[Informed consent in psychiatry--European standards and differences, problems and recommendations]

Abstract

Development and state of regulations and ethical debates of "informed consent" in 9 European countries are exposed. Commonalities and differences in significance, evaluation, and use of information, capacity to consent, and voluntariness as prerequisites of a valid consent are discussed with regard to care/dure and research. Consequently recommendations for regulations, research, teaching, and practice of "informed consent" and for research with incapacitated patients are given. The legal doctrine of "informed consent" tries to realize or even to operationalize the ethical demand for respect towards dignity and autonomy of the patient. This is particularly relevant in psychiatry because many states of mental disorders may impair the capacity to consent and the internal as well as external freedom of the patient. Validity, reliability, practicability, and acceptance of criteria and procedures of assessment of capacity to consent and of voluntariness of the patient, substitutes in the case of loss of these prerequisites of "informed consent", and its limitations, e.g. by the other ethical principle of the "best interest" of the patient or by his sociocultural context, are in need to be evaluated empirically in practice.