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Legal straitjacket could drive psychiatry underground

作者:翁驾    发布时间:2019-02-26 03:13:03    

By LEIGH DAYTON in SYDNEY Excessive restriction on ‘innovative’ treatments may stifle the development of therapies that would benefit people with mental illnesses. This warning from Justice John Slattery follows the publication last month of his report into the abuse of patients at a private psychiatric hospital in Sydney. In the second part of the report, published last week, Slattery also warned that if controls on treatments are too harsh they could drive doctors to sidestep the guidelines altogether. Slattery’s Royal Commission, set up to investigate the apparent abuse of patients at the Chelmsford Private Hospital, concluded that deep-sleep therapy, as used at the hospital, led to the deaths of 24 patients. The treatment was also linked to 19 suicides and to brain damage in two patients. All 1127 patients at the hospital were kept heavily sedated for up to 14 days with massive doses of tranquillisers and barbiturates (see This Week, 5 January). Three doctors at the hospital could face criminal charges. Slattery recommends the establishment of clear gguidelines and well-structured but flexible procedures for monitoring phychiatric practices. These will encourage solid research, clinical trials and experimentation by researchers and practitioners, he argues. A sensible range of checks and balances on new and experimental treatments should prevent a backlash against excessive regulation, Slattery says. Controls that are too strict, he fears, might prompt a dangerous return to the excesses of the unregulated human research conducted earlier this century. Slattery cites, among other examples, a 40-year study carried out by the US public health service in which penicillin was deliberately withheld from hundreds of black men suffering form syphilis in order to study the progression of the disease. Slattery found a trend in the field of mental health that is ‘strongly against innovation’. This attitude, he says, has discouraged research into the benefits of electroconvulsive therapy. ECT, which triggers a mild seizure by applying an electrical current to the brain, was used extensively to treat depression in the 1950s and 1960s. Although there have been abuses of ECT in the past, Slattery concluded that it can be a ‘successful therapeutic tool’. It would be ‘wrong and unjust’ to discourage further investigation of the technique, he says. On similar grounds, Slattery supports the continuation of psychosurgery in New South Wales. The controversial procedure, also known as a leucotomy, involves severing fibres in the frontal lobe of the brain to alter the emotions and behaviour of phychiatric patients. Regulations passed in 1990 offer patients ‘more than adequate protection’, Slattery says. Peter Collins, the health minister for New South Wales, disagrees. Collins regards psychosurgery as an experimental treatment and tried unsuccessfully to ban it two years ago. Slattery described efforts to prohibit psychosurgery as ‘overzealous’. Federal, state, local and institutional ethics committees should be set up to review all new or experimental procedures, Slattery recommended. Of particular concern are private practitioners and hospitals in New South Wales which operate largely outside existing review systems. For instance, he found that some receive money from international drugs companies to conduct unmonitored clinical trials. Slattery’s report also recommends that legislation should be passed to protect ‘whistle-blowers’ who expose fraudulent scientific research or medical malpractice. He also calls for a ‘bill of rights’ for people with mental illnesses, an independent mental welfare authority to protect the rights of all psychiatric patients,

 

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