论卫生法的基本原则

本文从法理的高度讨论了卫生法基本原则的功能和确立标准，分析了目前卫生法学界对卫生法基本原则的归纳存在的不足，进而提出了新的卫生法的基本原则：卫生法治和保护公民生命健康权。     

尊让与监督:美国防疫诉讼与公共卫生安全治理

法治是公共卫生安全治理中的重要组成部分。美国公共卫生安全治理中始终存在一系列权力与权利的矛盾关系。其中主要矛盾是州政府行使治安权保护公共卫生安全与个人权利之间的冲突。要有效落实防疫政策等公共卫生安全治理举措,必须在公共卫生安全利益与个人权利间实现平衡。司法权能够裁决争议、抑止损害,持续对公共卫生安全治理产生重要影响。历史上,美国法院在公共卫生案件中采取司法尊让立场,推动了公共卫生安全治理的发展。当前,法院对政府其他分支机构行使权力的司法监督增强。新冠肺炎疫情下,美国公共卫生安全法治缺乏必要的稳定性,法院难以通过司法方式有效平衡公共卫生安全利益与个人权利。这不仅削弱了美国司法体系对公共卫生安全治理的影响力,也加深了美国公共卫生安全治理的困境。     

Beyond police crisis intervention: Moving “upstream” to manage cases and places of behavioral health vulnerability

Law enforcement officers continue to serve on the front lines as mental health interventionists, and as such have been subject to a wave of “first generation” reform designed to enhance their crisis response capabilities. Yet, this focus on crisis intervention has not answered recent calls to move “upstream” and bolster early intervention in the name of long-term recovery. This paper reports on findings from an action research project in Philadelphia aimed at exploring opportunities for enhanced upstream engagement. Study methods include spatial analyses of police mental health transportations from an eight year period (2004–2011) and qualitative data from twenty-three “framing conversations” with partners and other stakeholders, seven focus groups with police and outreach workers, five key informant interviews as well as document reviews of the service delivery system in Philadelphia. Recommendations include the need to move beyond a focus on what police can do to a wider conception of city agencies and business stakeholders who can influence vulnerable people and vulnerable spaces of the city. We argue for the need to develop shared principles and rules of engagement that clarify roles and stipulate how best to enlist city resources in a range of circumstances. Since issues of mental health, substance use and disorder are so tightly coupled, we stress the importance of establishing a data-driven approach to crime and disorder reduction in areas of the city we term “hotspots of vulnerability”. In line with a recovery philosophy, such an approach should reduce opportunities for anti-social behavior among the “dually labeled” in ways consistent with “procedural justice”. Furthermore, crime and disorder data flowing from police and security to behavioral health analysts could contribute to a more focused case management of “repeat utilizers” across the two systems. Our central argument is that a twin emphasis on “case management” and “place management” may provide the pillars needed to move upstream and strengthen interventions along a continuum of engagement.     

Envisioning the next generation of behavioral health and criminal justice interventions

The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person–place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes.     

Forensic mental health assessment in France: Recommendations for quality improvement

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called “experts” in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.     

医疗改革中行政指导相关问题研究

随着我国法治进程的不断加快和医疗卫生环境的不断变化,行政指导作为＂市场经济国家关于市场功能、政府角色和行政模式的政策选择不断演进的结果,＂具有柔和、民主的色彩,既体现了行政行为的目的性,又兼顾了市场经济的自由性,已成为政府主导医疗改革不可或缺的重要手段。但是,由于我国行政指导法律机制不健全以及现实中政府责任意识淡薄,使得行政指导影响了医疗改革的效果及目标的实现。对此,本文认为,行政指导法治化是促进医疗改革的重要途径。     

精神障碍患者非自愿收治程序设计的若干法律问题研究(上)刘瑞爽

对于精神障碍患者的非自愿收治,应注意保障患者的人身权利,尤其是合理程序保障的权利。比较分析国际上的各国立法,在收治程序各个环节上,均须体现出对人权的保护,其主要问题有：制定强制收治的标准、送治主体、收治主体、初步裁定的步骤和时限、对初步裁定的救济、法律代表人制度、司法审查的介入（或独立第三方的介入）、危险的证明、避免无限期拘留而进行的后续定期审查、患者方获取信息的权利保障、上诉等。我国应坚持程序正义原则,借鉴国际上先进立法经验,弥补我国精神障碍患者非自愿收治程序设计的立法漏洞。     

Moving prison health promotion along: towards an integrative framework for action to develop health promotion and tackle the social determinants of health

The majority of prisoners are drawn from deprived circumstances with a range of health and social needs. The current focus within ‘prison health’ does not, and cannot, given its predominant medical model, adequately address the current health and well-being needs of offenders. Adopting a social model of health is more likely to address the wide range of health issues faced by offenders and thus lead to better rehabilitation outcomes. At the same time, broader action at governmental level is required to address the social determinants of health (poverty, unemployment and educational attainment) that marginalise populations and increase the likelihood of criminal activities. Within prison, there is more that can be done to promote prisoners’ health if a move away from a solely curative, medical model is facilitated, towards a preventive perspective designed to promote positive health. Here, we use the Ottawa Charter for health promotion to frame public health and health promotion within prisons and to set out a challenging agenda that would make health a priority for everyone, not just ‘health’ staff, within the prison setting. A series of outcomes under each of the five action areas of the Charter offers a plan of action, showing how each can improve health. We also go further than the Ottawa Charter, to comment on how the values of emancipatory health promotion need to permeate prison health discourse, along with the concept of salutogenesis.     

Doing justice to justice

Adshead's recognition that only when taken together can the many different conceptions of justice accommodate what is called for in the particularly demanding setting of forensic mental health care, is to be applauded. Each must be honoured and built into the systems of assessment and treatment that are the tasks of the forensic psychiatrist, she demonstrates. Adshead's far‐reaching revisions could resolve much that is troubling about the present practice of forensic psychiatry. Yet how much these revisions can overcome the moral dilemmas associated with dual roles in forensic psychiatry, is not so clear.     

From Big Data to Knowledge: An Ontological Approach to Big Data Analytics

The introduction of Big Data sets in the healthcare domain has presented opportunities to engage in analytics of very large sets containing both structured and unstructured data. With advances in information technology (IT), these data sets have become available from diverse sources at greatly increased rates. The availability of Big Data sets has introduced complexities that we must address, not only in terms of semantics and analytics but also in terms of data management, storage, and distribution. Currently, the capabilities to ingest, analyze, and manage multipetabyte data sets have underscored the limitations of our analytics capabilities supported by relational database management systems. This essay argues that an ontology‐based approach to data analytics provides a practical framework to address the semantic challenges presented by Big Data sets. No ontological framework can address the operational and management requirements introduced by the availability of Big Data sets, however. There are also a number of IT architectural factors that must be considered in implementing such a framework.