The remarkable group of experts—leaders in the field of psychiatry, behavioural sciences, ethics, philosophy, and legislation—whom Michael Dudley, Derrick Silove, and Fran Gale have brought together produced chapters rich in evidence as well as in experience and hopes about the protection of human rights in relation to illness. Some of the contributions before us are particularly relevant for the care of people with mental illness, others have a wider focus, embracing human rights issues related to other diseases, to research, education, and policy-making.
The wealth of information that has been assembled presents a platform on which it should be possible to fight for the rights of the mentally ill. At present, most planks of that platform are either demonstrations that there is much abuse of the human rights of the people with mental illness (in the process of mental health care, in daily life, in psychiatric research, in the management of co-morbid physical illness, and in many other situations) or exhortations about the need to ensure that rights be respected. The latter arguments are mainly justified by overarching ethical considerations which, while often accepted in principle, do not necessarily have the power of persuasion that would make those involved change their ways. To use the platform well, to make it help in ensuring that the rights of the people with mental illness are protected, it will be necessary to complement the presentation of these studies by a description in concrete terms of the benefits that the protection of human rights of the mentally ill may bring, in addition to satisfying an ethical demand.
These benefits include, at least: (i) the guarantee that people with mental illness will receive the same amount of care as people who suffer from other illnesses which, in turn, will reduce the length of their illness, diminish the probability that they will remain impaired and disabled after the illness, and reduce the chances that they will die from physical illness at present frequently neglected when occurring in a person with a serious mental disorder; (ii) the confirmation—by the provision of appropriate care to the mentally ill who need it—that the society in which we live is on the way to becoming a civic society in which all have the obligation to help others in need and the right to expect the same amount of help if they were to suffer from a similar condition; (iii) the creation of an antidote to the currently growing epidemic of burn-out in personnel working in mental health institutions who feel that their work is of little significance because it helps people who are of so little value that the society did not even recognize that they have the same rights as any other citizen.
There are two additional points that need to be included in the coda to such an excellent collection of essays. The first concerns the need to add to each chapter and each commentary a ‘sunset clause’, as is the case for many other texts which are valid for a time, and have to be re-examined at regular intervals. The world is changing very fast and many moral prescriptions or needs clearly present today will be replaced by others, tomorrow. The protection of human rights as a permanent objective may well remain relevant for a long time: but which rights, in which situations, or which people should receive priority? We should ensure that these questions are continually reviewed and perhaps urge governments to establish Standing Human Rights Committees that would identify what needs changing. While governments are considering the establishment of such committees, it will be important to assign the role of the standing committees to professional associations, patient and family organizations, and others who might help in keeping the effort well-focused and useful; a second revised edition of this book should already today be on the calendar of Dr Dudley and his colleagues, perhaps for the year 2015.
The second point that the coda should include is that of hope that the difficulties and non-observance of human rights described in this book will move people in power and all others to fight for the protection of human rights and to make this fight central to their activity. Having defined what needs to be done is not enough: we should each look in our own field of action and apply the principles and desiderata described in this book in our daily work, our publications, our education of others, and in the orientation of our research.