Ena ke karolo ho tsoa tlalehong e fanoeng ke Ramolao ea Khethehileng mabapi le tokelo ea motho e mong le e mong ea ho natefeloa ke maemo a holimo ka ho fetesisa a bophelo bo botle ba 'mele le kelello ho Lekhotla la Litokelo tsa Botho la UN. (A/HRC/44/48)
Kakaretso ea tlaleho e felletseng: Tlalehong ea hona joale, e rometsoeng ho latela qeto ea Lekhotla la Litokelo tsa Botho 42/16, Ramolao ea Khethehileng o hlakisa lintlha tse hlokahalang ho theha lenaneo la lefats'e le thehiloeng ho litokelo bakeng sa ho ntšetsa pele tokelo ea bophelo bo botle ba kelello. Rapporteur ea Khethehileng o amohela tlhokomelo ea machaba ea hore ha ho na bophelo bo botle ntle le bophelo bo botle ba kelello 'me o ananela mehato e fapaneng ea lefats'e ea ho ntšetsa pele likarolo tsohle tsa bophelo bo botle ba kelello lefatšeng ka bophara: ts'ehetso, thibelo, phekolo, tsosoloso le ho hlaphoheloa. Leha ho le joalo, o boetse o hatisa hore ho sa tsotellehe mekhoa e tšepisang, ho ntse ho e-na le ho hlōleha ha maemo a lefats'e ho sebetsana le tlōlo ea litokelo tsa botho tsamaisong ea tlhokomelo ea bophelo bo botle ba kelello. Boemo bona ba serame bo tiisa seketsoana se khopo sa khethollo, ho se be le matla, ho qobelloa, ho behelloa ka thoko sechabeng le ho hloka toka. Ho felisa potoloho, mahlomola, kalafo le tšehetso li tlameha ho bonoa ka bophara le ho feta hole kutloisiso ea biomedical ea bophelo bo botle ba kelello. Lipuisano tsa lefats'e, tsa libaka le tsa naha lia hlokahala ho buisana ka mokhoa oa ho utloisisa le ho arabela maemo a bophelo bo botle ba kelello. Lipuisano le liketso tseo li tlameha ho theoa holim'a litokelo, tse akaretsang 'me li thehoe bophelong ba ba siiloeng morao haholo ke litsamaiso tse kotsi tsa sechaba, mekhatlo le litloaelo. Ramolao ea Khethehileng o fana ka likhothaletso tse 'maloa bakeng sa Linaha, bakeng sa mekhatlo e emelang mosebetsi oa mafu a kelello le Mokhatlo oa Lefatše oa Bophelo.
Meriana e feteletseng le lits'oso ho litokelo tsa botho
A. Boemo: ho tloha ho “babe” ho isa “ho hlanya”. Matla a bongaka le taolo ea sechaba
27. Batho ba bangata ba tsoang lihlopheng tse neng li qheletsoe ka thoko sechabeng, joalo ka batho ba futsanehileng, ba sebelisang lithethefatsi le batho ba nang le bokooa ba kelello, ba tšoasitsoe ke batho boraro-bo-bong bo halalelang ba mabitso: (a) Batho ba babe/litlokotsebe, (b) Batho ba kulang kapa ba hlanyang kapa bakuli, kapa (c) Motsoako oa tsena tse peli.. Mabitso ao a siile sechaba se joalo se kotsing ea kotlo e feteletseng, kalafo le/kapa "toka" ea phekolo bakeng sa maemo kapa boitšoaro bo nkoang bo sa amohelehe sechabeng. Sephetho ke phaephe e khethollang, e khethollang 'me hangata ea khethollo ea morabe ho tloha likolong, literateng le lichabeng tse hlokang thuso ho ea lichankaneng, lipetlele le litsing tsa kalafo tse ikemetseng, kapa metseng e tlas'a litaelo tsa kalafo, moo litokelo tsa botho tlōlo ea molao e ka ba ea tsamaiso, e atile mme hangata ke tsa meloko. Puisano ea lefats'e ea bophelo bo botle ba kelello e ntse e itšetlehile ka mokhoa ona oa "bohlanya kapa bobe" le ho ea pele melao, litloaelo le maikutlo a ba amehang haholo a itšetlehileng ka maikutlo a hore tlhokomelo ea bophelo bo botle ba kelello e bua haholo ka ho thibela boitšoaro bo ka bang kotsi kapa bo hlokang ho kenella ho latela tlhoko ea bongaka (ea phekolo).. Mekhoa e buellang litokelo e kentsoeng ke melao-motheo ea sejoale-joale ea bophelo bo botle ba sechaba le bopaki ba saense e phephetsa "dichotomy ea bohlanya kapa e mpe" e siiloe ke nako, e khethollang ebile e sa sebetse.
28. Maiteko a mangata a lefats'e a mabapi le ho tlosoa chankaneng le ho tlosoa ha molao a amoheleha, empa tlhokomelo e lokela ho lefshoa ho lipolotiki tsa mohlokomeli le liphetoho tsa leano ho ea ho ts'ebetso ea ho phekola ka ho feteletseng, e leng se hlahisang mathata a bohlokoa a litokelo tsa botho. Ebang e koaletsoe kapa e qobelloa ka lebaka la polokeho ea sechaba kapa mabaka a bongaka, phihlelo e arolelanoang ea ho qheleloa ka thoko e pepesa tlaleho e tloaelehileng ea bofokoli bo tebileng, khethollo, pefo le ho hloka tšepo.
29. Mofuta ona o kotsi oa ho phekola e hlahisa liqholotso kholisong le ts'ireletsong ea tokelo ea bophelo bo botle. Bongaka bo etsahala ha mefuta e fapaneng ea boitšoaro, maikutlo, maemo kapa mathata a bophelo "e hlalosoang ka mantsoe a bongaka, a hlalosoang ho sebelisoa puo ea bongaka, e utloisisoang ka ho amoheloa ha moralo oa bongaka, kapa ho phekoloa ka thuso ea bongaka."[1]. Ts'ebetso ea bongaka hangata e amahanngoa le taolo ea sechaba kaha e sebeletsa ho tiisa meeli e potolohileng boitšoaro le liphihlelo tse tloaelehileng kapa tse amohelehang. Phekolo ea meriana e ka pata bokhoni ba motho ba ho tseba moo a leng teng le liphihlelo ka har'a maemo a sechaba, ho hlohlelletsa ho se tsejoe hantle ha mehloli e nepahetseng ea mahlomola (liphetho tsa bophelo bo botle, ts'oaetso e kopanetsoeng) le ho hlahisa khethollo. Ha e le hantle, ha liphihlelo le mathata li nkoa e le tsa bongaka ho e-na le tsa sechaba, tsa lipolotiki kapa tse teng, likarabo li itšetlehile ka mehato ea motho ka mong e ikemiselitseng ho khutlisetsa motho boemong ba ho sebetsa ka har'a tsamaiso ea sechaba ho e-na le ho sebetsana le lefa la mahlomola le. phetoho e hlokahalang ho thibela mahlomola ao boemong ba sechaba. Ho feta moo, phekolo ea meriana e ipeha kotsing ea ho lumella litloaelo tse qobellang tse hatakelang litokelo tsa botho 'me e ka eketsa khethollo khahlanong le lihlopha tse seng li ntse li le boemong bo soabileng bophelong bohle ba tsona le melokong eohle.
30. Ho na le mabapi le tšekamelo ea ho sebelisa meriana e le mokhoa oa ho hlahloba le ho tlosa seriti le boipuso ba motho. ka har'a libaka tse ngata tsa leano la sechaba, tseo bongata ba tsona li talingoang e le lintlafatso tse tsebahalang mekhoeng ea khale ea kotlo le ho koalloa chankaneng. Bongaka bo fapana le ho rarahana ha maemo joalo ka batho sechabeng, ho fana ka maikutlo a hore ho na le tharollo ea konkreite, ea mahlale ('me hangata e le ea bo-ntate). Seo se bonts'a ho se ikemisetse ha sechaba sa lefats'e ho tobana le mahlomola a batho ka mokhoa o nang le moelelo 'me se kenyelletsa ho hloka mamello ho maikutlo a tloaelehileng a mabe ao bohle ba nang le 'ona bophelong. Kamoo "phekolo" kapa "tlhoko ea bongaka" e sebelisoang ho lokafatsa khethollo le ho hloka toka sechabeng hoa tšoenya.
31. A mokhoa o matla oa biomedical o lebisitse ho Linaha ho lokafatsa bolaoli ba tsona ba ho kena lipakeng ka litsela tse fokotsang litokelo tsa batho ka bomong.. Ka mohlala, mabaka a phekolo ea meriana ha aa lokela ho sebelisoa e le tšireletso kapa ho lokafatsa maano le mekhoa e hatakelang seriti le litokelo tsa batho ba sebelisang lithethefatsi. Le hoja boiteko ba ho tlosa likarabo tsa tšebeliso ea lithethefatsi ho tloha ho mekhoa ea tlōlo ea molao ho ea ho tsa bophelo bo botle bo amoheleha, ke habohlokoa ho fana ka tlhokomeliso mabapi le kotsi ea phekolo ea meriana e ntseng e tsitlella tlhekefetso ea litokelo khahlanong le batho ba sebelisang lithethefatsi. Likarabo tsa bongaka bakeng sa ho sebetsana le bokhoba (haholo-holo ha li entsoe joalo ka lefu) li ka bonts'a litloaelo tse ts'oanang tsa khatello, botlamuoa, sekhobo le khaello ea tumello e fumanoang mekhoeng ea botlokotsebe. Ntle le ts'ireletso ea litokelo tsa botho, mekhoa ena e ka atleha 'me hangata e ka ama batho ba tobaneng le khethollo sechabeng, moruo kapa morabe.
liketane tsa 'mele le liloko li nkeloa sebaka ke lithibelo tsa lik'hemik'hale le ho lebela ka mafolofolo.
Danius Puras, Motlalehi ea Khethehileng oa Machaba a Kopaneng ka tokelo ea motho e mong le e mong ho
ho natefeloa ke boemo bo phahameng ka ho fetisisa ba mmele le kelello
bophelo bo botle, 2020
32. Ho kenella ho qobelloang maemong a bophelo bo botle ba kelello ho bile le mabaka a utloahalang ka lebaka la liqeto tsa "kotsi" kapa "tlhoko ea bongaka". Boikemisetso boo bo thehiloe ke motho e mong ntle le motho eo ho buuoang ka eena. Hobane li na le boikemelo, li hloka tlhahlobo e kholo ho latela pono ea litokelo tsa botho. Le hoja batho lefatšeng ka bophara ba ntse ba loanela ho lokolloa ha batho ba nang le khatello e matla ea maikutlo, liketane tsa 'mele le liloko li nkeloa sebaka ke lithibelo tsa lik'hemik'hale le ho lebela ka mafolofolo. Chebo ea Naha le ea matsete a lisebelisoa a lula a tsepamisitse maikutlo haholo ho laola motho ka "tlhoko ea bongaka", e atisang ho sebelisoa e le mabaka a ho lokafatsa taolo e joalo.
33. Ho sa tsotellehe ho ba sieo ha matšoao a likokoana-hloko bakeng sa boemo leha e le bofe ba bophelo bo botle ba kelello[2], bongaka ba kelello bo matlafalitse kutloisiso ea biomedical le acontextual ea khatello ea maikutlo. Ka lebaka la khaello ea kutloisiso e felletseng ea aetiology, le kalafo ea, maemo a bophelo bo botle ba kelello, ho na le mokhoa o ntseng o hola o khothaletsang phetoho hole le kalafo.[3]. Ho na le mehala e ntseng e hola ka har'a bongaka ba kelello bakeng sa "ho nahanoa bocha ka tsebo le koetliso ea kelello" le khatiso e nchafalitsoeng ea bohlokoa ba tlhokomelo ea likamano le ho its'epahallana ha bophelo bo botle ba kelello le ba sechaba.[4]. Moqolotsi ea Khethehileng o lumellana le eena empa e kopa lingaka tse hlophisitsoeng tsa kelello le baetapele ba eona ho tiisa litokelo tsa botho e le litekanyetso tsa mantlha ha ba etelletsa pele mehato ea bophelo bo botle ba kelello..
34. Ha ho nahanoa ka ho qalisa phekolo, molao-motheo oa primum non nocere, kapa "pele u se ke ua ntša kotsi", e lokela ho ba yona e tataisang. Ka bomalimabe, litla-morao tse boima tse bakoang ke mehato ea bongaka hangata li hlokomolohuoa, likotsi tse amanang le lithethefatsi tse ngata tsa psychotropic li nyenyefalitsoe mme melemo ea tsona e fetelelitsoe libukeng tse hatisitsoeng.[5]. Monyetla oa ho ho hlahlobisisa le ho phekoloa ka ho fetelletseng ka hona e tlameha ho nkuoa e le phello e ka bang teng ea iatrogenic ea boiteko ba hajoale ba lefats'e ba ho holisa phihlello ea kalafo. Ho phaella moo, litokelo tse pharaletseng tsa botho le likotsi tsa sechaba tse hlahisoang ke phekolo ea meriana, tse kang ho khetholloa sechabeng, phekolo e qobelloang, ho lahleheloa ke tokelo ea molao ea ho hlokomela bana le ho lahleheloa ke boipuso, li hloka tlhokomelo e kholoanyane. Bongaka bo ama karolo e 'ngoe le e 'ngoe ea bophelo ba batho ba nang le bokooa ba kelello; e nyenyefatsa bokgoni ba bona ba ho vouta, ho sebetsa, ho hira lehae le ho ba baahi ba felletseng ba nkang karolo metseng ya bona.
35. Hona joale ho tsebahala haholo hore ho koalloa ka bongata ha batho ba tsoang lihlopheng tse maemong a sotlehileng ke taba e hatellang ea litokelo tsa botho. E le ho thibela ho phekoloa ka bongata, ho bohlokoa ho kenya moralo oa litokelo tsa botho tabeng ea ho nahana, le maano a bophelo bo botle ba kelello. Bohlokoa ba ho nahana ka ho teba (mohlala, ho ithuta ka matla le bofokoli ba mohlala oa biomedical) le tsebo ea bohlokoa ba mokhoa o thehiloeng litokelong tsa botho le lits'ebetso tsa bophelo bo botle e tlameha ho ba karolo ea bohlokoa ea thuto ea bongaka.
References
[1] (21) Sheba Peter Conrad le Joseph W. Schneider, Deviance and Medicalization: ho tloha ho Bobe ho ea ho Bokuli (Philadelphia, Pennsylvania, Temple University Press, 2010).
[2] (22) Sheba James Phillips le ba bang, "Lipotso tse tšeletseng tsa bohlokoa ka ho fetisisa tsa tlhahlobo ea kelello: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis", Philosophy, Ethics and Humanities in Medicine, vol. 7, No. 3 (Pherekhong 2012).
[3] (23) Sheba Vincenzo Di Nicola. "'Motho ke motho ka batho ba bang': manifesto ea bophelo bo botle ba kelello bakeng sa lekholong la bo21 la lilemo", World Social Psychiatry, vol. 1, Nomoro 1 (2019).
[4] (24) Sheba Caleb Gardner le Arthur Kleinman, "Meriana le kelello - liphello tsa bothata ba boitsebiso ba kelello", The New England Journal of Medicine, vol. 381, No. 18 (Mphalane 2019).
[5] (25) Sheba Joanna Le Noury le ba bang, "Ho tsosolosa Thuto ea 329: katleho le likotsi tsa paroxetine le imipramine kalafo ea ho tepella maikutlo ho hoholo nakong ea bocha", The BMJ, vol. 351 (Lwetse 2015).
