The UN Centre for Human Rights compiles an annual report on action the UN has taken in regard to human rights. In a section that discusses resolutions formulated by the Commission on Human Rights there is a cumulative record of how the Commission has interpreted various human rights articles since its inception. Under the heading of ‘Freedom of thought, conscience and religion or belief’,[8] there is a record of the occasions when the Commission has been called upon to interpret Article 18 and what it has resolved.
The discussions and resolutions recorded to date only concern matters of conscience and religion. There is a record of repeated discussions on the subject of conscientious objection to military service, particularly in relation to apartheid, and also on the religious rights of minorities. But the Commission has not been called upon to make a ruling under Article 18 in regard to either mental health or psychiatric practice.
The key terms in Article 18—such as ‘thought’, ‘conscience’ and ‘belief’— are straightforward. Individuals should be free to think their own thoughts and to hold whatever beliefs they choose without interference. One human rights analyst has argued that this right is inviolable because ‘[t]here are some aspects of person’s lives that are so deeply personal and intrinsic, such as the right to freedom of thought . . . that they are not subject to explicit balancing because there is no cumulative or collective interest that can justify an intrusion’.[9]
One interpretation by the Human Rights Committee of the United Nations seems particularly relevant for defence against forced psychiatric treatment for schizophrenia:
"Article 18 protects theistic, non-theistic and atheistic beliefs, as well as the right not to profess any religion or beliefs. The terms belief and religion are to be broadly construed. Article 18 is not limited in its application to traditional religions or to religions and beliefs with institutional characteristics or practices analogous to those of traditional religions."[10]
A generalised UN interpretation of Article 18 emphasises the implied dichotomy of inner and outer, and says that ‘no restriction of any kind may be imposed upon man’s inner thoughts or moral conscience’ but goes on to point out that external manifestations ‘may be subject to legitimate limitations’.[11]
A conference of international jurists in 1984 made a detailed examination of the limitations allowed for in the ICCPR. The outcome of the conference was the Siracusa Principles,[12] which severely restrict the way in which limitations can be imposed. In relation to Article 18, for instance, the provision to limit the manifestation of beliefs could not be extended to limit the holding of beliefs. Nor would it be possible to place any limitations at all on a person’s thoughts or conscience.
Article 18 only allows for limitations to be placed on the manifestation of belief when it is ‘necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others’. According to the Siracusa Principles, ‘necessary’ means that it has to be ‘in response to a pressing public need’.[13] The definitions of ‘public safety’ and ‘public health’ would probably allow them to be used as justifications for limiting the kinds of manifestations of belief likely to be made by a person who was thought to have schizophrenia. So would protection of the ‘rights and freedoms of others’. But limitations on the grounds of public ‘order’ and ‘morals’ would probably not be allowed. For ‘public order’ to be invoked, ‘the rules which ensure the functioning of society’[14] have to be endangered and ‘public morals’ are generally recognised as being outside of the province of psychiatric practice.
So, according to the Siracusa Principles, mental health legislation does not violate human rights guaranteed under Article 18 when it empowers psychiatrists to limit a person’s manifestations of belief when those manifestations cause ‘danger to the safety of persons, to their life or physical integrity, or serious damage to their property’.[15] Similarly, limitations are permitted to protect the rights of others. But other people’s rights only have precedence if they are ‘more fundamental’ than the right to manifest a belief. Being more fundamental is indicated when a conflicting right is also specified in the ICCPR and has no limitations attached to it.[16] The limitation allowed on the grounds of protecting public health generally overlaps with public safety, but public health extends a little further and would probably include ‘preventing disease or injury’[17] to the person who is actually manifesting the belief.
Despite the severe restrictions on the application of these limitations, their existence still generates some uncertainty about the level of protection that Article 18 can offer against the involuntary hospitalisation of people who are alleged to have schizophrenia. However, it seems certain that an outward manifestation of a false belief (delusion)—which takes the form of dangerous behaviour motivated by the false belief—is the only primary symptom of schizophrenia for which limitations, such as incarceration, can be legitimately imposed.
But even though it might sometimes be legitimate under the provisions of Article 18 to lock people up who manifest beliefs in a dangerous manner, once they have been restrained they still retain inviolable rights to the freedoms of thought and conscience, and to hold, if not to manifest, whatever beliefs they like. If psychiatric practice on involuntary patients interferes with these rights, it unequivocally violates Article 18.
Next: A Hypothetical Mental Patient
[8] United Nations Centre for Human Rights, United Nations Action in the Field of Human Rights, p. 110.
[9] Margaret G. Wachenfeld, The Human Rights of the Mentally Ill in Europe Under the European Convention on Human Rights, p. 277.
[10] Human Rights Committee, United Nations, CCPR/C/21/Rev.1/Add.4. p. 1, quoted in Human Rights and Equal Opportunity Commission, Free to Believe? The Right to Freedom of Religion and Belief in Australia, p. 21.
[11] United Nations Centre for Human Rights, op. cit., p. 110.
[12] International Commission of Jurists, Siracusa Principles on the Limitations and Derogation Provisions in the International Covenant on Civil and Political Rights.
[13] Ibid., p. 6
[14] Ibid., p. 7.
[15] Ibid., p. 9
[16] Ibid.
[17] Ibid., p. 8.