Emmanuelle Bernheim

Factors influencing decisions on seclusion and restraint

Seclusion with or without restraint is a measure for managing aggressive or agitated clients and promoting site security, particularly in an emergency psychiatric setting. The decision to control a potentially dangerous persons behaviour by removal or seclusion seems ethically justifiable in such a setting. However, although the decisions on these restrictive measures are based on rational needs, they are also influenced by the healthcare teams perceptions of the client and by the characteristics of the team and the environment. The purpose of this paper is to set out and categorize the factors in play in aggression- and agitation-management situations as perceived by the healthcare teams, particularly the nurses. The first part of the paper deals briefly with the settings in which control measures are applied in a province in eastern Canada and the effect of such measures on patients and healthcare teams. The second part identifies the factors involved in the management of agitation and aggression behaviour. The final part discusses the current spin-offs from this knowledge as well as promising paths for further research on the factors involved. The ultimate objective is to reduce recourse to coercive measures and enhance professional practices.

Une tension normative irréconciliable. Les discours psychiatrique et juridique sur le risque psychiatrique

L’alliance entre les spheres de pouvoir politiques et psychiatriques s’est longtemps justifiee par la necessite et la complementarite. Or, depuis le milieu du vingtieme siecle, les bases de la gouvernance politique et les fondements du systeme juridique se sont profondement transformes. Comment concilier les fondements du systeme juridique, qui s’attache au droit des personnes, et les mesures preventives liees a la gestion du risque psychiatrique qui, de par leur nature, sont immanquablement attentatoires aux droits fondamentaux? L’auteure postule qu’a travers le developpement d’un discours psychiatrique expert sur le risque, de nouveaux reperes normatifs ont favorise l’emergence d’une tension au sein du systeme juridique. Ainsi, cette tension pourrait servir d’illustration au phenomene plus global de pluralisme normatif, qui complexifie le rapport individuel aux normes multiples et concurrentes. En outre, le formalisme juridique ne peut plus suffire a la protection des droits fondamentaux en toute egalite. Dans ce contexte, l’integration d’une perspective materialiste et holiste constitue eventuellement une avenue a emprunter.

Risques de santé et populations marginalisées : réflexion interdisciplinaire sur la centralité des droits de la personne dans le statut citoyen

Although risk management strategies adopted by the State and its agents are aimed theoretically at sheltering them from liability, it is noted that when these strategies are applied to those who are marginalized, they often have the effect of exacerbating and multiplying risks otherwise normally assumed by citizens. This situation violates the fundamental rights of marginalized persons and in fact, may increase their vulnerability to certain risks. The writers postulate that practices grounded on the rights of persons -in a ⪡ bottom up⪢ perspective -could constitute a counterweight to the law and to social and health policies that may, in fact, encourage the emergence of certain risks. In order to favor empowerment, it is suggested that there emerge a socialization process relating to human rights according to which the status of citizen would be viewed as an interface between the individual and society. SOMMAIRE