The changing purpose of mental health law: From medicalism to legalism to new legalism.

The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.

Patologização e penalização do uso de drogas: uma análise socioantropológica de proposições legislativas (2007-2010) / The pathologization and criminalization of drug use: a socio-anthropological analysis of legislative proposals (2007-2010)

Com base nas contribuições de N. Elias e H. Becker, buscamos identificar os processos de patologização e penalização do uso de drogas presentes em proposições legislativas apresentadas ao Congresso Nacional durante a 53ª Legislatura. As 147 proposições reunidas através do descritor "álcool, tabaco e outras drogas" no banco de dados do Observatório da Saúde no Legislativo também dizem respeito a diferentes temas, como "alimentação e nutrição" e "propaganda". No inteiro teor de alguns projetos de lei, há uma recorrente indistinção entre uso, abuso e dependência de substâncias psicoativas ilícitas e lícitas; inclusive na própria ementa dos mesmos é patente uma tendência no sentido do aumento da pena dirigida a usuários e também distribuidores de drogas. A atuação do Poder Legislativo no que tange à questão das drogas contribui para sua penalização e patologização, mais do que para sua politização.

Using concepts by N. Elias and H. Becker, we identified processes of pathologization and penalization of drug use in legislative proposals submitted to the National Congress during the 53th Legislature in Brazil. The 147 proposals gathered using "alcohol, tobacco, and other drugs" as descriptor on the database of the Congress Health Watch address other topics as well, such as "food and nutrition" and "advertising". At the core of some legal reform projects lays a recurrent lack of distinction between use, abuse, and dependence with regard to illicit psycho-active substances. A tendency to increase jail time for both distributors and users also evident. The role of the Legislature is key to the issue of drug use, contributing to its criminalizing and pathologization, rather than to its politicization.

Ethical and legal implications of elective ventilation and organ transplantation: "medicalization" of dying versus medical mission.

A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. "Elective ventilation" (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation.

Assessing child welfare under the Human Fertilisation and Embryology Act 2008: a case study in medicalisation?

This article reports on a study with staff working in assisted conception clinics in the UK about making welfare of the child (WOC) assessments pre-conception. This aspect of infertility treatment is obligatory under section 13(5) of the Human Fertilisation and Embryology Act, which was amended in 2008. The aim of the study was to find out how this change to the law had impacted on practice. In describing what we found, we also make a contribution to scholarship about the medicalisation of reproduction. S13(5) has often been discussed as a prime example of medicalisation, giving clinics power to grant or deny access to treatment on child welfare grounds, encompassing far more than purely clinical considerations. Yet, while such medicalisation may be entrenched in the law, our findings suggest this power is used with a very light touch. Further, while our interviewees offered near-universal support for the need to consider child welfare, this is now justified by concerns that address not only family form (e.g. the need for a father figure) but also the quality of interactions between parents and children. In this light we suggest that the concept of medicalisation may offer a rather blunt tool for understanding a far more complex reality.