Article excerpt

The Ethics of Involuntary Civil Commitment

Dear Editor

The involvement of the psychiatrist in involuntary commitment procedures of mentally disturbed persons to a psychiatric hospital has been discussed by Schneidman, Kalian, Bar-el, Elizur and Wapner (1) in a serious, though, in our view, incomplete manner. Issues that are not covered include ethical aspects and the existing tasks of the courts in relation to the mentally ill.

The main ethical issue is that we, as physicians, are decision-makers for the good of the patients who willingly or not are brought for needed medical help. Medicine is based on an obligating ethical code, in which we are committed to the principle of beneficence (the prevention or removal of harm and the promotion of well-being). Medical decision-making in involuntary civil commitment is one form of care for a patient who is in a particular clinical condition. The ethical question to be dealt with now by our professional guild is whether transferring this decision to a non-medical person compromises the principle of beneficence; the patient's autonomy may not be increased, but medical beneficence may be compromised.

The lawcourts already have jurisdiction concerning involuntary psychiatric examination and hospitalization. One of these functions in relation to persons suspected or convicted of committing a criminal offence is stated in sections 15, 16, 17 of the Israel Law for the Treatment of the Mentally Ill, 1991 (2). The psychiatrists' participation is determined by the decision of the court and they act as consultants for the judge. The courts also order the examination and/or treatment of civilian cases as is set down in several laws, e.g., the Guardianship Law (3) and the Law for the Prevention of Family Violence (4). Moreover, the courts have another function: in accordance with the Law for the Treatment of the Mentally (2), the Regional Court may act in matters of involuntary commitment as a court of appeal against the decisions of the District Psychiatrist and of the Regional Mental Health Tribunal and in doing so it monitors the activity of these two public service bodies. …