强制医疗保障性制度的困境与出路

强制医疗的制度体系在精神病鉴定、保护性约束、法律监督、案件审理、判决执行等诸多环节存在问题。精神病鉴定制度存在鉴定启动权的官方垄断、鉴定人责任不够明确、鉴定人中立性存疑、鉴定羁押制度缺失等问题;临时约束性保护措施存在"临时措施"名不副实、缺乏程序正义的公正外观、滥用措施缺乏法律责任、适用标准相对较低等问题;法律监督缺乏针对性的制度与合理的奖惩机制;辩护权保障不足,法律援助生成较晚;法院审理程序与普通案件审理程序有重大差异;法院强制医疗的决定缺乏有效执行的保障。困境成因是多元的、复杂的,既有主观上认识能力、价值取向、部门利益等因素,也有客观上精神病复杂性、资源稀缺、法治环境欠佳等限制。国家只有真正重视精神病人的权利保护,提供制度的物质基础,投入大量资源才有条件健全各项制度,从而保障强制医疗制度的有效运行。

The Predicament and Outlet of Compulsory Medical Security System

The problems of system of compulsory medical are in the identification of mental dis- eases, protective restraint, legal supervision, trial, execution and other links. Psychiatric evaluation system has the right to start the identification of official monopoly, identification of human responsibility is not clear, identification of neutrality, identification of problems such as lack of doubt custody system; temporary constraint protection measures are ＂Interim Measures＂ be more in name than in reality, the lack of justice, procedural justice appearance of abuse, lack of legal liability applica- ble standards is relatively low ; law in view of the lack of supervision mechanism of rewards and pun- ishments system and reasonable; lack of safeguard of the right to defense, the legal aid production later; the court procedure there is a significant difference in hearing and ordinary cases; court for compulsory medical decision is lack of effective implementation of safeguards. The causes are multi- ple and complex, have both subjective cognition, value orientation, department interests and other factors, there are objective psychiatric complexity, resource scarcity, the rule of law environment limit. The only way to the protection of the rights of real mental patients, put a lot of resources to provide the material basis of the conditions of perfect system, each system, so as to ensure the effec-tive operation of compulsory medical treatment system.