Parties and Trade Unions

The Committee “Giù le Mani dai Bambini” (“Hand off our children”) has asked the political forces operating within the Parliament to take a position on the delicate issue of  medicalization for minors’ diseases, with particular attention to the indiscriminate administration of psychiatric drugs to children. Many stands were taken and forwarded to our offices; some of them have been published in the “Institutions” page on this portal. Several representatives have also urgently questioned the Ministry of Health to report on the situation in front of the Parliament; we progressively provided information on the situation in our “Logbook” section, publishing the questions texts.   Finally, we proposed  the various parties to comply to guidelines which do nothing but reassert the position of the most renowned international agreements on the topic, for a better safeguard of the children’s right to health. All the political forces have been summoned; some already answered to our urging, while others are consulting their decision bodies in order to subscribe the document. In a few months, citizens will be able to draw their own ultimate conclusions on the attention paid by their party of reference to our country’s infancy… Here is the text of the “manifesto”, which can also be downloaded -in italian- in order to present it to national party leaders (a signature is needed from the Secretary or President of the political forces operating in the Parliament):

Download the Ethical Guidelines on Children’s Mental Health

Ethical Guidelines on Children’s Mental Health

The obligation to especially safeguard children is asserted by several international agreements, and it involves a wide spectrum of issues, the definition of which is not yet exhaustive. In the field of mental health during the age of development, pivotal concepts such as “cure”, “mental disease”, “mental disorder”, “benefit-cost ratio”, “human dignity” and “psychophysical integrity” are still shrouded in ambiguity. Many diagnoses referring to minors lie outside the field of science and meddle with moral and social issues. This obliges to evaluate with particular attention the therapeutic praxes concerning the solution of minors’ mental health problems, in which parents and tutors have little control power and, often, a knowledge that is inadequate for a correct assessment.

 Considering what was stated extremely clearly by the following bodies and in the following legislative papers (integrally quoted in the appendix):

 

The International Narcotic Control Board, a United Nations body

The United Nations Convention on the Rights of the Child

The Oviedo European Convention on Human Rights and Biomedicine

The United Nations Convention on the Norms on the Responsibilities of Translational Corporations and other Business Enterprises with regard to Human Rights

The United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment

The EU Charter of Fundamental Rights, adopted by the European Council

The United Nations Resolution for the Protection of Persons with Mental Illness and for the Improvement of Mental Health

Thus considering the noteworthy international legislation on the topic, and in complete coherence to such – universally acknowledged – principles regarding the right to psychophysical wellbeing and health during childhood; and in the light of what was aforementioned as an integrating and inseparable element of the present declaration, I hereby officially state:

my continuous commitment to support the aforementioned legislative principles, with regards to both the legal pronouncements already in use, and the ethical conclusions therefore deriving, summarized in the attachment to the present document;

my commitment to do everything under my power to promote approval and support to such principles from my party/trade union, which will also be committed to pursue them with any initiative within its own areas of work;

my support to the aforementioned principles, in all forms and occasions, and especially my support to legislative initiatives addressing a larger implementation of the norms which aim at better safeguarding the new generations.

 

Date ………………………….   Name and Surname …………………

Signature ………………………  Position/Role ………………….

 

Note: subscribing this document implies a commitment in principle and within the aforementioned limits and, in itself, does not entail an automatic support to the Social Campaign “Giù le Mani dai Bambini”® (“Hands off our children”) or to its other initiatives, present or future.[1]

 

Already submitted by:

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ATTACHMENT

NB: the following passages are extracted from the international conventions quoted in the document, which constitute the basis for the present declaration of Intents.

A report from the International Narcotic Control Board (1), a United Nations body, states as follows for what concerns the utilization of psychiatric drugs:

“Longer-term negative effects are often disregarded, underestimated, or subordinated to short-term cost savings. There is a wide range of complementary or alternative treatment approaches for many of the mental disorders and painful conditions treated today with pharmaceuticals (psychotherapy, counseling, traditional medicine), and such alternatives may often be culturally more relevant and more effective. Several recent studies, however, show that the use of multiple drugs (polypharmacy), often in irrational combinations, in inadequate dosages and for excessively long treatment periods, continues to be quite common. Such medical practice is contrary to the principles of cost-effectiveness and rational evidence-based therapy and is a waste of resources. […] Health authorities should promote the use of culturally relevant and proven complementary or alternative treatment modalities, keeping in mind that, by relying on such therapeutic options rather than on pharmacotherapy per se, cost savings can be substantial.”

 

Another report from the International Narcotic Control Board (2) states:

“Use of the stimulant, methylphenidate, to treat Attentional Deficit/Hyperactivity Disorder (ADHD) has risen by a staggering 100 per cent in more than 50 countries. In several nations – Australia, Belgium, Canada, Germany, Iceland, Ireland, the Netherlands, New Zealand, Norway, Spain and the United Kingdom – use of the drug could reach levels as high as in the United States, which currently consumes more than 85 per cent of the world total. The Board urges nations to seek out possible over-diagnosis of ADHD and curb excessive use of methylphenidate. Patients being treated with the drug, who were mainly primary school boys at the beginning of the 1990s, now include an increasing number of children, adolescents and adults. Children as young as one year are being diagnosed with ADHD in the United States.”

The 2005 United Nations report from the Concluding Observations Committee on the Rights of the Child (3), in its final notes on Australia, Denmark and Finland, and with regards to the observance of the principles asserted in the Declaration of the Rights of the Child, states:

“…ADHD and attention deficit disorder (ADD) are being misdiagnosed and therefore psychostimulant drugs overprescribed, despite the growing evidence of the harmful effects of these drugs. The Committee recommends that further research be undertaken on the diagnosis and treatment of ADHD and ADD, including the possible negative effects of psychostimulants on the physical and psychological well-being of children, and that other forms of management and treatment be used as much as possible to address these behavioural disorders”.

 

The United Nations Convention on the Rights of the Child (4) states:

Article 33: “States Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances…”

Article 36: “States Parties shall protect the child against all other forms of exploitation prejudicial to any aspects of the child’s welfare.”

Article 12/1: “States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.”

Prevention is therefore a priority which must be realized through an appropriate support provided to families, schools and children by supplying them with the necessary professionals;  at the public government level, furthermore, suitable measures should be taken to improve the quality of life of minors.

The Oviedo European Convention on Human Rights and Biomedicine (5) states:

Article 2: «The interests and welfare of the human being shall prevail over the sole interest of society or science.»

It is therefore evident how the therapeutic approach needs to be, in the first resort, of pedagogic nature, in its widest possible meanings; therefore including all suitable professional competences able to intervene with words-based therapies and with an active and participated re-education of the minor. This is of particular relevance when dealing with disciplinary issues, since what is provided to the minor is a problem solving model which the child may replicate with his/her friends, and later with his/her own children.

The United Nations Convention on the Norms on the Responsibilities of Translational Corporations and other Business Enterprises with regard to Human Rights (6) states:

“F. Obligations with regard to consumer protection 13: Transnational corporations and other business enterprises shall act in accordance with fair business, marketing and advertising practices and shall take all necessary steps to ensure the safety and quality of the goods and services they provide, including observance of the precautionary principle. Nor shall they produce, distribute, market, or advertise harmful or potentially harmful products for use by consumers.”

The deriving consideration is that the risk of a mass medicalization, with its consequent abuse in the prescription of psychiatric drugs, appears to be a deplorable phenomenon in principle, and an unacceptable one when applied to children; such products should therefore be considered as the very last therapeutic resource.

The 1987 United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (7) states:

“Article 16: 1. Each State Party shall undertake to prevent in any territory under its jurisdiction other acts of cruel, inhuman or degrading treatment or punishment which do not amount to torture as defined in article 1, when such acts are committed by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. In particular, the obligations contained in previous articles shall apply with the substitution for references to torture or references to other forms of cruel, inhuman or degrading treatment or punishment.”

While the EU Charter of Fundamental Rights (8) also states:

Chapter  I – Dignity

Article 1: «Human dignity is inviolable. It must be respected and protected»

Article 3: 1. «Everyone has the right to respect for his or her physical and mental integrity»

Article 4: «Prohibition of torture and inhuman or degrading treatment or punishment»

and in Article 3 – Right to the integrity of the person

c) the prohibition on making the human body and its parts as such a source of financial gain

From these regulations, it is clear that invasive and degrading treatments such as the electroshock, shock treatments of several kinds, including the insulin shock therapy among the others, cerebral psychosurgeries like lobotomy, among the others, genetic manipulation and the long-term administration of psychiatric drugs should be forbidden, since – in addition – the risk-benefit paradigm appears completely inappropriate, also considering the costs of the aforementioned, obsolete approaches. Moreover – in those cases where it can be noted a lack of solid scientific proves on the strictly genetic or physiologic nature of the mental disorders of the evolutive age – it is evident the necessity to foster a culture which must not be oriented towards the overmedication of children, also with the aim not to favor techniques of “genetic prevention”, initially theorized by the 1900s regimes, and, sadly, addressed to sustain researches targeting the prenatal “genetic rectification” of children.

The 1991 United Nations Resolution for the Protection of Persons with Mental Illness and for the Improvement of Mental Health (9) states:

“Principle 10 – Medication – 1: Medication shall meet the best health needs of the patient, shall be given to a patient only for therapeutic or diagnostic purposes and shall never be administered as a punishment or for the convenience of others. Subject to the provisions of this Convention mental health practitioners shall only administer medication of known or demonstrated efficacy.”

It is absolutely evident, therefore, that in those cases which are considered severe, and where the administration of synthetic or natural psychiatric drugs, even for short periods of time, is considered necessary, it must, hopefully, be forbidden to prescribe those drugs that imply collateral effects causing severe physical and mental suffering or  permanent iatrogenic pathologies, inducing suicide or violent acts and homicides, or that may cause the death of the patient, even at therapeutic dosage, or psycho-physical addiction; not only for a better safeguard of patients, but also to avoid a secondary relapse of therapeutic costs on the public healthcare system. In order to safeguard the patient and his/her family, informed consent should always be required, signed and provided with exhaustive explanations, both on the therapeutic limits of psychotropic drugs, and on all the possible collateral effects.

Bibliographic notes on the legislative documents quoted in the present Declaration of Intents:

(1) “INCB Report”, year 2000

(2) “INCB Report”, year 1999

(3) “ONU”, United Nations Committee on the Right of the Child, Concluding observations committee on the rights of the child, CRC/C/15/Add.268, 2005

(4) Resolution 44/25 of November 20th, 1989, come into force on September 2nd, 1990, ratification and order of execution in Italy approved with the law n. 176 of May 27th, 1991 (Supplement to the “Gazzetta Ufficiale” n. 135 of June 11th, 1991).

(5) Resolution of April 4th, 1997, come into force on December 1st, 1999, ratification and order of execution in Italy approved with the law n. 145 of March 28th, 2001 (“Gazzetta Ufficiale” n. 95 of April 24th, 2001). Ratification instrument not yet registered.

(6) Document adopted on August 13th, 2003 by the United Nations’ Sub-Commission on the Promotion and Protection of Human Rights, session n. 25, UN Doc. E/CN.4/Sub.2/2003/12/Rev.2, August 26th, 2003.

(7) Code 24841, come into force on June 26th, 1987. Ratification authorization and order of execution in Italy approved with the law n. 489 of November 3rd, 1988 (Supplement to the “Gazzetta Ufficiale” n. 271 of November 18th, 1988).

(8) Code 2000/C364/01, IT, published on the Official Journal of the European Union on n. n° C 364/1, December 18th, 2000. The Chart constitutes the Second Part of the Project for a European Constitution, discussed at the intergovernmental Conference of December 2003.

(9) Prot. A/RES/46/119, December 17th, 1991.