MONITORING PSYCHIATRIC INSTITUTIONS 4. The authorities have not considered the institutionalisation as the first and only measure but envisaged alternatives, including by exhausting non-custodial measures in the community. If such conditions are met, the deprivation of liberty must be for the shortest time possible and be subject to regular review (every 24, 48 or 72 hours). The principle of free and informed consent to treatment The principle of free and informed consent to any medical treatment is enshrined in several international documents that precede the adoption of the CRPD in 2006.7 Article 25 of the CRPD stipulates that the States Parties have the obligation to demand that health professionals “provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent.” The CPT and SPT standards also enshrine this principle. The CPT specifies that “Any derogation from this fundamental principle should be based upon law and only relate to clearly and strictly defined exceptional circumstances.” 8 Placement in a psychiatric establishment, whether voluntary or not, should never be interpreted as authorising treatment without consent. Consent can be considered to be “free and informed” if the persons are notified of all the implications of the treatment, including any possible side effects, as well as of their right to refuse treatment or any other form of medical intervention. Moreover, obtaining consent should not be limited to a simple formality and therefore requires taking the time to talk to the person and discussing the treatment he/she is likely to receive. Finally, pursuing a treatment option should not be based exclusively on consent expressed at the start. Obtaining free and informed consent should be an ongoing process required for every medical intervention. 7 8 See, at the European level, the Oviedo Convention on Human Rights and Biomedicine that entered into force in 1999 and the Charter of Fundamental Rights of the European Union of 2000 (Art, 3, §2). See also, Council of Europe Committee of Ministers, Recommendation Rec(2004)10 concerning the protection of the human rights and dignity of persons with mental disorder. CPT Standards, §41. 17