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Decision-making for involuntary commitment in Brazil: elucidating misunderstandings between reasons and justification

The decision of whether to commit a patient involuntarily is one of the most complex tasks in psychiatry, and arguably represents the pinnacle of responsibility in the profession. Nevertheless, despite the importance of the subject, there is a gap in the literature regarding how psychiatrists deal with the legal and ethical criteria for involuntary hospitalization in Brazil.11. Brasil, Código Civil. Lei n° 10216. Diário Oficial da União, 06 de abril de 2001. https://www2.camara.leg.br/legin/fed/lei/2001/lei-10216-6-abril-2001-364458-publicacaooriginal-1-pl.html
https://www2.camara.leg.br/legin/fed/lei...

2. Brasil, Presidência da República, Ministério da Saúde. Portaria n.2391. Diário Oficial da União, 26 de dezembro de 2002. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt2048_03_09_2009.html
http://bvsms.saude.gov.br/bvs/saudelegis...
-33. Brasil, Associação Nacional de Medicina do Trabalho (ANAMT). Resolução CFM n° 2.057/2013. Diário Oficial da União, 12 de novembro de 2013. https://www.anamt.org.br/portal/2017/03/02/resolucao-cfm-n-o-2-0572013/
https://www.anamt.org.br/portal/2017/03/...

According to Law 10216/01, supplemented by Ministry of Health Ordinance no. 2391/GM/2002, involuntary hospitalization is that which occurs “without consent of the individual and at the request of a third party.”11. Brasil, Código Civil. Lei n° 10216. Diário Oficial da União, 06 de abril de 2001. https://www2.camara.leg.br/legin/fed/lei/2001/lei-10216-6-abril-2001-364458-publicacaooriginal-1-pl.html
https://www2.camara.leg.br/legin/fed/lei...
This means that any patient who does not provide written consent for admission, regardless of reason, must have his or her potential hospitalization communicated to the judicial authority for evaluation.44. Barros DM, Serafim AP. Legal criteria for involuntary hospitalization in Brazil. Arch Clin Psychiatry. 2009;36:175-7.

In practice, this is done by completing a communication of involuntary psychiatric commitment form, which must be sent within 72 hours to the judicial authority.22. Brasil, Presidência da República, Ministério da Saúde. Portaria n.2391. Diário Oficial da União, 26 de dezembro de 2002. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt2048_03_09_2009.html
http://bvsms.saude.gov.br/bvs/saudelegis...
The form includes two major criteria in the evaluation of the patient: the reason for involuntary commitment and the justification for such commitment.

Given the overlapping complexity of assessing risk (which will be the reason for commitment) and evaluating a patient’s decision-making capacity (which will be the justification for involuntary commitment), it is imperative that these concepts be clear and that any misunderstandings be resolved.

Accordingly, determining whether a patient’s condition constitutes sufficient risk to effectively deprive them of freedom must be done on a case-by-case basis, taking into consideration not only a formal diagnosis, but also social support and the emotional conditions of family members to provide home care, or, alternatively, to advocate for involuntary commitment. This information is essential in the psychiatric decision-making process, since patient improvement is highly dependent on the involvement of family members in treatment.

Beyond simply evaluating whether a patient presents a risk to oneself, the psychiatrist must determine if the patient has ability to choose and bear responsibility for his or her actions, which will serve as the basis for justification of involuntary commitment when such ability is absent.

When a patient is brought to the psychiatrist by family members due to potentially self-injurious behavior, the psychiatrist should evaluate if that behavior is in fact a symptom of a mental disorder. In the absence of a diagnosed mental disorder, or if a mental disorder is present but does not deprive the patient of choice, involuntary hospitalization is not justified, because the patient’s autonomy must be respected unless there is an imminent risk of death.11. Brasil, Código Civil. Lei n° 10216. Diário Oficial da União, 06 de abril de 2001. https://www2.camara.leg.br/legin/fed/lei/2001/lei-10216-6-abril-2001-364458-publicacaooriginal-1-pl.html
https://www2.camara.leg.br/legin/fed/lei...

2. Brasil, Presidência da República, Ministério da Saúde. Portaria n.2391. Diário Oficial da União, 26 de dezembro de 2002. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt2048_03_09_2009.html
http://bvsms.saude.gov.br/bvs/saudelegis...

3. Brasil, Associação Nacional de Medicina do Trabalho (ANAMT). Resolução CFM n° 2.057/2013. Diário Oficial da União, 12 de novembro de 2013. https://www.anamt.org.br/portal/2017/03/02/resolucao-cfm-n-o-2-0572013/
https://www.anamt.org.br/portal/2017/03/...

4. Barros DM, Serafim AP. Legal criteria for involuntary hospitalization in Brazil. Arch Clin Psychiatry. 2009;36:175-7.
-55. Lima MA. Internação involuntária em Psiquiatria: legislação e legitimidade, contexto e ação. In: Conselho Regional de Medicina do Estado de São Paulo (CREMESP). Ética e psiquiatria 2a ed. São Paulo: CREMESP; 2007. p. 115-26.

In addition to being necessary for scientifically based decision-making and from an ethical-legal standpoint, clarifying these concepts will lead to more accurate completion of the involuntary hospitalization form mentioned above. Additionally, access to epidemiological data from this form will allow subsequent epidemiological analyses, free of ideological biases, which would permit consistent evaluation of the scenario of involuntary hospitalization in Brazil.

References

  • Corrigendum

    The authors of the letter entitled “Decision-making for involuntary commitment in Brazil: elucidating misunderstandings between reasons and justification” (http://dx.doi.org/10.1590/1516-4446-2019-0554), published in the Brazilian Journal of Psychiatry, year 2020, volume 42, issue 1, pages 108-109, have identified an error in the name of the second author: “Lilia B. Shraiber” should read “Lilia B. Schraiber.” Here we reproduce the final, correct version of the author byline:
    Gustavo B. Castellana, Lilia B. Schraiber, Thiago F. da Silva, Daniel M. Barros
    Citation of the editorial should be as follows: Castellana GB, Schraiber LB, da Silva TF, Barros DM. Decision-making for involuntary commitment in Brazil: elucidating misunderstandings between reasons and justification. Braz J Psychiatry. 2020;42:108-109. http://dx.doi.org/10.1590/1516-4446-2019-0554

Publication Dates

  • Publication in this collection
    03 Feb 2020
  • Date of issue
    Jan-Feb 2020

History

  • Received
    18 Feb 2019
  • Accepted
    4 Nov 2019
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