Zilles D, Koller M, Methfessel I, Trost S, Simon A
Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland.
Landgericht Göttingen, Göttingen, Deutschland.
Nervenarzt. 2018 Mar;89(3):311-318. doi: 10.1007/s00115-017-0445-5.
Severe affective and psychotic disorders may be accompanied by legal incapacity. If in this case the patient refuses treatment and in parallel there is a risk of serious damage to health, treatment can be carried out against the patient's non-autonomous will under defined prerequisites. Due to its good and partly superior effectiveness in the treatment of severe and pharmacotherapy-resistant affective and psychotic disorders, electroconvulsive therapy (ECT) is an important treatment option in such constellations.
Description of the general principles and prerequisites of therapeutic measures against the patient's will.
Based on a case report, the application of ECT as a medical measure against the patient's will is discussed and assessed in an interdisciplinary approach from clinical, legal, and ethical perspectives.
The (empirical) evidence on the general effectiveness of ECT, as well as its application against the will of patients with legal incapacity, clearly shows a positive benefit-risk ratio. When performed against the patient's will, ECT as all compulsory medical interventions, represents a severe encroachment on the individual's fundamental rights of both physical integrity and self-determination. Nevertheless, its application may be medically indicated, legally admissible and ethically appropriate in individual cases to prevent the threat of serious damage to the patient's health. Ethical and legal prerequisites of treatment against the patient's will should be evaluated by a multiprofessional team and the patient's legal guardian should be involved from an early stage.
严重的情感和精神障碍可能伴有法律上的无行为能力。在这种情况下，如果患者拒绝治疗，同时存在严重损害健康的风险，在特定前提条件下，可以违背患者的非自主意愿进行治疗。由于电休克疗法（ECT）在治疗严重的、对药物治疗耐药的情感和精神障碍方面具有良好且部分更为优越的疗效，因此在这种情况下是一种重要的治疗选择。
描述违背患者意愿的治疗措施的一般原则和前提条件。
基于一份病例报告，从临床、法律和伦理角度，以跨学科方法对将ECT作为违背患者意愿的医疗措施的应用进行讨论和评估。
ECT总体疗效的（实证）证据，以及其针对无行为能力患者意愿的应用，清楚地显示出积极的效益风险比。当违背患者意愿进行ECT治疗时，与所有强制性医疗干预一样，它严重侵犯了个人的身体完整性和自决权等基本权利。然而，在个别情况下，其应用在医学上可能是必要的，在法律上是可允许的，在伦理上是适当的，以防止对患者健康造成严重损害的威胁。违背患者意愿的治疗的伦理和法律前提条件应由多专业团队进行评估，并且应尽早让患者的法定监护人参与进来。
