從身心障礙者權利公約檢視日本醫療觀察法強制住院處遇：兼評台灣監護處分新制

The Treatments of Specialist Forensic Facilities as Laid Out in the Japanese Medical Treatment and Supervision Act from the Perspective of the Convention on the Rights of Persons with Disabilities: The Cases of Japan and Taiwan

本文主要係探討日本醫療觀察法如何決定精神障礙觸法者指定入院、相關程序與強制住院處遇的實際運作，由此觀察日本醫療觀察法的指定入院制度是否符合聯合國《身心障礙者權利公約》（The Convention on the Rights of Persons with Disabilities, CRPD）的要求，以及探討日本醫療觀察法的特色。醫療觀察法的立法並非是基於警政思維的保安處分，而是以提供醫療和促進社會復歸為宗旨，由此建立非自願性入院治療制度，然而從日本醫療觀察法之運作思維以觀，醫療觀察法較為偏向醫療模式，與CRPD的人權模式仍有未合之處。儘管如此，從指定強制住院處遇的實踐來看，指定強制住院處遇擁有跨領域的團隊，並且在資源豐富的狀況下對於精神障礙觸法者進行處遇，強調當事人同意等原則，並發展出像是當事人模式的處遇方式，以及社會復歸調整官的設置等制度，值得台灣監護處分的作為參考。最後，透過醫療觀察法與CRPD的討論，本文進一步提出以社會復歸為指引的保安處分，由此節制過度強調消除再犯危險性的面向，以及相關修法之建議，像是監護處分要件與審判程序之改善、機構內處遇的監督機制、社會復歸系統的貫徹與連結、受處分者的程序參與權、處遇規定法制化、設施戒護等級區分以及加強精神保健的照護網絡，並且應持續性地進行社會溝通，以化解偏見。

In this article, I discuss how the Japanese Medical Treatment and Supervision Act has determined the admission practices and treatment procedures at specialist forensic facilities for law breakers suffering from a mental disorder. The legislation of the Japanese Medical Treatment and Supervision Act is not a security measure that prioritizes either the provision of medical care or the promotion of social rehabilitation. Rather, the act, which reflects a law-enforcement mentality, has established a system of involuntary hospitalization treatment. The act is problematic principally because it is much more rooted in the bio-medical model than in the social model associated with the Convention on the Rights of Persons with Disabilities (CRPD). Treatments at specialist forensic facilities typically involve cross-disciplinary teams who treat violators of the law suffering from mental disorders. These treatments of Japan should rest on the condition of abundant resources, the principle of informed consent, the intervention of social-rehabilitation officers, and the “tojisha kenkyu” model, which emphasizes self-directed research through communication with similar others. In analyzing the Japanese Medical Treatment and Supervision Act and the CRPD, I propose the establishment of security measures based on the goal of social rehabilitation. To this end, current and future laws must refrain from attempting to completely eliminate the risk of recidivism—a goal that can lead only to more harm than good.