PubMed · 8689383
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G B Leong, J A Silva. 1996. Civil commitment and managed care.. https://doi.org/10.1176/ps.47.4.432
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In Switzerland civil law allows compulsory hospitalization under defined circumstances. It is in the power of municipal authorities to decide on compulsory treatment, though in many of the Swiss cantons this power has been delegated to physicians. This paper first specifies the requirements for medical certificates directing compulsory hospitalization. Then 100 not selected medical certificates from 1997-2000 are compared to these requirements. Only 21% of the certificates met with all the requirements of form and content, nearly half of them showed formal deficiencies. The certificates issued by psychiatrists (n = 44) turned out to be more correct and complete in form and content than the certificates issued by not psychiatric hospital doctors (n = 26) and those issued by general practitioners (n = 30). It seems that not specialized (not psychiatric) doctors, who are rarely confronted with patients requiring compulsory treatment, are overcharged with this delicate and demanding task. To blame is also the passivity of the municipal authorities, who do not exercise their supervision task and seem to be happy having delegated the delicate problem of compulsory hospitalization to physicians.
Moral and social attitudes towards medical treatment and research rapidly changed during the last four decades of the Twentieth Century. In the Netherlands these changes are reflected in three laws adopted in the 1990s. The Law on Medical Treatment Agreement (Wet Geneeskundige BehandelOvereenkomst, WGBO, 1992) reflects the respect for autonomy and the protection of patient's rights. The Law on Special Admission to Psychiatric Hospitals (Bijzondere Opneming Psychiatrische Ziekenhuizen, BOPZ, 1994) reflects the idea that psychiatric subjects should be entitled to execute their civil rights as long as no danger exists to themselves or others, while the Law on Medical Research (Wet Medisch Onderzoek, WMO 1999), reflects the present moral opinions on bio-medical research. From these laws objections can be derived against the development of treatment and experiments on early psychosis. It will be argued here that these laws can also be taken to stimulate this kind of research. The difference between the two options is related to preconceived moral opinions towards psychosis and schizophrenia.
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