treatment for patients with mental disorders is emphasized again. The fourth part: the ethical principles and ethical values embodied in the voluntary diagnosis and treatment of mental disorders. The contents of this chapter are divided into two parts. The provision of voluntary diagnosis and treatment embodies the principles of international mental health law, including the principle of safeguarding the interests of the patients and respecting the principle of autonomy. Second, the right to informed consent. Third, the principle of maintaining public interest. Fourth, the principle of justice. The right to voluntary diagnosis and treatment of mental disorders also promotes the development of mental health and standardizing the system of diagnosis and treatment. The ethical value of guaranteeing the interests of mental disorders and most people. The fifth part: improving the rights of voluntary diagnosis and treatment for patients with mental disorders. The contents of this chapter are divided into three aspects. First, to strengthen guardianship and protect the rights of the parties. Second: clear and detailed standards, abide by the principle of disease free pushing and setting. Third: strengthening the supervision mechanism, independent of the supervision mechanism. The third party organizations without interest have completed the function of social supervision.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：D922.16;D923

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