Қолдануға келмейтін медициналық араласу және оның салдары

Medical treatment undertaken without the consent of the person being treated

Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors. Some countries have general legislation allowing for any treatment deemed necessary if an individual is unable to consent to a treatment due to lack of capacity, other legislation may specifically deal with involuntary psychiatric treatment of individuals who have been diagnosed with a mental disorder. Psychiatric treatment normally happens in a psychiatric hospital after some form of involuntary commitment, though individuals may be compelled to undergo treatment outside of hospitals via outpatient commitment. The diagnosis of mental disorders can be carried out by some form clinical practitioner, or in some cases law enforcement or others, to be a danger to themselves or to others is permitted in some jurisdictions, while other jurisdictions have more recently allowed for forced treatment for persons deemed to be "gravely disabled" or asserted to be at risk of psychological deterioration. A patient may be detained because they are diagnosed with a psychiatric disorder or infectious disease. Forcible sterilization took place in the United States until at least 1981, more than 64 thousand people were forcibly sterilized. Denmark sterilized 60 thousand people between 1935 and 1976. During Nazi rule in Germany as part of their eugenics program about 600 thousand people were compulsorily sterilized. Involuntary euthanasia was carried out in Nazi Germany for those who had certain psychiatric disorders or learning disabilities as part of the Aktion T4 program. This program was run by Karl Brandt, a medical doctor, and Philipp Bouhler. Victims were murdered together in gas chambers and this program was a prototype for the extermination camps such as Auschwitz where the Holocaust took place. As part of Action 14f13, physicians involved in the euthanasia program visited concentration camps where they looked at documentation provided by SS camp doctors and approved the murder of camp inmates on the grounds of race, behavior and ability to work using the euthanasia program's facilities. Until 2004, every European state required that transgender people must be sterilized or provably infertile to have their preferred gender formally recognised. This practice continued in Sweden until 2012 and Denmark until 2014 Japan currently requires transgender people to be sterilized and have their ovaries removed to be recognised as a different gender.

The Hippocratic Corpus, an ancient Greek text discussing medical ethics, advises that physicians conceal most information from patients to give the patients the best care. The 1767 English case Slater vs Baker and Stapleton found against two doctors who had refractured a patient's leg without consent. Thomas Percival was a British physician who published a book called Medical Ethics in 1803, which makes no mention of soliciting for the consent of patients or respecting their decisions. The US Canterbury v. Spence case established the principle of informed consent in US law. Earlier legal cases had created the underpinnings for informed consent, but his judgment gave a detailed and thought through discourse on the matter. The judgment cites cases going back to 1914 as precedent for informed consent. Merchant sailors were made to isolate in lazarettos, hospitals for infectious diseases. People with symptoms of tuberculosis have been detained in New York from 1902. During the Spanish flu pandemic western cities implemented social distancing and closed schools, churches, theatres and restricted public gatherings. and social distancing.

In 1789 during the French Revolution, the French government issued a directive for the management of the insane. This directive ordered that the insane be incarcerated and treated. Bethlem Royal Hospital is a mental hospital in the United Kingdom, which started exclusively treating mental illness in 1377. In 1818, Urban Metcalf, a patient at Bethlam, published a book describing his experience there. He described physical restraint of patients who were attached to walls. This followed a report by the government in 1815 describing conditions in asylums in the UK. Psychiatry can be used to bypass standard legal procedures and political incarceration. The use of hospitals instead of jails prevents those detainend from receiving legal aid, makes indefinite incarceration possible, discredits the individuals and their ideas. During the Nazi era and the Soviet rule religious and political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments". From the 1960s to 1986, abuse of psychiatry for political and ideological purposes was reported to be systematic in the Soviet Union, and occasional in Eastern European countries such as Romania, Hungary, Czechoslovakia and Yugoslavia. Some countries have legislation to involuntarily detain or examine those suspected to have tuberculosis, or treat them if infected. Some countries have general legislation allowing for any treatment deemed necessary if an individual is unable to consent to a treatment due to lack of capacity. In some countries, antipsychotics and sedatives can be forcibly administered to those who are committed, using intramuscular depot injection. Those with anorexia nervosa may receive force feeding. Those with infectious diseases such as tuberculosis can be detained and isolated. Bulgaria, Costa Rica, Croatia, Italy, make certain vaccinations mandatory. In the Czech Republic, men convicted of sex offenses are in practice given the choice of long term detention or castration. Japan requires transgender people to undergo sterilization to have their gender formally recognized.

Individuals may be forced to undergo mental health treatment which is legally "voluntary" under the threat of involuntary treatment. Once voluntarily within a mental health hospital, rules, process, and information asymmetry (a healthcare providers know more how the hospital functions than a patient) can be used to achieve compliance from a person in voluntary treatment. To prevent someone from leaving voluntarily, staff may use stalling tactics made possible by the fact that all doors are locked. For example, the person may be referred to a member of staff who is rarely on the ward, or made to wait until after lunch or a meeting, behaving as if a person in voluntary treatment does not have the right to leave without permission. When the person is able to talk about leaving, the staff may use vague language to imply that the person is required to stay, relying on the fact that people in voluntary treatment do not understand their legal status. Szmukler and Appelbaum constructed a hierarchy of types of coercion in mental health care, ranging from persuasion to interpersonal leverage, inducements, threats and compulsory treatment. Here persuasion refers to argument through reason. Forms of coercion that do not use legal compulsion are referred to as informal coercion or leverage. Studies show that 51%, 35% and 29% of mental health patients have experienced some form of informal coercion in the US, England and Switzerland respectively. A patient may issue an advance healthcare directive specifying how they would like to be treated if they are unable to consent to treatment. In the UK, a healthcare worker does not need to follow an advanced directive but they will influence decisions.

In some instances when a patient refuses the medication suggested by a healthcare professional healthcare workers will cause a patient to take the medication by hiding medication in their food a practice known as covert medication.

The faith of Jehovah's Witnesses forbids blood transfusion. Courts in the United States have consistently upheld the right of competent adults to decline blood transfusion even when it would be life saving, though there have been exceptions where the death of a patient could leave a child orphaned. In the United States, courts have ordered pregnant women to involuntarily undergo caesarean section, intrauterine transfusion, and enforced bed rest. There are cases of clinicians threatening pregnant patients with removal of child custody or withdrawal of care if they decline treatment.

Parents or medical doctors may make decision about the treatment of children, a principle known as parens patriae. In the United States, doctors are responsible for providing a good standard of care for patients who are children which can lead them to make decisions at odds with the parents wishes. Parents have less autonomy to make decisions about their children's care than adult patients have over their own care. For some procedures, a child may be distracted to allow for treatment.

There is a lot of variation in the rate of involuntary commitment between countries. A review in Europe in 2004 found a thirty fold difference in the rate of psychiatric commitment between countries, with the median rate being 74 per hundred thousand people. It is estimated that 38% of people who are involuntarily committed experience another form of compulsion such as seclusion or forced medication.

A 2014 Cochrane systematic review found that compulsory outpatient treatment of those with severe mental health disorders "results in no significant difference in service use, social functioning or quality of life compared with standard voluntary care." A 2006 review found that as many as 48% of respondents did not agree with their treatment, though a majority of people retrospectively agreed that involuntary medication had been in their best interest. A review in 2011 looked at people's experience of coercion in mental health care. It found common themes of feeling violated, disrespected, and not being heard, commonly conceptualized as being dehumanized through isolation. A minority of narratives from people who had been treated involuntarily talked about the necessity of treatment in retrospect. Studies suggest that coercion in mental health care has a long lasting psychological effect on individuals leading to reduced engagement and poorer social outcomes, but that this may be reduced by clinicians' knowledge of the effects of coercion.

In medical ethics, involuntary treatment is conceptualized as a form of parens patriae whereby the state takes on the responsibilities of incompetent adults on the basis of the duty to protect and the duty of beneficence (the duty of the state to repair the random harms of nature). The duty to protect is reflected in utilitarianism and communitarianism philosophy, though psychiatrist Paul Chodoff asserted a responsibility to "chasten" this responsibility in light of the political abuse of psychiatry in the Soviet Union. This duty to protect has been criticized on the grounds that psychiatrists are not effective at predicting violence, and tend to overestimate the risk. Paul Ricœur distinguishes two forms of self, the idem, a short term experience of the self, and the ipse, a longer term persistent experience of the self. In mental illness, the autonomy of the ipse can be undermined by the autonomy of the idem, so involuntary mental health treatment can trade one form of autonomy for another. but that this risk is often in conflict with broadly defined goals of recovery including living a satisfying life.