M.J.R. s/insanía

On June 4, 1982 M.J.R. , a minor, accused of aggravated murder, was declared unpunishable by law by the National Criminal Examining Court of First Instance number 16, which determined he had to remain in hospital as a safety measure. On July 11, 1983, the advisor on minors filed a process of disability to the National Civil Court of First Instance number 14, which declared M.J.R. ’s civil incapacity on the basis that he was “mentally ill, insane in the legal sense, suffering from schizophrenia”.  The sentence was supported by the report submitted by the Forensic Medical Team, who noted that M.J.R.  was dangerous to himself and to other people.

In the same sentence, the judge ordered that M.J.R. remain under the exclusive supervision of her jurisdiction, a decision which was not accepted by the examining magistrate, who resolved his court would be in exclusive supervision of M.J.R.  This disagreement resulted in a conflict of jurisdiction and the filing of the records to the National Supreme Court. In 1984, the National Supreme Court stated it was not its duty to resolve the jurisdiction conflict between two national courts of first instance.

On December 30, 1986, the National Chamber of Civil Appeals rejected the ruling filed by the examining judge and ordered the proceedings be held under the National Civil Court number 14 based on the fact that the unpunishable status of M.J.R. was due to his disability and not due to the fact that he was under the legal age to be sentenced. Therefore the judge who declared the disability of the individual was supposed to maintain oversight of the proceedings.

According to what was then resolved, the national examining judge no longer supervised M.J.R. and ordered the communication of such resolution to the National Chamber on Civil Appeals. The National Chamber on Civil Appeals reassigned the case to National Civil Court of First Instance number 9 in which the judge recused himself from involvement in the case because M.J.R. was hospitalized in a psychiatric hospital in another jurisdiction. The judge supported his decision on article 5, item 8 of the National Civil and Commercial Code, which states that for practical reasons, the disabled be placed under the supervision of a magistrate in the jurisdiction of hospitalization.

The proceedings were referred to the Civil and Commercial Court of First Instance and its judge rejected the referral order by the national judge because it was issued late. The judge ordered to send the case to the National Supreme Court of Justice to solve the conflict on jurisdiction.

The case was finally sent to the Supreme Court on October 2006. During the years that M.J.R. was hospitalized there were no periodic exam carried out to verify the continuance of his mental illness and the conditions of his hospitalization.

Although the Supreme Court was asked to resolve the jurisdiction conflict, the Court also considered the special circumstances related to constitutional rights which were implicated by the case. The Court noted that “the structural legal weakness suffered by people with mental illnesses, who are in fact more exposed to abuses, creates real “risk groups” regarding the full and free enjoyment of fundamental rights” and therefore, situations of internment for the mentally ill required significant judicial protections and oversight.

The Court noted that both the domestic principles of legality, appropriateness, proportionality, equality and legal guardianship were strengthened by both the national constitution and international instruments regarding the internment of people without criminal behavior. The Court also set forth the specific rights of persons suffering psychological disorders including, inter alia, the right that medication not be provided to a patient for the convenience of others, right to reinsertion into the community, and the right to the least invasive treatment, and the right of non-discrimination.

Considering these rights, the Court held that a person with a mental affectation can only be hospitalized for as long as the patient presents a serious and immediate threat to himself or others. Such hospitalization must be for as limited a time as possible and presented only as a last option. Thus, the reasons for any hospitalization must be reviewed periodically and within the framework of the patient’s constitutional rights, to determine if the conditions which dictated the internment are still valid.

Looking at the facts of M.J.R.’s case, the Court found that his rights had been violated as, inter alia, there were no periodic reviews on the mental health situation of M.J.R. or the lawfulness of his continued internment, the report on the presumed dangerousness of M.J.R. had not been carried out by psychiatric experts, the parents of M.J.R. were not notified of their guardianship of M.J.R. for several years after his internment, and there was no comprehensive judicial oversight over M.J.R’s internment. The Court noted that M.J.R. had been interned for longer than he would have been incarcerated for, had he been initially convicted of the crime he was accused of.

Regarding the competence dispute, the Court held that the court responsible for the proceedings should be the court most familiar with the case in order to ensure that the individual concerned was not abandoned. Generally, this would be the court with jurisdiction of the location of hospitalization. The Court further noted that, Argentina’s more recently created family courts would be the competent courts for matters related to the declaration of incapacity and guardianship as such courts contain interdisciplinary teams of experts.

Finally, the Court ordered the immediate elaboration of a detailed scientific report on the mental and physical health status and the hospitalization conditions of M.J.R.

“That the structural legal weakness suffered by people with mental illnesses, who are in fact more exposed to abuses, creates real “risk groups” regarding the full and free enjoyment of fundamental rights, a situation which generates the need to establish an effective legal protection towards the rehabilitation and reinsertion of the patient in the social and family environment as today nobody denies that psychiatric interventions which are unnecessarily prolonged are harmful and lead, in many cases, to marginalization, exclusion and maltreatment and frequently lead to an avoidable “hospitalization”. In fact the law should exercise a function preventive and protective of the fundamental rights of the mentally ill person, with the jurisdictional activity fulfilling this important role.-

The institutionalized patients, especially when they are kept involuntarily and without knowing the reasons of their hospitalization, are entitled to a certain set of essential rights, such as the right to life and health, the defense and the respect of decency, to freedom, to a due process, among others. However, it is undeniable that such people, due to their confinement, are entitled to basic rights which are limited by their condition. In view of such unequal circumstance, the rule should be the acknowledgement, exercise and special protection of these rights from which the legal obligations of the State or individuals are derived, and which, at the same time, allow for the encouragement of their fulfillment.-“ Section 6.

“Que la debilidad jurídica estructural que sufren las personas con padecimientos mentales de por sí vulnerable a los abusos, crea verdaderos "grupos de riesgo" en cuanto al pleno y libre goce de los derechos fundamentales, situación que genera la necesidad de establecer una protección normativa eficaz, tendiente a la rehabilitación y reinserción del paciente en el medio familiar y social en tanto hoy nadie niega que las internaciones psiquiátricas que se prolongan innecesariamente son dañosas y conllevan, en muchos casos, marginación, exclusión y maltrato y no es infrecuente que conduzcan a un "hospitalismo" evitable. En esta realidad, el derecho debe ejercer una función preventiva y tuitiva de los derechos fundamentales de la persona con sufrimiento mental, cumpliendo para ello un rol preponderante la actividad jurisdiccional.-

Los pacientes institucionalizados, especialmente cuando son recluidos coactivamente sin distinción por la razón que motivó su internación, son titulares de un conjunto de derechos fundamentales, como el derecho a la vida y a la salud, a la defensa y al respeto de la dignidad, a la libertad, al debido proceso, entre tantos otros. Sin embargo, deviene innegable que tales personas poseen un estatus particular, a partir de que son sujetos titulares de derechos fundamentales con ciertas limitaciones derivadas de su situación de reclusión. Frente a tal circunstancia desigual, la regla debe ser el reconocimiento, ejercicio y salvaguardia especial de esos derechos de los que se derivan los deberes legales del sujeto pasivo sea el Estado o los particulares y que permiten, a su vez, promover su cumplimiento.-“ Seccion 6.

“That such legislative framework, national and supra-national enables the establishment of a catalogue of minimum specific rights for those who suffer psychological disorders which must be firmly respected. Among them, it is worth mentioning the following: a) the right to be informed about the diagnosis and the most adequate and least risky treatment, b) the right to a medical examination performed under an approved by national law procedure, c) the right to refuse to receive certain treatment or therapies, d) the right to receive adequate means of healing or improvement where delay or negligence of a treatment can lessen the arguments for the hospitalization or render it illegitimate, e) the right to continuity of treatment, f) the right to adequate drug therapy, from which it follows that the medication should not be provided to the patient as a punishment or for the convenience of third-parties, but rather to assist the needs of the patient and strictly for therapeutic purposes, g) the right to an accurate record of the therapeutic process and access to it, h) the right to confidentiality of the treatment, even after discharge, i) the right to reinsertion into the community as an axis of the therapy, j) the right to least invasive and most limited treatment, k) the right to not be discriminated against on the basis of his condition.” Section 9.

“Que dicho marco normativo tanto nacional como supranacional, permite fijar un catálogo de derechos mínimos específicos para quienes padezcan trastornos psíquicos que deben ser respetados rigurosamente. Entre ellos cabe mencionar a los siguientes: a) derecho a ser informado sobre su diagnóstico y sobre el tratamiento más adecuado y menos riesgoso, b) derecho a un examen médico practicado con arreglo a un procedimiento autorizado por el derecho nacional, c) derecho a negarse a recibir un determinado tratamiento o formatos terapéuticos, d) derecho a recibir los medios adecuados tendientes a la cura o mejoría donde las negligencias o retardos en la prestación de un tratamiento pueden restar justificación a la internación, y volverla ilegítima, e) derecho a la continuidad del tratamiento, f) derecho a la terapia farmacológica adecuada, del que se deriva que la medicación no debe ser suministrada al paciente como castigo o para conveniencia de terceros, sino para atender las necesidades de aquél y con estrictos fines terapéuticos, g) derecho a un registro preciso del proceso terapéutico y acceso a éste, h) derecho a la confidencialidad del tratamiento, incluso después del alta o la externación, i) derecho a la reinserción comunitaria como un eje de la instancia terapéutica, j) derecho al tratamiento menos represivo y limitativo posible, k) derecho a no ser discriminado por su condición.-“ Seccion 9.

“On the basis of the above mentioned, the internment of a patient should be legally reviewed through simple, expeditious, and quick proceedings, and if it is necessary to prolong the imprisonment for therapeutic reasons, the reasons for hospitalization must be reviewed periodically, exhaustively and under the corresponding jurisdiction, in order to study if the conditions that determined the internment are still valid or if they have changed with time, always in the framework of the constitutional principles and guarantees mentioned. If this is not the case, the hospitalization becomes an imprisonment without time limit.” Section 10.

“En virtud de lo dicho, la medida de privación de la libertad del paciente debe ser revisada judicialmente mediante procedimientos simples, expeditivos, dotados de la mayor celeridad y, si correspondiera prolongarla por razones terapéuticas, ello debe ser objeto de un minucioso control periódico jurisdiccional obligatorio de los motivos de la internación, a los efectos de estudiar si las condiciones que determinaron su reclusión se mantienen o se modificaron en el tiempo, y siempre en el marco de los principios y garantías constitucionales mencionados. De no ser así, la internación se convierte en los hechos en una pena privativa de la libertad sin límite de duración.” Section 10.

“In this regard, it is worth mentioning that M.J.R. has remained involuntarily deprived of his liberty more time that he would have to be if he would have been condemned to the maximum punishment for the crime committed... In such conditions, the principles of proportionality and equality which were aimed at with the declaration of lack of punishment, are seriously violated because it is unreasonable that a person, to whom the State did not want to punish, is more affected than if he/she would have been eventually punished for the crime”. Section 14

“De esta forma, es dable destacar que M.J.R. ha permanecido privado de su libertad, de manera coactiva, más tiempo incluso del que le habría correspondido in abstracto en el supuesto de haber sido condenado a cumplir con el máximo de la pena previsto para el delito cometido... En estas condiciones, tanto el principio de proporcionalidad como el propósito de respetar el principio de igualdad, que se buscó con la declaración de inimputabilidad, se ven seriamente comprometidos debido a que se muestra como irrazonable que una persona, a la que el Estado no quiere castigar, se vea afectada en sus derechos en una medida mayor a la que hubiese correspondido de haber sido eventualmente condenada como autor responsable” Section 14.