Helmchen Hanfried
Klinik für Psychiatrie und Psychotherapie, CBF, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
Nervenarzt. 2021 Mar;92(3):259-266. doi: 10.1007/s00115-020-00998-7.
Within the framework of the legal and ethical requirements of the application of coercion in psychiatry, the perspective of its prevention is discussed. Coercion is permissible exclusively in cases of incapability of self-determination and immediate specific danger for the patient's physical integrity or life. Practical difficulties in assessing these criteria are illustrated by means of case examples. Preventive procedures for avoidance of coercion (advance directives, trust-building procedures, recognition of influence of context, sensitization against coercion) as well as clarification of indications and control of the application of coercion and a change of attitude toward assistance of decision aim at strengthening respect for the right to self-determination of the mentally ill and thereby to fairly balance the psychiatrist's conflict between responsibility for care and respect for the right of self-determination of the patient.
在精神病学中强制手段应用的法律和伦理要求框架内，探讨了预防强制手段的观点。只有在患者无法自我决定且对其身体完整性或生命构成直接特定危险的情况下，强制手段才是允许的。通过案例说明了评估这些标准时的实际困难。避免强制手段的预防程序（预先指示、建立信任程序、认识情境影响、提高对强制手段的敏感度）以及明确强制手段的适用指征和控制其应用，还有改变对决策协助的态度，旨在加强对精神病患者自决权的尊重，从而公平地平衡精神科医生在护理责任与尊重患者自决权之间的冲突。
