Abstract
The analysis presented in this article reveals an ambiguity and tension in human rights theory concerning the delusional person’s freedom of belief and thought. Firstly, it would appear that the concepts ‘opinion’ and ‘thought’ are defined in human rights discussion in such a way that they do include delusions. Secondly, the internal freedom to hold opinions and thoughts is defined in human rights discussion and international human rights covenants as an absolute human right which should not be restricted in any situation for any reason. These views, if understood literally, imply that a person has an absolute right to hold a delusion. However, this kind of conclusion has not been made in mental health laws, the ethical principles guiding psychiatric care or the practice of psychiatry. Instead, they assume that the use of involuntary antipsychotic medication is justified even thought its purpose is to influence delusions. The ambiguity and tension in human rights theory concerning the freedom of belief and thought challenge us to develop this theory within an interdisciplinary discussion so that people with delusions are taken into account properly.
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Notes
I will refer to the constellation of these human rights with the shorter expression ‘freedom of belief and thought’.
For a critique of Berrios’s suggestion, see Bortolotti 2010, p. 118–121.
See also Campbell and Cosans v. United Kingdom 1982.
For a critique of the American definition for the concept of belief, see Evans 2001, 63
See also the Case of Lingens v Austria 1986 and Dichand and others v Austria 2002.
Since it seems to be the case that evaluative judgements are more protected than expressions dealing with factual matters, it might be that publicly expressing a delusion along the lines of “my problems are caused by Satan who has stolen my neighbour’s soul and now influences my life spiritually through him” might receive more protection than a delusional expression like “my neighbour has blown up the door of my house”.
See also Scheinin (2000, 6), who refers to Partsch’s definition.
See also Winick (1997, 162), who writes in the American context, as follows: “Thoughts deemed ‘disordered’ would seem no less entitled to First Amendment protection.”
Making this kind of distinction between the external and internal dimension is philosophically problematic. Moreover, the borders between internal and external are not clear. However, since this distinction is presupposed in both human rights conventions and human rights discussion I utilize it and lean on it.
See also Evans 2001, p. 52.
Nowak does not consider the cases of psychotic patients, thus it is unclear what he thinks about involuntary antipsychotic medication as a psychiatric treatment.
The relationship between competence and rights is also an unclear and much argued about issue in the discussion concerning the rights of children (see Langlaude 2007, 45–53, 101–104). Sylvie Langlaude (2007, 136) seems to interpret The United Nations Convention on the Rights of the Child (1989, article 14) in such a way that restrictions on the forum internum are not permissible. However, it is unclear whether and to what extent the forum internum should be applied in cases involving children.
Justice Stevens 1990, while invoking fundamental rights, seems to suppose that the person is competent: “There is no doubt, as the State Supreme Court and other courts that have analyzed the issue have concluded, that a competent individual’s right to refuse such medication is a fundamental liberty interest deserving the highest order of protection.”
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Acknowledgements
I’m grateful to professor Jaana Hallamaa and assistant professor Ville Päivänsalo for their comments and suggestions. I am also grateful to the reviewers for bringing various important points to my attention.
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I have no conflicts of interests.
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This work was supported by the Alfred Kordelin Foundation.
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Stenlund, M. Is There a Right to Hold a Delusion? Delusions as a Challenge for Human Rights Discussion. Ethic Theory Moral Prac 16, 829–843 (2013). https://doi.org/10.1007/s10677-012-9390-3
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DOI: https://doi.org/10.1007/s10677-012-9390-3