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Advisor(s)
Abstract(s)
As medidas compulsivas em saúde mental levantam várias questões éticas, em particular ao
médico que se depara com o dever de cuidar, numa sociedade que está, cada vez mais, consciente
da autonomia e dos direitos da pessoa doente. Ao longo dos tempos, a forma de encarar a doença
mental e o internamento sofreram mudanças profundas. Atualmente, as medidas compulsivas
requerem critérios de aplicação específicos, regulados por documentos internacionais e pela lei
interna, para restringir o seu uso e assegurar que os direitos dos doentes e exigências éticas sejam
respeitados. Constata-se a importância dos critérios de aplicação, dos procedimentos, da
monitorização da prática, do exercício dos direitos do doente e da formação dos profissionais em
assuntos bioéticos. De forma a assegurar que, a nível nacional, estes objetivos se concretizem é
fundamental promover o entendimento destes temas e conhecer a opinião dos profissionais.
O objetivo deste trabalho é contribuir para a concretização das orientações relacionadas
com as medidas compulsivas, aplicada à realidade nacional, de duas formas: a) contextualização do
internamento compulsivo (IC), análise de vários documentos internacionais na área da saúde
mental, IC e bioética e comparação com a Lei de Saúde Mental (LSM) portuguesa; b) realização de
um estudo transversal, quantitativo, sobre medidas compulsivas, através de um inquérito de opinião
elaborado pela investigadora, aos médicos portugueses.
O estudo das 99 respostas obtidas (75 especialistas e 24 internos de especialidade de
Psiquiatria) foi realizado através da análise descritiva e da comparação entre grupos. Foram
estudados: o propósito terapêutico, o risco e a perda de competência para tomar decisões, o direito
à informação e a recusar tratamento, a organização e monitorização de procedimentos, no âmbito
do IC, a opinião relativa à regulamentação, benefício, utilização e eficácia do tratamento
ambulatório compulsivo e a opinião relativa a casos clínicos considerados de difícil decisão.
Este trabalho verifica diferenças entre a opinião dos médicos, as disposições internacionais
e a lei de saúde mental, bem como a incompleta aplicação das mesmas e a necessidade de
desenvolver ações de informação e formação. Foi elaborado um plano de ação/divulgação através
da criação de dois folhetos informativos, um para utentes e outro para profissionais, no âmbito dos
aspetos legais e bioéticos do IC. De salientar, ainda, a identificação da necessidade de debate
acerca de questões éticas e de medidas a implementar, no âmbito do IC.
Compulsory measures in mental health raise several ethical issues, as physicians have the duty of care, in a society that is increasingly aware of the autonomy and rights of the patient. Throughout time, the ways of facing mental illness and hospitalization have deeply evolved. Currently, compulsory measures require specific application criteria, which are regulated by international documents and the national law, as to restrain their use and ensure that the rights of the patients and ethical demands are respected. In concern to bioethical issues, there is a relevant importance of application criteria, procedures, practice monitoring, exercising patient’s rights and training professionals. In order to make sure that these important issues are adequately taken into account within the Portuguese reality, it is fundamental to promote the understanding of these topics and evaluate the opinion of professionals. The purpose of this research work is to contribute to the understanding/application of orientations related to compulsory measures, applied to the Portuguese reality in two distinct main vectors: a) contextualizing compulsory admission (CA), evaluation of several international documents regarding mental health, CA and bioethics, as well as comparing them to the Portuguese Mental Law (PML); b) performing a transversal quantitative study about compulsory measures through an opinion poll directed to Portuguese physicians. The study of the 99 obtained responses (75 specialists and 24 residents in Psychiatry) has been performed through descriptive analysis and comparison among groups. The study comprised evaluation of: therapeutic purpose, risk and loss of competence for decision-making, the right for information and treatment denial, the organization and monitoring of procedures in the scope of CA, the opinion regarding regulations, benefits and efficacy of compulsory outpatient treatment, and the opinion regarding controversial clinical cases. This study led to the observation of differences between the opinion of physicians, the international dispositions and the PML, as well as insufficient application of regulations, and the need to the carry out informative and formative actions. A plan for action/dissemination has been elaborated through the creation of two informative leaflets targeted for users and professionals, in the scope of legal and bioethical aspects of CA. It is also worth remarking the identification of needs for debate in regard to ethical issues and measures to implement in the scope of CA.
Compulsory measures in mental health raise several ethical issues, as physicians have the duty of care, in a society that is increasingly aware of the autonomy and rights of the patient. Throughout time, the ways of facing mental illness and hospitalization have deeply evolved. Currently, compulsory measures require specific application criteria, which are regulated by international documents and the national law, as to restrain their use and ensure that the rights of the patients and ethical demands are respected. In concern to bioethical issues, there is a relevant importance of application criteria, procedures, practice monitoring, exercising patient’s rights and training professionals. In order to make sure that these important issues are adequately taken into account within the Portuguese reality, it is fundamental to promote the understanding of these topics and evaluate the opinion of professionals. The purpose of this research work is to contribute to the understanding/application of orientations related to compulsory measures, applied to the Portuguese reality in two distinct main vectors: a) contextualizing compulsory admission (CA), evaluation of several international documents regarding mental health, CA and bioethics, as well as comparing them to the Portuguese Mental Law (PML); b) performing a transversal quantitative study about compulsory measures through an opinion poll directed to Portuguese physicians. The study of the 99 obtained responses (75 specialists and 24 residents in Psychiatry) has been performed through descriptive analysis and comparison among groups. The study comprised evaluation of: therapeutic purpose, risk and loss of competence for decision-making, the right for information and treatment denial, the organization and monitoring of procedures in the scope of CA, the opinion regarding regulations, benefits and efficacy of compulsory outpatient treatment, and the opinion regarding controversial clinical cases. This study led to the observation of differences between the opinion of physicians, the international dispositions and the PML, as well as insufficient application of regulations, and the need to the carry out informative and formative actions. A plan for action/dissemination has been elaborated through the creation of two informative leaflets targeted for users and professionals, in the scope of legal and bioethical aspects of CA. It is also worth remarking the identification of needs for debate in regard to ethical issues and measures to implement in the scope of CA.
Description
Keywords
Internamento compulsivo Tratamento ambulatório compulsivo Bioética Saúde mental Médicos Compulsory admission compulsory outpatient treatment Bioethics Mental health Physicians