本文選題：精神障礙患者 + 自愿原則�。� 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：精神障礙患者的自主權(quán)應(yīng)當(dāng)?shù)玫较鄳?yīng)的尊重和保護(hù),作為社會(huì)的弱勢(shì)群體,精神障礙患者的思想和行為能力存有缺陷,無法完全對(duì)自身的健康與合法權(quán)益予以保護(hù),“自愿原則”將精神障礙患者從歷史“異端”拉進(jìn)社會(huì)關(guān)愛中,并用法律予以規(guī)范,是法制與人權(quán)的進(jìn)步。本文通過對(duì)維護(hù)病人利益原則、尊重自主權(quán)原則、知情同意權(quán)原則、維護(hù)公共利益原則、和公正原則這五大原則進(jìn)行倫理精神分析,論述精神衛(wèi)生法對(duì)精神障礙診療實(shí)行自愿原則的相關(guān)規(guī)定,提出“自愿原則”實(shí)施的倫理正當(dāng)性,為衡平正義提供價(jià)值考量。本文分為前言,第一至第五部分及結(jié)語。第一部分：精神障礙患者自愿診療權(quán)利的基本理論。這一章的內(nèi)容分為兩個(gè)方面去論述。第一：精神障礙患者自愿診療權(quán)利產(chǎn)生的倫理涵義。首先說明倫理的含義和從倫理角度研究的必要性,再說明精神衛(wèi)生法規(guī)定的精神障礙患者自愿診療的權(quán)利是否具有合法性與合理性價(jià)值是其正當(dāng)性基礎(chǔ)。第二：精神障礙患者自愿診療的法律規(guī)定。包括精神障礙患者自愿診療的具體規(guī)定和精神障礙患者非自愿診療的情形。自愿原則并不等于無限制的自由,基于正當(dāng)性本質(zhì),不能完全否認(rèn)強(qiáng)制診療。第二部分：其他國(guó)家和地區(qū)精神障礙患者自愿診療權(quán)利的倫理研究。本章內(nèi)容分為四個(gè)方面去論述。第一：美國(guó)精神障礙患者自愿診療權(quán)利的倫理研究。首先簡(jiǎn)單介紹了美國(guó)的精神衛(wèi)生立法發(fā)展,筆者尤其注重對(duì)于自愿診療方面的研究,發(fā)現(xiàn)美國(guó)在自愿入院制度中既規(guī)定了“危險(xiǎn)性”標(biāo)準(zhǔn)又設(shè)置了司法介入程序。然后對(duì)比我國(guó)精神障礙患者自愿診療權(quán)利的規(guī)定,筆者認(rèn)為我國(guó)精神衛(wèi)生立法中采用的“危險(xiǎn)性”標(biāo)準(zhǔn),有效的防止強(qiáng)制住院的門檻過低造成“被精神病”泛濫,具備倫理的合理性要求。第二：英國(guó)精神障礙患者自愿診療權(quán)利的倫理研究。英國(guó)早在18世紀(jì)末,就開始進(jìn)行了綜合性立法以維護(hù)精神障礙患者的權(quán)益。對(duì)比我國(guó)對(duì)精神障礙患者自愿診療權(quán)利的保護(hù),發(fā)現(xiàn)其中有很多值得借鑒之處,可以更好的體現(xiàn)倫理的正當(dāng)性。第三：日本精神障礙患者自愿診療權(quán)利的倫理研究。日本在1988年就首次規(guī)定了“自愿入院”制度,提倡保障精神障礙患者自愿入院的權(quán)利,符合倫理上的合理性要求。由于日本在文化風(fēng)俗等方面與我國(guó)有著許多相似的地方,因此日本精神衛(wèi)生服務(wù)遇到的困境,也同樣值得我們重視。第四：臺(tái)灣地區(qū)精神障礙患者自愿診療權(quán)利的倫理研究。臺(tái)灣地區(qū)的法律很多都是以國(guó)民黨的法律規(guī)則為藍(lán)本的,因此對(duì)于強(qiáng)制診療對(duì)象的范圍及強(qiáng)制診療程序都存在很大的不同,值得學(xué)者進(jìn)行深入的研究學(xué)習(xí),探討是否具備實(shí)施的倫理正當(dāng)性。第三部分：法律干預(yù)精神障礙患者自愿診療權(quán)利的倫理正當(dāng)性分析。本章內(nèi)容分為三方面去論述。第一,精神障礙患者權(quán)利的倫理沖突。包括社會(huì)公眾權(quán)利與精神障礙患者權(quán)利的直接沖突和精神障礙患者的健康權(quán)與自主權(quán)之間的沖突。精神衛(wèi)生法的倫理使命就是在沖突中尋找平衡點(diǎn),堅(jiān)持國(guó)家利益、集體利益與個(gè)人利益平衡原則,不斷完善精神衛(wèi)生立法。第二：法律干預(yù)精神障礙患者自愿診療的倫理正當(dāng)性。為了維系權(quán)利秩序,用法律的手段干預(yù)精神障礙患者的診療是社會(huì)發(fā)展的要求。精神障礙患者的平等權(quán)、精神障礙患者的自由自主權(quán)、精神障礙患者的醫(yī)療權(quán)都是精神衛(wèi)生法所必須維系的權(quán)利,是他們所應(yīng)當(dāng)具有的權(quán)利。第三,法律干預(yù)精神障礙患者自愿診療權(quán)利缺失的危害。分別從對(duì)社會(huì)、對(duì)醫(yī)學(xué)界和對(duì)精神障礙患者三個(gè)方面所造成的危害進(jìn)行分析,再次強(qiáng)調(diào)法律干預(yù)精神障礙患者自愿診療權(quán)利的必要性。第四部分：精神障礙患者自愿診療權(quán)利所體現(xiàn)的倫理原則和倫理價(jià)值。本章內(nèi)容分為兩個(gè)部分。我國(guó)精神衛(wèi)生立法中關(guān)于精神障礙患者自愿診療的規(guī)定體現(xiàn)了國(guó)際上關(guān)于精神衛(wèi)生法的原則,包括第一,維護(hù)病人利益原則、尊重自主權(quán)原則。第二,知情同意權(quán)。第三,維護(hù)公共利益原則。第四,公正原則。精神障礙自愿診療權(quán)利也體現(xiàn)了促進(jìn)精神衛(wèi)生事業(yè)發(fā)展、規(guī)范診療制度、保障精神障礙患者和大多數(shù)人民群眾利益的倫理價(jià)值。第五部分：完善精神障礙患者自愿診療權(quán)利。本章內(nèi)容分為三個(gè)方面。第一：加強(qiáng)監(jiān)護(hù),保障當(dāng)事人的權(quán)利。第二：明確詳細(xì)標(biāo)準(zhǔn),遵守?zé)o病推定原則。第三：強(qiáng)化監(jiān)督機(jī)制,由獨(dú)立的無利益第三方機(jī)構(gòu)完成社會(huì)監(jiān)管職能。
[Abstract]:The autonomy of the patients with mental disorders should be respected and protected accordingly. As a social vulnerable group, the mental and behavioral abilities of the mentally disabled persons are defective, and they can not completely protect their own health and legitimate rights and interests. "Voluntary principles" pull the mentally disabled from the historical "heresy" into social care and use them. The law is standardized, it is the progress of the legal system and human rights. By analyzing the five principles of the principle of safeguarding the interests of the patients, respecting the principle of autonomy, the principle of informed consent, the principle of maintaining public interest and the principle of justice, this paper discusses the relevant provisions of the voluntary principle of mental health law to the diagnosis and treatment of mental obstacle, and puts forward the "voluntary" principle. The ethical justification of the principle of "principle" provides value for equity. This article is divided into preface, the first to fifth parts and conclusion. The first part: the basic theory of the right of voluntary diagnosis and treatment for patients with mental disorders. The content of this chapter is divided into two aspects. First: the ethical meaning of the right of voluntary diagnosis and treatment for mental handicap patients. First, it explains the meaning of ethics and the necessity of studying from the ethical point of view, and then explains whether the rights of voluntary diagnosis and treatment of mental disorders prescribed by mental health law are legitimate and reasonable. Second: the legal provisions of voluntary diagnosis and treatment for patients with mental disorders, including the specific voluntary diagnosis and treatment of mental disorders. Non voluntary diagnosis and treatment of patients with mental disorders. Voluntary principle is not equal to unrestricted freedom. Based on the nature of legitimacy, it can not completely deny compulsory diagnosis and treatment. The second part: the ethical study of voluntary diagnosis and treatment in other countries and regions. This chapter is divided into four aspects. First: American spirit The ethical research on the rights of voluntary diagnosis and treatment for patients with obstacles. First, the development of mental health legislation in the United States is briefly introduced. I pay particular attention to the research on voluntary diagnosis and treatment. It is found that the United States has set up the "danger" standard in the voluntary admission system and the judicial intervention process. Then it compares the voluntary diagnosis of patients with mental disorders in our country. The provisions of the treatment rights, the author believes that the "dangerous" standard adopted in China's mental health legislation, effectively preventing the low threshold of compulsory hospitalization, resulting in the spread of "psychosis", has ethical rationality requirements. Second: the ethical study of the right of voluntary diagnosis and treatment for the British mental disorders. Comprehensive legislation to protect the rights and interests of patients with mental disorders. Compared to the protection of the rights of voluntary diagnosis and treatment of mental disorders in China, many of them have been found to be worthy of reference, which can better reflect the ethical legitimacy. Third: the ethical study of the right of voluntary diagnosis and treatment for patients with mental disorders in Japan. In 1988, Japan first stipulated that "Voluntary admission" system, advocating the right to protect mental disorders patients voluntarily admission, in line with the ethical requirements. Because of Japan's cultural customs and other aspects of our country have many similar places, so the difficulties encountered in the Japanese mental health service are also worth our attention. Fourth: the mental disorder patients in Taiwan region The ethical study of the rights of voluntary diagnosis and treatment. Many laws in the Taiwan region are based on the legal rules of the Kuomintang. Therefore, there are great differences in the scope and compulsory diagnosis and treatment procedures of the compulsory diagnosis and treatment. It is worth a thorough study and study of the ethical justification for the implementation of the compulsory diagnosis and treatment. The third part: the law The ethical analysis of the rights of voluntary diagnosis and treatment for patients with premental disorders. The contents of this chapter are divided into three aspects. First, the ethical conflict of the rights of patients with mental disorders. The conflict between the rights of the public and the mental disorders and the conflict between the right to health and the autonomy of the mental disorders. The mission is to find the balance point in the conflict, adhere to the national interests, the principle of the balance of collective interests and individual interests, and constantly improve the mental health legislation. Second: the legal intervention of the ethical legitimacy of voluntary diagnosis and treatment for patients with mental disorders. In order to maintain the right order, the diagnosis and treatment of the patients with pre mental barriers by law means the social development. The equal right of the mental disorder, the free self sovereignty of the mental disorder sufferer, the medical right of the mentally disabled patients are the rights that the mental health law must maintain and the right they should have. Third, the harm of the lack of the right of voluntary diagnosis and treatment of the mental disorder patients. The harm caused by the three aspects of the patient is analyzed, and the necessity of legal intervention for the right of voluntary diagnosis and treatment for patients with mental disorders is emphasized again. The fourth part: the ethical principles and ethical values embodied in the voluntary diagnosis and treatment of mental disorders. The contents of this chapter are divided into two parts. The provision of voluntary diagnosis and treatment embodies the principles of international mental health law, including the principle of safeguarding the interests of the patients and respecting the principle of autonomy. Second, the right to informed consent. Third, the principle of maintaining public interest. Fourth, the principle of justice. The right to voluntary diagnosis and treatment of mental disorders also promotes the development of mental health and standardizing the system of diagnosis and treatment. The ethical value of guaranteeing the interests of mental disorders and most people. The fifth part: improving the rights of voluntary diagnosis and treatment for patients with mental disorders. The contents of this chapter are divided into three aspects. First, to strengthen guardianship and protect the rights of the parties. Second: clear and detailed standards, abide by the principle of disease free pushing and setting. Third: strengthening the supervision mechanism, independent of the supervision mechanism. The third party organizations without interest have completed the function of social supervision.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：D922.16;D923

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