Cognition & Reality

Thursday, 13 January 2011

Medicine & Law: The Psychiatric “Hold”

Filed under: Diagnosis,Medical Morality,Psychotherapy — drtone @ 1:54 pm

Many are familiar with the meaning of the term “5150,” It refers to a provision of California law, Section 5150 of the Welfare & Institutions Code, pertaining to the involuntary commitment of an individual designated as “a danger to self or others” or “gravely disabled.” The law is administered at the county level, usually involving county sheriffs as the main agents of commitment, although others, principally psychiatrists so designated by the county, can place a person in an involuntary “hold” at a psychiatric facility. Naturally, such a law is a constant matter of debate among civil libertarians, but let us stipulate, for the moment, that there are circumstances in which it is necessary to confine someone who is acting out in a potentially dangerous manner or is manifestly and severely suffering from self-neglect.

From my perspective, the interesting thing about this kind of “hold” is the legal power it places in the hands of physicians, not so much in admitting the individual in question, but in ending the hold and allowing him or her to leave the facility. According to a subsection of the law, WIC Section 5152, not only is it up to a psychiatrist to continue or end a hold, but the final decision to end a hold in disputed cases resides with the head of the medical facility where the person is being held, or if that doctor is not a psychiatrist, by a psychiatrist appointed by him or her. Think about that: A segment of the medical profession, psychiatrists, have legally defined powers over a person’s freedom. This is surely not the only instance where doctors are written into the law. We take it for granted, however, that members of a given profession who are usually not public officials deserve a level of trust far in excess that accorded other citizens. I’m not suggesting it’s wrong that we do this, but only that we consider what it means.

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