LAUSR

47 involuntary admission and treatment may be a very painful and traumatic experience. Finally, it has represented a strong challenge to be met by the development of new contributions that may help to build a much-needed consensus. The proposal of Szmukler and Dawson goes in that direction and proves that it is possible to formulate a law that is generic, non-discriminatory towards people with mental health disabilities, based on decision-making ability in relation to a particular treatment decision at a particular time, and that permits involuntary treatment when all attempts at support have failed in helping the person to make a decision that could be considered autonomous. The proposal of a more subjective approach to both the concept of best interests and the assessment of the person’s decision-making ability could also help to ensure that the deep beliefs and values (in other words, the will and preferences) of the person are taken into consideration. Although differing from this approach in several specific aspects, the proposals put forward by Freeman et al and Scholten and Gather share some of its principles. Important differences remain between these proposals and the Committee’s view. However, they all represent valuable contributions to the construction of a formulation that will take into account the complexity of what is at stake and will have real chances of being incorporated into the mental health laws of most countries. For this to happen, several things are necessary: a) to promote all forms of debate that may help to build a new consensus; b) to ensure the participation in the discussion of a much broader range of stakeholders (e.g., different groups of people with mental disabilities, family members, mental health professionals with clinical experience, and experts in mental health legislation and policy); c) to clarify the definition of and the relations between relevant concepts (e.g., mental disorders, disabilities, psychosocial disabilities); d) to admit that, rather than concentrating our efforts on “an absolute prohibition on involuntary treatment (that) is, at least at present, not credible”, we should “devote more time to thinking about how to make the essential practice of substitute decision-making as respectful as possible”; and e) to invest more on the reform of services and practices, without which no meaningful change in protection of the human rights of people with mental disorders will ever occur.