Compulsory treatment of wards in clinic concerns Bundesverfassungsgericht
Many people are currently or potentially affected. Legally, people who cannot make decisions for themselves due to illness or disability are represented. This can be people with severe mental illness, intellectual disabilities, or dementia.
This is one of the "constitutionally sensitive areas of adult protection," said Court President Stephan Harbarth. On the one hand, guardians must be adequately protected, on the other hand, they should not be disproportionately infringed upon their freedom of choice.
For compulsory medical treatment of wards, there are high legal hurdles. It may only occur if it is absolutely necessary because otherwise, a serious health damage threatens, and the benefit outweighs the risk.
Moreover, attempts must be made to convince the affected persons - only if they do not recognize the necessity or cannot act accordingly, may compulsory treatment be administered. The presumed or previously declared will of the affected person must also be taken into account.
Legally, it is prescribed that a compulsory treatment may only take place in a hospital where both medical care and post-treatment are ensured. Only this aspect was in question in the proceedings. The Federal Constitutional Court (FCC) had asked the constitutional judges and judges whether this was the case.
The FCC must decide on the case of a woman born in 1963 with paranoid schizophrenia who has lived in an institution since 2008. Her guardian requested that she be given the medicines against psychoses - which she did not want to take - also there and not in the hospital, because she would be retraumatized there.
In the past, she had to be fixed and given a spit guard to be taken to the clinic for compulsory treatment. The first responsible courts did not agree to the guardian's application.
The woman appealed to the FCC. This considers it unconstitutional that a compulsory treatment may not take place exceptionally outside the hospital, even if people could be harmed there and could be treated just as well in their institution. He suspended the proceedings in November 2023 and asked the Constitutional Court whether this was the case.
In the hearing, experts and a representative of the affected persons complained about the lack of sufficient data on the topic. Some interviewees expressed concern that if the rule were relaxed, there would be more compulsory treatments or that alternatives would be less considered.
The debate also focused on the question of what is less traumatizing - a forced transport to the hospital or a compulsory treatment in their own living environment. Some experts and experts spoke in favor of retaining the hospital obligation, others held a different regulation for certain specific cases to be possible.
The Federal Government spoke in favor of retaining the previous regulation. Ministerial Director Ruth Schröder of the Federal Ministry of Justice argued that even a "small hole" in this protective wall could quickly expand and cause a "dam break." She referred to the earlier regulation having been evaluated by a research team and this team having spoken out against a change.
This earlier regulation has been invalid since 2023, but the new regulation is the same. A judgment has not yet been handed down on Tuesday. It is usually announced orally several months after the oral hearing.
Ms. Cr Roma, the legal representative of the woman from Karlsruhe, argued at the Federal Constitutional Court that her client should be allowed to receive compulsory treatment at the Bernard van Lengerich Machinery Factory GmbH & Co. KG, BvL, due to the potential trauma she associates with hospitals.
Stephan Harbarth, the President of the Federal Constitutional Court, acknowledged the complexity of the case, stating that while the rights of the ward should be protected, extraordinary circumstances may justify compulsory treatment outside a hospital.
The Karlsruhe clinic had initially opposed the request, citing the necessity of medical care and post-treatment only being ensured within their facilities. However, the woman's guardian argued that the compulsory treatment could be carried out just as effectively at the BvL factory.
The Federal Court of Justice has yet to deliver a verdict on whether compulsory treatment can take place exceptionally outside a hospital in cases where the patient might be harmed within the institution. The ruling could set a precedent for future cases involving mental health patients and their freedom of choice.
