March 3 1999 were The Voiceless and A.P.R.E.S., movements which that are active in the defense of psychiatric patients, represented by Madame Therese Krummenacher, Master of law Roger Dagon and Master of law Mauro Poggia, heard by the working group of psychiatry and human rights of the council of Europe in Strassbourg.
At the moment of the exposition on the state of the affairs by the president of the working group, Professor David Kingdon, it appearred that there is still major confusion on non-voluntary admittance and forced treatment.
The Delegation has emphasized the fact that a non-voluntary admittance doesn’t automatically imply a forced treatment and that one has to make above all a difference as long as the patient has the capability to make a distinction to decide for a treatment which is offered to him.
Thus must the wish of the patient, taking the capability of distinction of the patient in account, a condition which must be presumed, be respected without any exception and doctors must refrain from any treatment if it is refused by the patient.
In relation to a patient, who is not capable of distinction and in the absence of a guideline previously given by the patient, it is the presumed will of the patient that must be researched.
This research passes along next of kin, friends and the physician and it is only an option, that doctors can take decisions for the patient. Taking care not to ignore that, which is strictly necessary for the patient to regain his capability of distinction that is necessary for the patient to agree with the treatment. (principle of proportionality) The difficulty of this theoretical exposition stems from the fact that in practice the patient finds before him a doctor, who thinks that the patient doesn’t have the possibility of making a distinction even though he agrees with the treatment proposed to him, assuming that a refusal of treatment could only be an expression of the impossibility of the patient to comprehend the seriousness of his situation and the need for treatment.
This is the reason why the Delegation has suggested that the possibility of refusal is offered to the patient to appeal to a second doctor of choice, who then must ascertain whether the refusal of the proposed treatment is indeed the expression of the real will of the patient.
This right of the patient should be connected to adequate and complete information that should point the patient to his right to appeal to an association, specialised in the defense of the rights of mentally ill, which should have representatives which are residing in psychatric hospitals.
The Delegation has as much pointed at the suffering caused by a treatment of neuroleptics, of which the side-effects, completely known in this day, can be worse that the discounted advantages and which can have consequences for the whole life of the patient.
Finally the Delegation has asked attention to the working group for the situation of autistic patients, who unfortunenately do not profit form the infrastructure, which if adepted to their specific problem and who are all to often compared with other mentally ill in state institutions.
Translation by Lex Rabbie from French