精神病学实践中的自我约束性指令:对理由的系统审查
Lucy Stephenson1, Astrid Gieselmann2, Tania Gergel1
1Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
The lancet. Psychiatry
|September 15, 2023
概括
自约指令 (SBD) 允许提前申请非自愿治疗,提出伦理辩论. 本次审查澄清了SBD的支持和反对的原因,并提出了提高实践能力的敏感指令.
科学领域:
- 精神病学是一个精神病学.
- 生物伦理学生物伦理学
- 心理健康法 心理健康法
背景情况:
- 自约指令 (SBD) 是对非自愿精神治疗的预先决定.
- 他们的道德争议需要对支持和反对的论点进行系统的审查.
研究的目的:
- 系统地审查有关精神病学SBD的学术文献.
- 阐明在临床实践中使用它们的理由和反对理由.
主要方法:
- 50篇全文文章的系统审查.
- 国际跨学科团队对文学进行主题分析.
- 制定支持和反对SBD的理由的层次结构.
主要成果:
- 关于SBD的原因包括促进自主权,福祉,人际关系和减少胁迫.
- 反对SBD的原因包括自主权的减少,实施挑战,能力评估问题和潜在的危害.
- 确定了对产能敏感的SBDs的澄清概念.
结论:
- 能力敏感的SBD需要进一步的研究和试点实施.
- 对知情同意,能力评估,起草支持和独立审查的保护措施至关重要.
- 在做出治疗决策之前,平衡自主性和安全性仍然是一个关键的挑战.
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