[Compulsory treatment under legal uncertainty: part 2: consequences of legal uncertainty in clinical practice - suggestions for improvement]

Abstract

The current legal uncertainty on compulsory treatment of mentally ill patient incapable of giving consent favors the practice of defensive treatment, such as the increased use of isolation and fixation instead of medication. Such a stance runs the risk of acute or chronic health damage for patients. The dissent between legal practitioners and psychiatrists on compulsory treatment is obviously based on a different understanding of autonomy and its prerequisites. We advocate an individual centered, preferably open form of treatment by medicinal and milieu therapeutic approaches in association with intensified relationships with the aim to restore or improve the ability for self-determination. We also call upon the legislative authorities to establish legal certainty. It is decisive that the characteristics of mental diseases and the possibilities of modern treatment are taken into consideration in order to suitably respect patient autonomy without neglecting the necessary help.