Transcript Class participation

MENTAL HEALTH LAW
AND NEUROETHICS
Introduction and Overview
Overview
• Introductions
• What drew you to the topic?
• What would you like to get out of the class?
• Logistics for the class
• Overview of topics
• Guest speakers
• Method of student evaluation
• Brief introduction to mental health, mental disorder and
mental disability – legal and cultural history.
• Class debate
Introductions
• What’s your name?
• What drew you to the topic?
• What would you like to get out of the class?
• Is there a topic you would particularly like to ensure we
cover?
• Chandler
• Specialize in health law and bioethics.
• Particular research focus:
• Brain, mind and the law
• Organ donation, transplantation and regenerative medicine.
Class topics and readings
• Four main pillars
• (1) Mental Health Law
• Medical treatment – consent, hospitalization
• Tort law – malpractice, responsibility of those with mental illnesses
• (2) Criminal Law
• Fitness, NCRMD, automatism
• Mental Health Court
• Roles: defense lawyer, expert psychiatric witness
• Sentencing, dangerousness assessment, dangerous and long term offenders.
• (3) Human Rights Law
• Access to care
• Discrimination and accommodation
• Calls for reform
• (4) Neurolaw and neuroethics
• Admissibility of novel forms of evidence (e.g. neuroimaging for lie detection)
• Significance of emerging theories of biological causes of behaviour (e.g. behavioural
genetics)
• Looking into the mind and the law (e.g. disorders of consciousness and pain detection)
• Detecting and manipulating cognitive functions (e.g. memory)
• Research ethics in psychiatric research
Guest Speakers
• Dr. Alison Freeland
• Associate Chief of Psychiatry, Royal
Ottawa Hospital
• Lisa Murphy
• Forensic Psychometrist, Royal Ottawa
Hospital
• Michelle O’Bonsawin
• General counsel, Royal Ottawa
Hospital
• Dr. Paul Fedoroff
• Forensic Psychiatrist, Royal Ottawa
Hospital and President, Canadian
Association of Psychiatry and the Law
• Michael Davies
• Partner, Foord Davies LLP
• Dr. Helen Ward
• Clinical Director, Forensic Program,
Royal Ottawa Hospital
Student evaluation
• Two important components
• Class participation (30%)
• Preparation
• Class participation
• Reflection paper on the readings when absence is unavoidable (1 week after
missed class). (2 freebies)
• Research paper (70%)
• High expectations – start early.
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Original and challenging topic
Clear thesis (not vague, general or superficial)
Thorough research that is appropriate to the topic
Excellent standard of writing
Attention to rules regarding plagiarism
• Deadlines: Topic statement (Feb. 27); Outline (Mar. 6); Final paper (Apr. 25).
• P.S. I am available to advise you on your paper, but will be away for a
2 week period in April after classes end. Please start early, and come
to talk to me if you would like advice on your paper.
Note – two scheduled make-up classes
• Thursday, February 13th – 8:30-10 a.m. FTX 136.
• Replaces class cancelled on Tues. Feb. 25th.
• We also have class that afternoon Thursday, Feb. 13th, 1-3 p.m.
• Thursday, March 20th – 8:30-10 a.m. FTX 137.
• Replaces class cancelled on Thurs. March 13th.
• We also have class that afternoon Thurs. March 20th, 1-3 p.m.
Mental health, mental disorder and mental
disability
• Large range of mental conditions
• Mental illnesses
• Cognitive conditions
• Brain damage (e.g. accidents, strokes, dementia, illnesses)
• Neurodevelopmental (e.g. genetic, prenatal events like FASD or
hypoxia)
• Great variability
• Types of symptoms
• Severity of symptoms
• Very complex causation
• Environmental
• Biological
• Social
• Political/ideological
• Role of genotype in the
cycle of violence in
maltreated
children. Caspi A, McClay J,
Moffitt TE, Mill J, Martin J, Craig
IW, Taylor A, and Poulton R 2002
Science 297:851-854.
Prevalence
• Schizophrenia 1%
• Major depression 8%
• Anxiety disorder 12%
• Drug or alcohol dependence 10%
• Moderate or severe gambling problem 3.8%
• FASD 0.9% (but up to 20% in some communities)
• Data: CAMH based on 2001- 2003 data from Health Canada, Statistics
Canada, Canadian Centre for Substance Abuse as well as Public Health
Agency of Canada.
• http://www.camh.ca/en/hospital/about_camh/newsroom/for_reporters/Pages/a
ddictionmentalhealthstatistics.aspx
Brief historical overview
• Ancient history of mental illness
• “melancholia”
• Spiritual or supernatural
explanations
• Scientific revolution
• Institutionalization
• De-institutionalization in the 1960s
and 1970s.
Eugenics movement
• 1920s-1930s
• Buck v. Bell (1927, US Supreme Court):
“Three generations of imbeciles are enough.”
• Muir v. Alberta (1996 ABQB)
• E. (Mrs.) v. Eve (1986 SCC)
• “The grave intrusion on a person's rights and the
certain physical damage that ensues from nontherapeutic sterilization without consent, when
compared to the highly questionable advantages
that can result from it, have persuaded me that it
can never safely be determined that such a
procedure is for the benefit of that person.
Accordingly, the procedure should never be
authorized for non-therapeutic purposes under the
parens patriae jurisdiction.”
“Psychosurgery”
• Long history
• E.g. trephining (trepanning)
• Moniz
• Nobel prize for medicine in 1949 for
frontal leucotomy.
• Pattern of unchecked
experimentation and
implementation.
• Modern versions
• Surgical lesioning continues
• Neuromodulation (deep brain
stimulation) now being explored for
psychiatric applications.
Social, cultural and political aspects
• Political psychiatry
• Medicalization
• “Psychiatric homophobia” (declassified by APA 1973)
• New syndromes “shyness or social phobia”
• New DSM 5 published 2013.
• Sanism and Neurodiversity
Class Debate:
• Mental Health Act, Ontario
• Psychosurgery
• 49.(1)Psychosurgery shall not be administered to an
involuntary patient, to a person who is incapable of giving
or refusing consent to psychosurgery on his or her own
behalf for the purposes of the Health Care Consent Act,
1996, or to a person who is remanded or detained in a
psychiatric facility pursuant to the Criminal Code
(Canada). 1992, c. 32, s. 20 (39); 1996, c. 2, s. 72 (30).
• Same
• (2)Psychosurgery is any procedure that, by direct or
indirect access to the brain, removes, destroys or
interrupts the continuity of histologically normal brain
tissue, or that inserts indwelling electrodes for pulsed
electrical stimulation for the purpose of altering behaviour
or treating psychiatric illness, but does not include
neurological procedures used to diagnose or treat organic
brain conditions, intractable physical pain or epilepsy, if
these conditions are clearly demonstrable. 1992, c. 32,
s. 20 (39).
Deep brain stimulation
• Emerging applications….
http://thejns.org/doi/abs/10.3171/2013.4.JNS121639
Does the MHA prohibit
this in Ontario?
Debate
• (1) The existing prohibition on psychosurgery in the MHA
should remain in place as is.
• (2) The existing prohibition on psychosurgery in the MHA
should remain in place, but should be modified as
follows….
• (3) We should remove the existing prohibition on
psychosurgery in the MHA altogether.