therapeutic plans. Moreover, it specifies that more active listening would be conducive to giving hospitalised persons increased awareness of their responsibilities. 105 The notion of autonomy may thus be understood through the acknowledged fundamental rights of all patients: right to information, right to choice of doctor, choice of lawyer, right to dignity, right not to be subjected to torture or inhuman or degrading treatment, right to respect of private and family life, right of expression, right to vote etc. It emerges from the visits conducted by the CGLPL that the conditions of operation of psychiatric institutions, as well as their geographical location in certain cases, lead to restriction or deprivation of autonomy for persons hospitalised without their consent. We shall examine these findings by means of an institutional approach, for the most part marked by restrictions of autonomy (I), followed by their consequences on patient’s lives and fundamental rights (II). 3.1 The Institutional Approach From the point of view of the institution, several elements may be put forward in order to explain the restrictions placed upon autonomy: hesitation about change, the constraints of the legal framework of deprivation of liberty and the layout of premises as well as scarcity of human resources. As for decisions of a medical order that limit personal autonomy, they shall only be questioned insofar as they are non-personalised and/or based upon considerations other than those strictly pertaining to the patient’s interests (for example, in order to make the management of a department more fluid) and may be considered unjustified infringements of personal rights. In the first place, there are reasons for questioning the way in which legislative changes and the reinforcement of patients’ rights have been taken into account within the psychiatric environment. Reluctance to change was expressed at the time of publication of the Act of 4 March 2002 and then increased, in a part of the world of psychiatry, as from the inception of the Act of 5th July 2011. Indeed, questions concerning the extension of patients’ rights and even opposition thereto emerged at the time of the debates about the aforementioned Acts, as shown by certain articles in specialised works: “With the abandonment of a position of medical infantilisation, the “citizen-person suffering from illness” is being replaced by the “person suffering from illness-citizen”, but with the inevitable consequence of an increase in the importance of legal norms and citizens’ rights and the risk of reducing the person to nothing more than a legal entity with rights and obligations”; moreover, “situations of conflict caused by opposition between the duty to provide assistance and the duty to protect society” were denounced. 106 th Have these doubts continued? Have the legislative objectives focused upon increasing rights, reintegration and making patients more aware of their responsibilities, met with any response within the framework of treatment? Although, generally speaking, psychiatric institutions have adapted to the new provisions, the CGLPL has ascertained great heterogeneity of practices. 105 Cano N, et al, “ L'hospitalisation en psychiatrie : point de vue des patients et perspectives éthiques ”, Annales médicopsychologiques, no. 171/8, 2013; Cano N, et al, “L’isolement en psychiatrie : point de vue des patients et perspectives éthiques”, Encéphale (2010) 106 Le livre blanc de la fédération française de psychiatrie, Fédération française de psychiatrie, 2003. 122

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