科研之友
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摘要
In case of court-ordered involuntary hospitalization due to danger to self or to others psychiatric advance directives can lead to clinically and ethically challenging situations - especially when they contain (total) treatment refusals. In such situations, patients can neither be discharged from hospital nor medically treated. This article discusses ethical challenges in the context of advance treatment refusals from an interdisciplinary perspective. We outline legal limitations of advance directives and normative preconditions of valid advance directives (such as mental capacity at the time of composition, applicability to the current life and health situation) and analyse them with regard to clinical practice. Hence, we elaborate on ethical arguments for and against the conduction of coercive measures and coercive treatments in situations of danger to self or to others. By identifying normatively relevant aspects, our paper further contributes to the objective of ethically justified clinical decision-making in the context of advance treatment refusals. Finally, we summarize implications for clinical practice that follow from the legal authority of advance directives. On a general level, we discuss ethical tensions resulting from psychiatry's legal obligation to intervene in situations of danger to self or to others in the context of advance treatment refusals. On the level of the individual physician-patient relationship, we outline professional offers for consultation. Further, we reflect on their potential to better inform patients about possible far-reaching consequences (total) advance treatment refusals could entail.
- 出版日期2016-9
- 单位河北医科大学
