心理健康的自我判斷權

Abstract

在現代國家的治理之下，對於個人心理狀態的判斷被認為是屬於專家的知識範圍。縱然在國際人權法與健康權的相關論述中皆對個人自主的重要性有所強調，惟個人對於自身的主觀感受大多時候仍舊未被看重。也因為如此，在與行使個人自由相關的心理狀態判斷中，個人並未擁有一個對於自身心理狀態進行判斷的權利─或者說這個權利在國家法律與精神醫學權威的交互運作下遭到了壓抑。 然而，何以個人對於自身心理狀態不具有由個人主觀感受來加以判斷的權利？現代國家的運作中，對於權利的限制必須說明其正當性。本文欲指出的即是公共衛生如何作為公益，以及法律與公共衛生政策在對於人民心理健康的治理層面中所展現出的家長主義傾向，並以此作為限制個人對自身心理狀態進行判斷的理由。惟透過對於家長主義之定義與正當性條件的闡釋，我們可以發現國家與其所授予權威者在心理狀態的判斷上並非一律具有獨占該判斷權利的正當性。 本文主張應將心理健康理解為一具有實踐意義的概念，其係由生物、社會性因素以及個人主觀感受所共同構成。當專家無法藉由生物、社會性因素對於個人的心理狀態給出一確切判斷時，國家即不得繼續以家長主義式的理由來限制以個人主觀感受來判斷自身的心理狀態。此時，個人即得以主張心理健康的自我判斷權來以自身的感受來判斷自己的心理健康，並藉此排除國家以其心理健康為名對其個人自由所作出的侵害。

Under the governance of modern states, the assessment of mental state is regarded as an area of expertise. Even though the importance of personal autonomy is emphasized in the discourse of international human rights law and right to health, the subjective feelings of an individual are still overlooked most of the time. Thus, when it comes to the assessment of mental state related to the exercise of personal freedom, an individual does not have the right to assess their own mental state, or we could say the right is inhibited under the interaction of the authority of law and psychiatry. However, why does an individual not have the right to assess their own mental state using their subjective feelings? Under the operation of modern states, any inhibition of rights needs to be legitimated. This thesis aims to point out how public health serves as a public interest and the paternalistic tendency of law and public policies in governing people’s mental health. They are both used as reasons to restrict an individual’s right to assess their own mental state. Yet through the interpretation of the definition and the justification condition of paternalism, we could find that the state and other authorities granted by it do not always have the legitimacy to monopolize the right to assess one’s mental state. I argue that mental health should be understood as a concept with practical meaning that consists of biological and social elements, and one’s own subjective feelings. When experts could not give a definite assessment of an individual’s mental state based on biological and social elements, the state should not continue using paternalistic reasons to restrict an individual’s assessment of their own mental state using their subjective feelings. An individual could then claim the right to self-assessment and assess their own mental state using their subjective feelings and keep the state from violating their personal freedom even if the state asserts that the violation is for the good of their mental health.