Involuntary psychiatric hospitalization involves balancing the state's responsibility to provide treatment and care with the need to protect individual rights. Although the Mental Health Act, 2018, represents a significant legislative advancement in mental health governance in Bangladesh, previous research has not adequately examined whether the Act safeguards the human rights of individuals subject to involuntary admission. This article undertakes a doctrinal analysis of the Mental Health Act, 2018, to critically evaluate the rights relating to admission procedures, medical certification, and oversight mechanisms. It adheres to the principles of liberty, autonomy, and informed consent and examines the Act's compatibility with the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the International Covenant on Civil and Political Rights (ICCPR). Without any empirical data on the implementation of the Act, this study finds that the Act introduces a formal structure for regulating involuntary hospitalization but reflects a predominantly medicalized paternalistic approach that raises serious questions about patient autonomy. The analysis identifies significant deficiencies in procedural safeguards against arbitrary detention, independent review mechanisms, supported decision-making frameworks, and oversight and accountability structures. The article recommends strengthening procedural safeguards, introducing independent judicial review for prolonged admissions, replacing substitute decision-making with supported decision-making mechanisms, investing in community-based services, and establishing an independent monitoring system to enhance accountability.
Objective Forensic Orders (FOs) are the primary legal mechanism by which individuals found not guilty by reason of ‘insanity’ are diverted from criminal justice into forensic mental health care. Although grounded in shared principles, the legislations and operation of FOs vary considerably across jurisdictions. This study compares legislative frameworks governing the management of individuals found not guilty by reason of ‘insanity’ across Australia and New Zealand (NZ). Method We compared primary legislation governing FOs in all Australian jurisdictions and NZ. Provisions concerning the making, duration, review, variation, and transition between inpatient and community orders were extracted, interpreted, and summarised. Results Substantial interjurisdictional variation was identified in decision-making authority, detention settings, duration, review processes, and transition pathways of FOs. Despite these differences, common principles were evident, including the use of FOs for both therapeutic intervention and risk management; the imposition of conditions to support treatment and mitigate risk; and the preservation of clinical autonomy in treatment decisions. Conclusion These legislative differences have significant implications for clinical practice, procedural fairness, and transparency. Greater articulation of shared principles may support more coherent and equitable forensic mental health systems.
Assisted suicide in patients affected by mental disorders represents one of the most controversial issues in contemporary legal medicine, as it requires distinguishing between an autonomous, stable, and competent request for death and an expression of suffering potentially related to the psychiatric disorder itself. The aim of this narrative medico-legal review is to comparatively analyze the international regulation of medically assisted dying in the presence of psychological suffering, with particular attention to the concept of irremediability of mental suffering and to the limits imposed by the Italian legal system.A narrative review of the international medico-legal, bioethical, and legal literature was conducted, integrated with a comparative analysis of the main legislative, jurisprudential, and professional sources relating to assisted suicide and euthanasia in patients with psychiatric disorders. Jurisdictions were selected through purposive, information-oriented sampling to maximize contrast among permissive, autonomy-based, restrictive, and terminal-illness-based regulatory models.The analysis reveals marked international heterogeneity. The Netherlands and Belgium constitute the most developed models of access to medically assisted dying for psychiatric suffering, subject to rigorous procedures for assessing irremediability and decision-making capacity. Switzerland and Germany attribute comparatively greater weight to individual self-determination, although through different normative arrangements. Canada has suspended until 17 March 2027 the eligibility of mental illness as the sole underlying medical condition for medical assistance in dying. Conversely, the United States, Australia, and New Zealand substantially restrict access to patients affected by terminal conditions or diseases severely limiting survival. Despite procedural differences, the main element of divergence among legal systems concerns the definition of irremediable psychological suffering and the methods used to assess decision-making capacity.In the Italian context, Constitutional Court judgments no. 242/2019 and no. 135/2024 confirm that non-punishability of assistance in suicide requires the cumulative satisfaction of strict requirements, including an irreversible disease, suffering considered intolerable, full capacity for self-determination, and dependence on life-sustaining treatments, with verification by the National Health Service and involvement of the territorially competent ethics committee. Subsequent judgment no. 204/2025 further clarified that regional organizational measures cannot modify these substantive prerequisites.Psychiatric illness alone is therefore not currently sufficient to meet the requirements established by the Italian constitutional framework.The comparative analysis suggests that the fundamental medico-legal and ethical issue does not lie exclusively in ascertaining the applicant's autonomy, but rather in the absence of universally shared clinical criteria for defining the irremediability of mental suffering and distinguishing it from residual therapeutic potential. This uncertainty remains the principal limitation to extending medically assisted dying to psychiatric patients.
Mandatory Treatment Orders (MTOs) are used in Singapore to manage offenders whose culpability is diminished by mental illness, yet guidance on their optimal application remains limited. This qualitative study explored psychiatrists' perspectives on the use of MTOs and their role within the broader mental healthcare and justice system. Semi-structured interviews were conducted with 21 practicing psychiatrists at a tertiary mental health institution, and data were analyzed thematically. Participants described substantial variability in MTO practice, shaped by clinical experience and levels of forensic involvement. Three overarching themes emerged: determining appropriate MTO duration, distinguishing between criminal and civil use of MTOs, and balancing forensic assessor continuity with independence. Longer MTOs were generally favored for individuals with psychotic disorders and histories of non-adherence, while shorter MTOs were viewed as sufficient for milder conditions, minor offences, and individuals with established engagement and insight. Many participants expressed ethical concerns about extending MTOs to civil contexts, citing risks of coercion, weaker enforcement mechanisms, and prioritization of social control over therapeutic benefit. Although continuity of the forensic assessor was often preferred for clinical and practical reasons, concerns regarding impartiality were also raised. Overall, psychiatrists viewed MTOs as occupying a dual therapeutic–justice role, generating tensions that contribute to variability in practice. Clarifying policy objectives, strengthening training and operational supports, and defining assessor roles may help improve fairness, consistency, and treatment outcomes.
