MONITORING PSYCHIATRIC INSTITUTIONS The CRPD Committee has begun to develop standards on the subject, which still require protocols for their implementation in practice. It recommends in particular a move from a system of “substitute decision-making” to one of “supported decision-making”.9 The former is based on appointing a third party who bases their decisions on the principle of the person’s “best interests”, sometimes even against their will. The latter allows the persons to express their will and preferences with someone else’s support, if necessary. The Committee has identified examples of practices to guarantee this right, such as the possibility of obtaining the individual’s prior consent or of resorting to a “personal ombudsman” or even to the testimonies of family members. The principle of free and informed consent: practical challenges to its implementation The issue of situations that justify circumventing an individual’s consent was the subject of lively debate. The participants agreed on the need to differentiate between two very separate scenarios: emergency situations, which present an imminent risk to the life of the person or to others, in which the absence of treatment could cause irreparable harm, and long-term healthcare measures for which consent cannot be circumvented. A consensus was reached in which situations of imminent danger to the life of a person could justify treatment without consent. The views and experiences of former service users illustrated the various positions and complexity of this issue. Some believed that forced treatment could be justified in order to save a life, while others were of the opinion that any forced treatment is a violation of the right not to be tortured since certain treatments can cause serious harm to the person’s health in the medium or long-term, and should therefore be prohibited in favour of an ongoing attempt to seek consent and alternatives. Finally, it was clearly stated that crisis situations should be seen to be exceptional and cannot under any circumstances form the basis of public policy on this matter. 9 CRPD Committee, General Comment N°1 on Article 12 (Equal recognition before the law), UN Doc. CRPD/C/GC/1, 19 May 2014, §3, http://tbinternet.ohchr.org/_ layouts/treatybodyexternal/Download.aspx?symbolno=CRPD/C/GC/1&Lang=en 19