Smith Alexander, Theil Stefan, Hart Stephen D, Liebrenz Michael
Department of Forensic Psychiatry, University of Bern, Bern, Switzerland.
Faculty of Law, University of Cambridge, Cambridge, United Kingdom.
Int J Law Psychiatry. 2023 Jul-Aug;89:101908. doi: 10.1016/j.ijlp.2023.101908. Epub 2023 Jul 17.
In recent years, political events have reignited contentious debates about psychiatry and democratic governance. This discourse has largely centred around the ethics and morality of public commentary, particularly in relation to the American Psychiatric Association's Goldwater Rule. Yet, few studies have examined the practical implications of health-related limitations due to mental illness in national leadership and the constitutional and legal provisions that surround these issues, including voluntary or involuntary proceedings. Accordingly, this theoretical paper analyses these topics in a German context using the position at the head of the executive: the chancellorship. Germany was selected as a case example as the biggest democracy in Europe with modern legal frameworks representative of the post-World War Two era in European constitutionalism, and for its economic and political influence within the European Union. Throughout this paper, we do not speculate on the mental health of any individual (past or present), but instead explore jurisdictional mechanisms around health-related limitations in German high office. Consequently, we outline relevant constitutional and legal scenarios, and how short- or long-term medical incapacity may determine requisite responses and contingent complexities. This underpins our discussion, where we consider legal ambiguities, functional capacity, and ethical concerns in psychiatric practice.
近年来，政治事件重新引发了关于精神病学与民主治理的激烈辩论。这场讨论主要围绕公众评论的伦理和道德，特别是与美国精神病学协会的《戈德华特规则》相关。然而，很少有研究探讨精神疾病导致的健康相关限制在国家领导人层面的实际影响，以及围绕这些问题的宪法和法律规定，包括自愿或非自愿程序。因此，这篇理论性论文以德国为例，从行政首脑的职位——总理一职的角度来分析这些话题。选择德国作为案例是因为它是欧洲最大的民主国家，拥有代表二战后欧洲宪政时代的现代法律框架，且在欧盟具有经济和政治影响力。在整篇论文中，我们不猜测任何个人（过去或现在）的心理健康状况，而是探讨德国高级职位中与健康相关限制的管辖机制。因此，我们概述了相关的宪法和法律情景，以及短期或长期医疗无行为能力如何决定必要的应对措施和可能出现的复杂情况。这为我们的讨论奠定了基础，在讨论中我们会考虑精神病学实践中的法律模糊性、功能能力和伦理问题。
