Reviewed by:

• Compulsory Mental Health Interventions and the CRPD: Minding Equality by Anna Nilsson
• Faraaz Mahomed (bio), Janos Fiala-Butora (bio), and Michael Ashley Stein (bio)

Countries as far afield as Peru, India, and Kenya have recently engaged in law reform efforts to bring their mental health statutes in line with international standards.¹ In particular, the introduction of the Convention on the Rights of Persons with Disabilities (CRPD or Convention) has been a significant catalyst because of its wide ratification and because of treaty provisions which, read alongside the interpretation of the Committee on the Rights of Persons with Disabilities (CRPD Committee), prohibit substitute decision-making by clinicians, law enforcement or even family members. Essentially, according to proponents of this "paradigm shift," what this means is that coercion in mental health care is outlawed in international human rights law, and efforts to prevent and correct measures that result in involuntary mental health treatment need to be undertaken in domestic laws and practices.²

Since the introduction of the Convention and General Comment 1 on CRPD Article 12, legal scholars and mental health practitioners have been reflecting on the rationality, scope and extent of the prohibition and indeed, in many instances, on arguments that these positions are untenable where an individual with a mental health condition might pose a risk to him or herself or to others.³ Anna Nilsson's book is one such contribution. The author examines to what extent (if any) Article 12 and the interpretation of the CRPD Committee allow for involuntary treatment and what arguments might be made in support of, or in opposition to, this allowance.

Nilsson argues that a conclusive answer to the question of whether or not the CRPD outlaws involuntary treatment cannot be determined by treaty interpretation. Instead, she proposes an anti-discrimination approach to separate lawful and unlawful practices. Nilsson's approach is novel, but it rests heavily on the assumption that the understanding of discrimination in the CRPD is similar to older human rights instruments. She puts forward important arguments for this thesis, and the account is credible, but an equally strong case can be made for differences in the CRPD's non-discrimination approach, reflected in the definition of disability and General Comment No. 6 on equality and non-discrimination.⁴ The CRPD is at least in [End Page 616] part a non-discrimination treaty,⁵ but one could also argue that its understanding of equality is different from existing treaties.⁶

Nilsson's method of choice to analyse discrimination is proportionality reasoning, grounded in the work of Robert Alexy. She proposes a formula for assessing the permissibility of coercive interventions in limited circumstances that considers the potential suitability of involuntary mental health treatment while also seeking out an optimal balance between rights and freedoms and rational clinical limitations. In Nilsson's view, Alexy's approach "breaks down proportionality argumentation into a step-by-step process and sets out clear criteria to be fulfilled at each step."⁷ This is perhaps another point of contention, as one could very well make the argument that such an assessment is inappropriate in the context of an absolute prohibition on involuntary treatment, or treatment that has been equated to torture by Juan Mendez, the United Nations Special Rapporteur on the right to be free from torture, cruel and inhuman and degrading treatment.⁸ Indeed, for some scholars who share Mendez's view, the question using Nilsson's framing and put fairly bluntly would read something like "Under what circumstances would the use of torture result in optimal outcomes?" This is perhaps a simplistic summation but is not an inaccurate one.

Leaving aside the aforementioned question, it is worth noting that there has been very little concurrence among scholars and activists regarding the absolute or limited nature of the prohibition of involuntary mental health treatment. Many clinicians and jurists have argued for limitations and exceptions based on risk assessment.⁹ This is the context in which Nilsson's contribution must navigate its own arguments. Essentially, she suggests that stark dichotomies...

审核人：

• 强制心理健康干预和 CRPD：安娜·尼尔森 (Anna Nilsson) 的平等意识
• Faraaz Mahomed（生物）、Janos Fiala-Butora（生物）和 Michael Ashley Stein（生物）

远在秘鲁、印度和肯尼亚的国家最近都在进行法律改革，以使其精神卫生法规与国际标准接轨。¹尤其是，《残疾人权利公约》（CRPD 或公约）的出台起到了重要的推动作用，因为它获得了广泛的批准，而且条约规定与残疾人权利委员会的解释一起阅读。残疾（CRPD 委员会），禁止临床医生、执法人员甚至家庭成员做出替代决策。从本质上讲，根据这种“范式转变”的支持者，这意味着国际人权法禁止精神卫生保健中的胁迫行为，国内需要努力预防和纠正导致非自愿精神卫生治疗的措施。法律和惯例。²

自从公约和关于 CRPD 第 12 条的一般性意见 1 出台以来，法律学者和精神卫生从业人员一直在反思禁令的合理性、范围和程度，实际上，在许多情况下，这些立场在以下情况下站不住脚的论点有心理健康状况的个人可能会对他或她自己或他人构成风险。³ Anna Nilsson 的书就是这样的贡献之一。作者研究了第 12 条（如果有的话）和 CRPD 委员会的解释在多大程度上允许非自愿治疗，以及支持或反对这种允许的论据。

Nilsson 认为，对于 CRPD 是否禁止非自愿治疗的问题，不能通过条约解释来确定最终答案。相反，她提出了一种反歧视的方法来区分合法和非法行为。Nilsson 的方法很新颖，但它很大程度上依赖于这样一个假设，即 CRPD 中对歧视的理解与旧的人权文书相似。她为这篇论文提出了重要论点，这个说法是可信的，但同样有力的理由可以证明 CRPD 的非歧视方法的差异，体现在残疾的定义和关于平等和非歧视的第 6 号一般性意见中。歧视。⁴ CRPD 至少在[End Page 616]部分是一项非歧视条约，⁵但也有人可能会争辩说，它对平等的理解不同于现有条约。⁶

Nilsson 选择的分析歧视的方法是比例推理，以罗伯特·阿列克西 (Robert Alexy) 的工作为基础。她提出了一种评估在有限情况下强制干预的可允许性的公式，该公式考虑了非自愿心理健康治疗的潜在适用性，同时也在权利和自由与合理的临床限制之间寻求最佳平衡。在 Nilsson 看来，Alexy 的方法“将比例性论证分解为一个循序渐进的过程，并制定了每一步要实现的明确标准”。⁷这也许是另一个争论点，因为在绝对禁止非自愿治疗或被联合国特别报告员胡安·门德斯等同于酷刑的待遇的背景下，人们很可能会提出这样的评估是不合适的。免于酷刑、残忍、不人道和有辱人格的待遇的权利。⁸事实上，对于一些同意门德斯观点的学者来说，使用尼尔森的框架并坦率地说，这个问题会读成“在什么情况下使用酷刑会导致最佳结果？” 这也许是一个简单的总结，但并非不准确。

撇开上述问题不谈，值得注意的是，对于禁止非自愿精神健康治疗的绝对或有限性质，学者和活动家之间几乎没有达成一致。许多临床医生和法学家都主张基于风险评估的限制和例外。^{9 在}这种背景下，尼尔森的贡献必须围绕自己的论点展开。从本质上讲，她建议严格的二分法......