Kulawa ba tare da son rai ba

**Kulawa ba tare da son rai ba,** (wanda kuma masu magana ke kira **magani mai taimako** da kuma masu suka a matsayin **tilasta yin amfani da miyagun kwayoyi**) yana nufin jinyar da aka yi ba tare da izinin wanda aka kula da shi ba. Doka ba da izini ba cikin doka wasu ƙasashe yayin da sashin shari'a ke kula da shi ta hanyar umarnin kotu; wasu ƙasashe suna jinkirta kai tsaye zuwa ga ra'ayin likitocin.

Maganin rashin hankali na mutanen da aka gano suna da tabin hankali kuma wasu nau'ikan aikin likita ne suka ɗauke su, ko kuma a wasu lokuta tilasta doka ko wasu, don zama haɗari ga kansu ko ga wasu an yarda da su a wasu yankuna, yayin da wasu hukunce-hukuncen sun ba da izini kwanan nan don tilastawa wajan tilasta wa mutanen da ake zaton sun "taƙaice ƙwarai" ko kuma aka tabbatar da cewa suna cikin haɗarin tabarbarewar halayyar su. Irin wannan maganin yakan faru ne a asibitin mahaukata bayan wani nau'i na sadaukar da kai, kodayake ana iya tilasta wa mutane shan magani a wajen asibitoci ta hanyar sadaukar da kai  ko Kuma matsawa mutum.

## Sigogi

Ana iya amfani da magani ba tare da son rai ba don magance wata cuta ta musamman dake damun mara lafiya. Kuma a wasu ƙasashe ana iya ba da maganin ƙwaƙwalwa da kwantar da hankali ta hanyar tilas ga waɗanda suka aikata, misali ga waɗanda ke da alamun rashin lafiya.  Waɗanda ke fama da cutar anorexia nervosa na iya karɓar ciyarwa da ƙarfi. Kuma  a cikin Czechia, mazajen da aka yanke wa hukuncin laifin mai tsananin a  aikace ana ba su zaɓi na tsarewa na dogon lokaci ko jefa su shiga kurkuku.  Wasu ƙasashe suna da babbar doka da ke ba da izinin kowane magani da ake ganin ya zama dole idan mutum ya kasa yarda da magani saboda ƙarancin ƙarfinsa.   

A wasu ƙasashe, ba a amfani da magani na rashin hankali don lafiyar hankali don magance wata alama da ke nan, maimakon rage haɗarin bayyanar cututtukan da ke dawowa ta hanyar amfani da maganin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa. Ana samun wannan ta hanyar amfani da sadaukar da kai na asibiti inda za'a iya tsare mara lafiya a asibiti idan suka kasa shan magungunan da likitocin su suka rubuta musu domin tsaren sun zaisa mara lafiya ya karkata wajen shan magani.  

## Tasiri
Wani bincike na shekara ta 2014 na Cochrane na gano cewa kula da marasa lafiya na tilas ga wadanda ke fama da cutar rashin tabin hankali "ba shi da wani banbanci na amfani da aiyuka,  dan haka shan magani ba akan kaida ba na faihar da wasu matsaloli da dama musamman a kwakwalwar mutum.

 

A binciken na shekarar 2006 ya gano cewa kusan 48% na masu amsa ba su yarda da maganin su ba, koda yake mafi yawan mutane sun yarda daga baya cewa shan magani ba tare da izini ba ya kasance cikin kyakkyawar maslaharsu. 

Wani bita a cikin shekarar 2011 ya kalli kwarewar mutane na tilastawa. Ya samo jigogi na yau da kullun game da jin daɗin keta, rashin girmamawa, da rashin jinsu, wanda aka fahimta da yawa kamar ana lalata mutum ta hanyar keɓewa. 'Yan tsirarun labaru daga mutanen da aka yiwa magani ba tare da son rai ba sunyi magana game da mahimmancin magani a cikin tunani.  Nazarin ya nuna cewa tilastawa a cikin kula da lafiyar hankali yana da tasiri mai tasiri na tsawon lokaci ga mutane wadanda ke haifar da raguwar aiki da kuma rashin sakamako mai kyau na zamantakewar al'umma, amma wannan na iya ragewa daga likitocin sanin illar tilastawa. 

Binciken na yau da kullun da ƙirar meta daga 2020, wanda ya haɗu da kwarewar masu ruwa da tsaki (masu amfani da sabis, masu ba da kulawa na yau da kullun irin su 'yan uwa, da ƙwararrun ƙwararrun masu hankali), sun gano ƙwarewar rashin daidaito tsakanin masu ruwa da tsaki.  Binciken ya gano cewa waɗannan rashin daidaiton ikon sun hana girmama haƙƙin masu amfani da sabis, wasiyyan, da kuma abubuwan da suke so.

## Tilasci a cikin lafiyar lafiyar hankali ta hankali
Ana iya tilasta wa mutane shan magani na tabin hankali masu magana bisa doka "son rai" a ƙarƙashin barazanar ba da magani ba da son rai ba.   Mutane da yawa waɗanda doka za a duba su a matsayin karɓar maganin ƙwaƙwalwar ƙwaƙwalwa da son rai sun yi imanin cewa ba su da zaɓi a cikin lamarin.  Nazarin ya nuna cewa 51%, 35% da kuma 29% na shafi tunanin mutum da kiwon lafiya marasa lafiya sun samu wasu nau'i na na yau da kullum kama-karya a cikin Amurka, Ingila da kuma Switzerland bi da bi.  

Da zarar cikin yardar ranka a cikin asibitin lafiyar kwakwalwa, ana iya amfani da dokoki, tsari, da kuma bayanin-asymmetry don cimma biyan buƙata daga mutum cikin kulawa ta son rai. Don hana wani fita daga radin kansa, ma'aikata na iya amfani da dabarun da suka kawo tarko kasancewar duk ƙofofin suna kulle. Misali, ana iya tura mutumin zuwa ga wani ma'aikacin da ba safai yake zuwa unguwa ba, ko kuma a sa shi ya jira har bayan cin abincin rana ko wani taro, yana nuna kamar mutumin da ke jinyar son rai ba shi da 'yancin fita ba tare da izini ba. Lokacin da mutun ya iya magana game da barin sa, ma’aikatan na iya amfani da kalamai marasa ma'ana don nuna cewa ana bukatar mutumin ya zauna, ya dogara da gaskiyar cewa mutanen da ke cikin kulawa ta son rai ba su fahimci matsayin su na doka ba. 

Szmukler da Appelbaum sun gina jerin nau'ikan tilastawa a cikin kula da lafiyar hankali, tun daga rarrashi zuwa yin amfani da damar mutum, shigar da abubuwa, barazana da kuma tilas. Anan rarrashi yana nufin bahasi ta hanyar hankali. Sifofin tilastawa waɗanda ba sa amfani da tilasta doka ana kiran su a matsayin **tilasta** doka ko **yin amfani da shi** .   Amfani da keɓaɓɓen mutum na iya tashi daga sha'awar farantawa ma'aikatan kiwon lafiya waɗanda dangantaka ta kulla da su. Barazanar na iya kasancewa kan ma'aikacin lafiya yana taimakawa ko hana karɓar fa'idodin gwamnati. 

## Da'a
A cikin ka'idodin likitanci, ana ba da magani ba tare da izini ba a matsayin wani nau'i na *parens patriae* inda jihar ke ɗaukar nauyi na manya waɗanda ba su da ƙwarewa bisa la'akari da haƙƙin kiyayewa da aikin fa'ida, aikin jihar na gyara bazuwar cutarwar yanayi . The wajibi a kare da aka nuna a utilitarianism da communitarianism falsafa, ko likita hauka Paul Chodoff ikirarin da alhakin zuwa "hukunta" wannan alhakin a cikin hasken da siyasa da rikici da ilimin halin tababbu a cikin tarayyar Soviet .   An soki wannan aikin na karewa bisa hujjar cewa likitocin mahaukata ba su da tasiri a hango tashin hankali, kuma sun fi ɗaukar haɗarin.  

Matsayi na haɗarin haɗari ƙa'ida ce wacce aka yi amfani da ita ga wasu dokar lafiyar ƙwaƙwalwar da ke riƙe da cewa parens patriae ya kamata a yi amfani da shi idan mutum ya kasance haɗari ga kansu ko wasu. 

Paul Ricœur ya rarrabe siffofin biyu na kai, **idem** na ɗan gajeren kwarewar kai da kuma **ipse** wani dogon lokaci na ƙwarewar kwarewar kai. A cikin rashin tabin hankali, mulkin mallaka na ipse zai iya lalacewa ta hanyar cin gashin kansa wanda ya saba da ipse, don haka maganin lafiyar hankali zai iya kasuwanci da wani nau'i na cin gashin kansa da wani.  

## Ilimin zamantakewar al'umma
Ilimin zamantakewar al'umma na likita yana neman fahimtar hanyoyin zamantakewar da ke yanke hukunci da aka yanke a cikin magani.

Masanin halayyar dan adam Jeremy Dixon, wanda ke magana a cikin mahallin Burtaniya, ya bayar da hujjar cewa tantancewa da sa ido kan haɗari babban ɓangare ne na aikin lafiyar ƙwaƙwalwa   ta hanyar cewa wannan haɗarin yakan zama cikin rikice-rikice tare da maƙasudin maƙasudin dawo da rayuwa ciki har da rayuwa. rayuwa mai gamsarwa.   Ya yi jayayya cewa wannan mayar da hankali kan haɗari yana haifar da ƙwararrun masu ilimin  ƙwaƙwalwa.   Ya ambaci bincike da ke nuna yadda kwararrun likitocin tabin hankali na iya neman karkatar da nauyin da ke wuyan mutane kan lura da halaye daban-daban na wadanda ke da larurar mutum saboda ana musu kallon wadanda suka fi dacewa da halayensu, ko kuma zuwa sauran ayyukan kiwon lafiyar jama'a.   Themselvesididdigar haɗarin kansu ba kasafai ake rabawa tare da marasa lafiya ba.  

## Masu goyon baya da masu batawa

Magoya bayan ba da kulawa ba tare da izini ba sun hada da kungiyoyi kamar su National Alliance on Mental Illness (NAMI), Psyungiyar chiwararrun  Americanwararrun Amurka, da Cibiyar Bayar da Shawarwarin Kulawa .

Da dama daga cikin masu rajin kare hakkin dan adam da na kare hakkin dan adam, da kungiyoyin masu yaki da tabin hankali, da kungiyoyin likitanci da na ilimi, da masu bincike, da kuma mambobin kungiyar masu tabin hankali suna adawa da magani ba tare da izini ba kan dalilan kare hakkin dan adam ko kuma saboda tasiri da dacewar likita, musamman game da rashin son rai Gudanar da abubuwa masu canzawa, ECT, da hauka. An yi wasu zargi game da tsada, da kuma rikice-rikice na sha'awa tare da masana'antar harhada magunguna. Masu sukar, kamar New York 'Yanci Union, sun yi tir da karfi launin fata da kuma socioeconomic biases a tilasta magani umarni.  

## Doka

### Amurka
Marasa lafiya masu hankali suna da cikakken haƙƙin ƙi jinya.   

Duk jihohi a Amurka suna ba da izini don wani nau'in magani na rashin yarda don cutar tabin hankali ko halin ɓata na ɗan gajeren lokaci a ƙarƙashin yanayin gaggawa, kodayake sharuɗɗa sun bambanta. Arin magani ba tare da izini ba a waje mai tsabta da latsawa na gaggawa inda aka tabbatar da cewa barazanar tsaro ga jama'a yawanci yana buƙatar umarnin kotu, kuma duk jihohi a halin yanzu suna da wasu matakai a wuri don ba da damar wannan. Tun daga ƙarshen shekara ta 1990s, yawancin jihohi suka karɓi dokokin *Taimakon pwararriyar Ba da Agaji (AOC).* 

A karkashin taimakon marasa lafiya, mutanen da suka aikata ba da son rai ba za su iya rayuwa a wajen asibitin mahaukata, wani lokacin a karkashin tsauraran sharudda da suka hada da bayar da rahoto ga alƙawarin alƙawarin masu tabin hankali, shan magungunan tabin hankali a gaban ƙungiyar masu jinya, da gwajin matakan jini. A halin yanzu jihohi arba'in da biyar suna ba da izini don ba da haƙuri. 

A cikin shekara ta 1975, Kotun Koli ta Amurka ta yanke hukunci a *O'Connor v.* *Donaldson* cewa kwantar da hankali da  ko magani ba tare da izini ba ya keta haƙƙin ɗan adam . Dole ne mutum ya kasance yana nuna halin da ya zama haɗari ga kansu ko wasu kuma dole ne a karɓi umarnin kotu na fiye da ɗan gajeren lokaci (misali awanni 72). Dole ne a yi maganin a cikin mafi ƙarancin yanayin da zai yiwu. Tun daga wannan shayar an shayar da shi ta hanyar fikihu ta wasu bangarori kuma an karfafa shi ta wasu bangarorin. Dogon lokacin da ake "ajiyar kaya", ta hanyar sake tsarin gwamnati, ya ƙi a cikin shekaru masu zuwa, kodayake yawan mutanen da ke karɓar ba da son rai ba ya ƙaruwa a kwanan nan.  &#x5D; Dokokin sun ɗan bambanta daga jihar zuwa jihar.

A cikin shekara ta 1979, Kotun  Amurka da aka kafa a *Rogers v.* *Okin* cewa mutumin da ya cancanta da aka ba da shi zuwa asibitin mahaukata yana da damar ƙin karɓar magani a cikin yanayin da ba na gaggawa ba. Shari'ar *Rennie v.* *Klein ya* tabbatar da cewa mutumin da ya aikata ba da gangan ba yana da haƙƙin tsarin mulki na ƙin shan magungunan psychotropic ba tare da umarnin kotu ba. *Rogers v.* *Okin* tabbatar da haƙƙin mutum na yanke shawara game da magani muddin har yanzu ana ɗaukar su masu cancanta.

Decisionsarin hukunce-hukuncen Kotun Koli na Amurka sun daɗa ƙarin ƙuntatawa, da wasu faɗaɗawa ko takunkumi mai tasiri, ga ba da ganganci da magani. *Foucha v.* *Louisiana* kafa unconstitutionality na ci gaba da sadaukar da kai daga mahaukaciyar wanda ba shi da tabin hankali. A cikin *Jackson v.* *Indiana* kotu ta yanke hukuncin cewa mutumin da ya yanke hukunci ba zai iya aikata laifi ba har abada. A cikin *Perry v.* *Louisiana* kotu ta soke amfani da karfi da karfi na wani fursuna da nufin bashi damar kashe shi. A cikin *Riggins v.* *Nevada* kotun ta yanke hukuncin cewa wanda ake tuhuma yana da 'yancin kin shan magungunan mahaukata yayin da yake gaban shari'a, domin a rage masa alamun rashin lafiyar. *Sayar da v.* *Amurka* sanya takunkumi mai tsauri a kan hakkin karamar kotu don umartar da tilasta amfani da magungunan antipsychotic ga wanda ake tuhuma da aikata laifi wanda aka yanke hukuncin rashin cancantarsa na fuskantar shari'a saboda kawai ya sa su kasance masu iyawa kuma za a iya yi musu shari'a. A *Washington v.* *Harper* Kotun Koli ta goyi bayan shan magani ba bisa ka'ida ba na fursunonin da aka gyara kawai a karkashin wasu halaye kamar yadda manufofin da hanyoyin suka gindaya.

## Duba kuma

### Abubuwan da suka dace

* Abun tilastawa
* Kididdigar Haɗarin wajibi
* Cin zarafin siyasa na tabin hankali (wanda aka fi sani da "psychiwararriyar siyasa" da kuma "azabar azanci")
* Kula da jama'a
* Provisionsayyadaddun tanade-tanaden hukunce-hukuncen don umarnin tsarewa na ɗan lokaci don ƙimar lafiyar hankali da yiwuwar ƙarin son rai ko ba da son rai:

:* Amurka:
::* Kalifoniya: 5150 (riƙe da hauka ba da son rai ba) da Laura's Law (bayar da umarnin ba da haƙuri ga kotu a kotu)
:::* Lanterman – Petris – Gajeren Dokar, tare da daidaita sharuɗɗa da ƙaddamarwa ba da son rai ba a California
::* Florida: Dokar Baker da Dokar Marisman

### Fitattun masu gwagwarmaya

* Giorgio Antonucci (kawarwa)
* Thomas Szasz (kawar)
* Robert Whitaker (raguwa)
* E. Fuller Torrey (fadadawa)
* DJ Jaffe (fadada)

### Kungiyoyin da'awa

* Lafiyayyen Lafiyar Amurka (raguwa / gyarawa)
* Hauka a Amurka (raguwa / kawarwa)
* PsychRights (raguwa / kawarwa)
* Anti-psychiatry, wanda aka fi sani da "motsi na maganin hauka" (raguwa / kawarwa)
* Jama'a Hukumar kare hakkin dan adam (raguwa / kawar; kafa wani hadin gwiwa kokarin da anti-tabin hankali Church of Scientology da sassaucin raayi shafi tunanin mutum-kiwon lafiya-hakkokin umurni da Thomas Szasz )
* MindFreedom International (raguwa / kawarwa)
* Cibiyar Ba da Shawara (Kulawa)
* Manufofin Rashin Lafiya na Hankali (fadada)
* NAMI (fadada)

 

 

#### Manazarta
* Aringungiyar Taimakawa Kai da Kai ta Masu Amfani da Lafiya ta Hauka