Should we abolish care without consent in psychiatry? Michel David, honorary hospital child psychiatrist, outgoing President of the French Federation of Psychiatry (FFP), publishes an editorial on this subject. We publish here the beginning of his analysis, to be found in full on the FFP website.
The first civil chamber of the Court of Cassation rendered two judgments on January 26, 2023 to be found in the section
“Care without consent, isolation and restraint”, thus transmitting two priority questions of constitutionality relating to seclusion and restraint. The complexity of this subject escapes common sense and can only be grasped, on a theoretical level, by rare specialists. What are these two judgments regarding? The regulations do not provide for:
– the obligation for the director or the doctor to inform the patient, from the start of an isolation or restraint measure, of the remedy available to him to challenge the decision;
– the systematic intervention of a lawyer next to the patient during the control of the isolation and restraint measures.
These omissions do not respect certain essential constitutional principles (to be read in the judgments) and do not allow a fair trial. The argument is very legal and a person unfamiliar with psychiatry will not perceive that these are “decisions” (and no longer prescriptions) for people hospitalized because they are ill: the court and its procedures rather than hospital and care. On the other hand, in the field, whether for patients, caregivers or hospital administrators, the incessant changes do not facilitate care and they do not seem to have drastically reduced isolation or restraint measures. Serious mental illness resists the legal ideal. Obviously, some gifted psychiatrists claim to be able to do without these measures. Unfortunately, psychiatrists are increasingly deserting the hospital and inevitably also the most gifted among them…
Also, a question should be asked: should we simply abolish care without consent? Moreover the title of an article published in Dalloz news, all in ambiguity, suggests: “Isolation and restraint in psychiatric care without consent: towards a third repeal? Abolish care without consent in psychiatry would allow us to get out of the ambiguity and hypocrisy relating to care methods that seem outdated and increasingly rejected (at least legally). Indeed, the Constitutional Council, by asking twice for a modification of the regulations on isolation and restraint and not citing the fundamental right to the protection of health, has already taken psychiatry out of the health code. public. The Constitutional Council has never put forward the constitutional principle of health protection, which is nevertheless the first article of the public health code and which is a principle of constitutional value on a par with that of the freedom to come and go, the only one retained by the Constitutional Council. However, during the Covid crisis, the restriction of the freedom to come and go before was justified by the protection of individual and collective health. Why is it not the same for psychiatry? is this a profound misunderstanding of psychiatry? fear and denial of serious mental illness? is it the force of conviction of antipsychiatric movements? is it a submission to a European law that is also unaware of psychiatry?
Dr. Michel David answers these questions and gives his arguments in his editorial of February 2023 to read in full ici
