“Benevolent Coercion’’ in Psychiatry

Particularly in inpatient facilities, measures can be observed which, due to their coercive character, represent a serious infringement of the fundamental rights of the person concerned. Therefore, it is especially important that such measures are ethically and legally justified. Coercive measures include, among others, the custodial placement of persons in hospitals and other inpatient facilities, the treatment of mental and somatic illnesses without the person’s consent, restraint through medication in cases of challenging behaviour, as well as custodial measures such as the use of bed rails or restraint belts and structural coercion.

The German Ethics Council is currently preparing an Opinion on the following questions: which forms of coercion can be identified; what role coercive measures play in fields such as psychiatry, nursing, social work, child and youth services as well as disability welfare; to what extent these measures are ethically and legally problematic; and what need for change exists for practice and legal regulation. Of particular interest to the Ethics Council are those coercive measures that are carried out based on the justification of ensuring the self-protection of the person concerned (so-called “benevolent coercion”).

The hearing will deal in particular with compulsory placement, measures involving deprivation of liberty, forced treatment, but also structural coercion in psychiatry, and will seek the expertise of affected persons, relatives and professionals. In a second hearing, the Ethics Council will address the other fields mentioned above.

The special focus of this hearing is on the challenges that arise on the practical level due to changes in the legal situation (new versions of the Psychisch-Kranken-Gesetze [Mental Health Laws], decisions of the highest courts), but also as a result of current discussions (for example, shaped by the ZEKO statement “Zwangsbehandlungen bei psychischen Erkrankungen” [“Coercive Treatment in Psychiatric Illnesses”]) as well as with regard to fundamental and human rights issues.

Focusing on compulsory placement and compulsory treatment, the German Ethics Council wants to inquire about experiences of what is currently changing in concrete terms in practice as a result of the above-mentioned factors, and what problems can be identified in this context.