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Publications (71)
The use of coercion within mental healthcare raises many ethically relevant questions. These include the analytical question about which actions amount to coercion, and the normative question whether and in which situations the use of coercion is justified. This chapter aims to provide an overview of answers to these questions. In answer to the ana...
Relatives are increasingly recognized as important in the care of people with a serious mental health condition, such as major depressive disorder, bipolar disorder, or schizophrenia. Research indicates that in providing care, relatives use so-called treatment pressures, such as persuasion, interpersonal leverage, inducements, or threats, to promot...
Most qualitative health research is subject to ethics review and approval by a research ethics committee (REC). While many studies have identified the challenges that current ethics review practices pose to qualitative health research, there is currently a call to move the research focus from the shortcomings of ethics review practices to the possi...
Psychiatric advance directives (PAD), also known as advance statements or advance choice documents, are legal documents that enable people with mental health conditions to specify their treatment preferences in advance for possible future crises. Subtypes of PADs include crisis cards, joint crisis plans and self-binding directives (also known as Ul...
Background
Advance research directives (ARDs) provide a promising way to involve individuals with mild cognitive impairment (MCI) in research decisions before they lose the capacity to consent. At the same time, the views of people with MCI on ARDs are underexplored. This study assesses the perceptions of people with MCI and family members on the b...
Zusammenfassung
Hintergrund
Im Rahmen klinischer Ethikberatung unterstützen Ethikberater*innen im Gesundheitswesen Professionelle in der Psychiatrie dabei, moralische Probleme zu identifizieren und zu analysieren.
Ziel der Arbeit
Darstellung von zentralen ethischen Grundbegriffen und Begründungsansätzen, die für die klinische Ethikberatung in der...
Background
Treatment pressures encompass communicative strategies that influence mental healthcare service users’ decision-making to increase their compliance with recommended treatment. Persuasion, interpersonal leverage, inducements, and threats have been described as examples of treatment pressures. Research indicates that treatment pressures ar...
This chapter provides an overview of German laws that are particularly relevant to the rights of people with mental disorders. While its focus is on guardianship law, the chapter also briefly discusses Mental Health Assistance Laws, the implications of the United Nations Convention of the Rights of Persons with Disabilities, and the Patients’ Right...
According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on the...
This study explores how qualitative health researchers navigate the demands of medical research ethics committees in Germany where qualitative research is subject to approval only when it is conducted in medical contexts. We present the results of a grounded theory study to investigate qualitative health researchers’ experiences with procedural eth...
The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as "procedural ethic...
Treatment pressures are communicative strategies that mental health professionals use to influence the decision-making of mental health service users and improve their adherence to recommended treatment. Szmukler and Appelbaum describe a spectrum of treatment pressures, which encompasses persuasion, interpersonal leverage, offers and threats, argui...
Background
Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concern...
Background
Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefi...
Introduction
This article provides an overview of German guardianship law and Mental Health Assistance Laws (Psychisch-Kranken-Hilfe-Gesetze), with a special focus on the rights of people with mental disorders. Two legal systems in Germany are relevant in this context: the law on guardianship, which is part of civil law and the Mental Health Assist...
Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt oder unterlassen werden sollen. Einwilligungsfähigkeit und Freiwilligkeit sind Voraussetzungen, um dieses Recht auf Selbstbestimmung auszuüben – sie lassen sich jedoch besonders in der psychiatrischen Versorgung nicht immer einfach beurteilen. Eine Hilf...
Purpose
Self-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family mem...
Objective:
Psychiatric advance directives (PADs) are documents that allow users of mental health services to express their preferences for treatment in future mental health crises. To increase the use of PADs in psychiatric practice, it is helpful to consider how service users view PADs and the factors that facilitate or hinder PAD creation and im...
Zusammenfassung
Hintergrund
Die Auslegung von Artikel 12 der Behindertenrechtskonvention der Vereinten Nationen (Art. 12 UN-BRK) durch den Ausschuss für die Rechte von Menschen mit Behinderungen hat zu einer Kontroverse über die Umsetzung des Artikels in der Psychiatrie geführt.
Fragestellung
Wie kann Art. 12 UN-BRK auf ethisch vertretbare Weise...
Objective:
Psychiatric advance directives (PADs) enable users of mental health services to express their treatment preferences for future mental health crises. PAD completion rates remain low despite high rates of interest among service users and empirically confirmed benefits of their use. A systematic review of service users' preferences regardi...
The aim of this paper is to shed light on the complex relations between friendship and blame. In the first part, I show that to be friends is to have certain evaluative, emotional and behavioral dispositions toward each other, and distinguish between two kinds of norms of friendship, namely friendship-based obligations and friendship-constituting r...
Definition of the problemThe reform of German guardianship law coming into force in 2023 will remove the term “well-being” from the law. This is intended to emphasise that the legal guardian should be guided by the subjective wishes of the person rather than by an objective understanding of well-being. This article analyses the understanding of wel...
Background
Psychological pressure refers to communicative strategies used by professionals and informal caregivers to influence the decision-making of service users and improve their adherence to recommended treatment or social rules. This phenomenon is also commonly referred to as informal coercion or treatment pressure. Empirical studies indicate...
Objective:
Research on coercion in mental healthcare has recently shifted to the investigation of subjective aspects, both on the side of the people with mental disorders affected and the staff members involved. In this context, the role of personality traits and attitudes of staff members in decision-making around coercion is increasingly being a...
In Deutschland gilt: Eine medizinische Behandlung darf nur durchgeführt werden, wenn sie vom Patientenwillen getragen wird. Doch Menschen mit schweren psychischen Erkrankungen sind in Krisensituationen manchmal nicht mehr in der Lage, diesen zu äußern. Hier erfahren Sie, wie Betroffene ihre Behandlungswünsche schon vorab schriftlich festlegen könne...
The right to make autonomous decisions is enshrined in law. However, the question how persons with cognitive deficits can be enabled to make autonomous decisions has not been satisfactorily addressed. In particular, the concept of supported decision-making and its implementation into practice has been poorly explored for persons with dementia (PwD)...
Self-binding directives (SBDs) are a special type of psychiatric advance directive by means of which mental health service users can give advance consent to compulsory hospital admission or treatment during a future mental health crisis. SBDs are legally binding in the Netherlands since 2008. On the 1st of January 2020, the Dutch Law on Special Adm...
Objective:
To collect experiences and opinions of chief psychiatrists in relation to changes in the practice of involuntary hospitalization during the COVID-19 pandemic.
Methods:
Online survey among members of the Association of Chief Physicians for Psychiatry and Psychotherapy in North Rhine-Westphalia (LLPP) and analysis of protocols of LLPP b...
The aim of this paper is to situate Kant in the debate on free will. Whereas Kantians often assume that Kant's views on free will cannot be brought under any of the headings of this debate, contemporary free will theorists commonly assume that Kant is an incompatibilist of the libertarian type. I argue against both assumptions: Kant can and should...
According to what we propose to call “the competence model,” competence is a necessary condition for valid informed consent. If a person is not competent to make a treatment decision, the decision must be made by a substitute decision-maker on her behalf. Recent reports of various United Nations human rights bodies claim that article 12 of the Conv...
In this paper, I show that Kant’s solution to the third antinomy is a reply sui generis to the consequence argument. If sound, the consequence argument yields that we are not morally responsible for our actions because our actions are not up to us. After expounding the modal version of the consequence argument advanced by Peter van Inwagen, I show...
Background: Individual staff factors, such as personality traits and attitudes, are increasingly seen as an important factor in the reduction of coercion in mental health services. At the same time, only a few validated instruments exist to measure those factors and examine their influence on the use of coercion.
Aim: The present study aimed to dev...
This report is about ethical issues surrounding legal capacity insofar as these relate to the lives and wellbeing of people with dementia. It reflects on the relationship between law and ethics with regard to decision making in key areas of the lives of people with dementia and touches on a wide range of topics such as disability, equity, wellbeing...
The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the context of the treatment of people under involuntary commitment. The question arises at various points in the procedure for and process of involuntary commitment whether procedural modifications or further restrictive measures are necessary to minimise...
Introduction
“Advance decision making” (ADM) refers to people planning for a future when they may lose the capacity to make decisions about treatment (decision making capacity for treatment or DMC-T). This can occur in a variety of physical and mental health scenarios. Statutory provision for ADM is likely to be introduced to mental health legislat...
It is a common picture that Kant is committed to an uncompromising account of moral responsibility that leaves no room for excuses. I argue that this picture is mistaken. More specifically, I reconstruct a Kantian quality of will account of excuses according to which an agent is excused for performing a morally wrong (or omitting a morally obligato...
In this paper, I demonstrate that Kant's commitment to an asymmetry between the control conditions for praise and blame is explained by his endorsement of the principle Ought Implies Can (OIC). I argue that Kant accepts only a relatively weak version of OIC and that he is hence committed only to a relatively weak requirement of alternate possibilit...
This case commentary investigates whether the risks and benefits of an interview study with persons under involuntary commitment on open-door policies in psychiatry were proportional and fairly distributed. Given that there is little data available on the views of service users on open-door policies, the study had significant social value. Because...
In this case commentary, we analyze ethical concerns that were raised in response to an interview with a woman with bipolar disorder who was under involuntary commitment. We focus on competence and voluntariness as two prerequisites for valid informed consent. We recommend that judgments of competence be based on whether prospective research partic...
Psychiatric advance directives (PADs) are documents by means of which mental health service users can make known their preferences regarding treatment in a future mental health crisis. Many states with explicit legal provisions for PADs have ratified the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). While importa...
In this paper, I give a reconstruction of the so‐called Reinhold–Sidgwick objection and show that Korsgaard‐style Kantian constructivists are committed to two key premises of the underlying argument. According to the Reinhold–Sidgwick objection, the Kantian conception of autonomy entails the absurd conclusion that no one is ever morally responsible...
Background
Mental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy.
Objective
To provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures.
Methods
Empirically informed conceptual and ethical anal...
Zusammenfassung
Der Deutsche Bundestag hat im November 2016 eine Änderung des Arzneimittelgesetzes beschlossen. Nach dieser Änderung soll gruppennützige Arzneimittelforschung mit nicht-einwilligungsfähigen Erwachsenen unter bestimmten Bedingungen erlaubt sein. Eine dieser Bedingungen ist, dass der Proband eine sogenannte Forschungsvorausverfügung a...
Es gilt als allgemeinhin akzeptierte ethische und rechtliche Anforderung, dass vor Eingriffen in die körperliche Unversehrtheit eines Menschen z.B. durch medizinische oder Forschungsinterventionen die informierte Einwilligung des potentiellen Empfängers der Intervention eingeholt wird, bevor eine Intervention durchgeführt wird. Menschen haben das R...
The fourth amendment to the German Medicinal Products Act (Arzneimittelgesetz) states that nontherapeutic research in incompetent populations is permissible under the condition that potential research participants expressly declare their wish to participate in scientific research in an advance research directive. This article explores the implement...
It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. Accordi...
In this paper, I give a Kantian answer to the question whether and why it would be inappropriate to blame people suffering from mental disorders that fall within the schizophrenia spectrum. I answer this question by reconstructing Kant’s account of mental disorder, in particular his explanation of psychotic symptoms. Kant explains these symptoms in...