AG Awad, MD, FRCPC, Editor-in-Chief, CPA Bulletin; Professor of Psychiatry, University of Toronto; Director, Psychopharmacology Program, The Clarke Institute of Psychiatry, Toronto, Ontario.

Individual Rights and “The Right to Health”

In this edition of the Bulletin, we launch a new feature: Notes and Noteworthy from Recent Conferences and Symposia. Several times a year the Bulletin will publish an abridged summary of some of the important issues relevant to the practice of psychiatry that emanate from recent conferences or symposia in Canada or abroad.

The number of symposia, conferences, and think tank and roundtable discussions devoted to specific psychiatric issues has increased phenomenally to become an industry in itself. For the busy clinician, attending some of these important meetings is often impossible. The symposia and conference proceedings are often published; however, this can be a lengthy process, and  information may already be outdated before it reaches clinicians.

The purpose of publishing this new Bulletin section is to provide readers with some of the important highlights from recent meetings that are deemed to be helpful to the practicing clinician. This new feature will also be open to contributions from Bulletin readers. The only provison is that the contributions must be brief and must focus on issues of relevance to practicing psychiatrists. Obviously, such contributions must also conform to Bulletin style and will be subject to editorial review.

Dr Joel Jeffries, a psychiatrist at The Clarke Institute of Psychiatry division of the Addiction and Mental Health Services Corporation in Toronto, has provided the first contribution to this new feature. Dr Jeffries summarizes deliberations from a multidisciplinary symposium devoted to an important issue in psychiatric practice: Restraint or Treatment? Protecting Patient and Provider. Although the issue of what constitutes treatment or restraint is not new and has been the subject of ongoing debate, recent changes to the provincial Mental Health Acts have caused the treatment of psychiatric patients to move from a medical–psychiatric perspective to a complex legalistic one. As Dr Jeffries rightly points out: “Emphasis on patient autonomy has become such a preeminent issue that patients may actually suffer from having “autonomy” by not receiving necessary care” (p 51).

I believe that providing safeguards for psychiatric patients to protect their freedom is extremely important and necessary, yet recently it seems that the pendulum has swung to an extreme. There is no amount of freedom that can justify the suffering of psychiatric patients or the anguish of their families. I doubt very much that any of the issues raised in the symposium, as reported by Dr Jeffries, would have been raised in the treatment of other medicalconditions—clearly a double standard toward psychiatric practice.

Unfortunately, psychiatric management has often become a complicated and expensive legal process rather than  a medical treatment guided by accepted ethical concerns that respect the autonomy and freedom of the individual while ensuring his or her right to good health. Several recent provincial inquests, as well as editorials in some of the leading national media, have highlighted many of these issues which, unfortunately, have often led to psychiatric patients receiving less or no care and have often resulted in tragic consequences.

I believe that the time has come to have a balanced review of each province’s Mental Health Act to ensure that they are instruments for help, not hindrance, and to make the acts more sensitive to the needs of our patients and their families.

–AG Awad

Les droits individuels et « le droit à la santé »