Quote:
Originally Posted by Makarov
I understand those concerns. Really. I share them.
In response, I'd just say this:
1. Any legislation permitting involuntary treatment would undoubtedly require a psychiatrist (ie, a physician bound by their fiduciary duty to their patient) to be the front-line person who decides that a person is enough of a danger to themselves to order involuntary detention and involuntary treatment.
2. Any such legislation would obviously also grant affected people (or someone appointed their power of attorney over personal care, etc) to challenge such a decision.
3. We've come a long way as a society since the late 1970s. I'd like to think that institutions that provide involuntary treatment are much more sophisticated and humane now.
4. As alluded to in my paragraph 3, every province in Canada already has legislation permitting involuntary treatment. However, most of them only permit it when the affected person lacks the capacity to consent to treatment. That's a very high test. However, there are a couple of provinces which already have legislating permitting involuntary treatment. However, those provinces have not invested in sufficient institutional space so the authority is not exercised very often.
5. All provinces already have legislation which permits involuntary detention under mental health legislation. When that legislation does not also permit involentary treatment, it actually creates the potential for a terrible situation: indefinite involuntary detention (indefinite because the affected person does not receive treatment, so continues to meet the threshold for involuntary detention).
6. Most of the studies out there on involuntary treatment compare its results to voluntary treatment. Unsurprisingly, voluntary treatment tends to yield better results than involuntary treatment. However, I think those studies miss the point (to a degree anyway). The comparison should really be between outcomes after involuntary treatment and outcomes after no treatment (sleeping rough in encampments and daily use of fentanyl).
7. People who regularly use fentanyl die. At utterly appalling rates. And even when they're saved by staff at safe consumption sites or even by shelter staff, their hearts regularly (like, multiple times a year) stop for significant periods of time, causing repeated damage to their brains.
8. I think that a sophisticated government, acting in good faith and on the advice of experts, could design involuntary treatment legislation and institutions that are humane and effective (well, at least significantly more effective than the current do-nothing approach).
Anyway, sorry for the long argument.
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Thoughtful response, I’d be really worried about this hinging on number 8 though, that’s pretty much the opposite of what we have.
Another not insignificant concern is I feel this would disproportionately affect indigenous people and we also don’t have a good track record there.
But more needs to be done, now, I think we all agree on that.