All people have the right to decide how to live their lives and thus also to decide about measures that affect their health. Self-determined, possibly supported decision-making by patients is therefore a prerequisite for good medical treatment.
As a general rule, just because someone has a mental illness one cannot assume that they cannot and should not make decisions themselves. The question of how to deal with individual cases in which a mental illness severely limits a patient’s ability for self-determination has been a subject of intensive discussion for years – both within the DGPPN and in discussions with service users, relatives, lawyers and politicians.
What is clear is that it is not sufficient to demand human rights and patient autonomy in position papers and on podiums but this attitude must be adopted in clinical practice. The discussions in recent years have caused treatment teams to move closer to patients and their relatives, to take their needs and worries seriously and, as far as possible, to make decisions jointly with the patient. In addition to considering self-determination rights, however, doctors have to be guided by their duty to provide care: if severely ill patients who are incapable of making their own decisions pose a significant risk to themselves or others and at the same time refuse medical treatment, psychiatrists and all those involved may find themselves in an ethical dilemma.
The UN Convention on the Rights of People with Disabilities (CRPD) contains comprehensive demands to strengthen the human rights of people with long-term physical, emotional, mental or sensory impairments. These demands include not only the promotion of patients’ participation in medical decisions, reduction of measures that restrict freedom and nationwide documentation of such measures but also the preparation of appropriate guidelines on the necessary space and personnel in hospitals. On the basis of these demands, the hurdles for medical compulsory measures were significantly increased in German federal and state laws.