Inability of patients to give valid consent to psychiatric hospitalization

Abstract

The issues of voluntary and involuntary hospitalization are regulated by a very brief and incomplete Directive of the Minister of Health and Social Welfare promulgated over 30 years ago. In accordance with this Directive an individual can be admitted to a psychiatric hospital at his own request or at the request of his relative, legal representative or actual care-taker. The Court or the Public Prosecutor also is authorised to order such a course of action. In emergency cases when any delay would either have a strongly adverse effect on the patient’s condition or would endanger the life of patient or others, the patient may be hospitalized on the decision of the admitting officer. In every case referred to a mental hospital by a physician, the referring physician is obligated to personally examine the patient. The Directive has been considered a temporary regulation rather than a law. Its shortcomings with respect to the rights of an individual are self-evident and do not require commentary. The long-standing practices based on this Directive resulted in lack of perception, by a significant number of psychiatrists, of both legal and social aspects in the doctor-patient relationship. Consequently, it was not surprising that the newly proposed regulation regarding the principle of self-determination, the narrowed grounds for involuntary hospitalization, and the provision for judicial control met with serious objections.’ These objections focus mainly on the restriction of the decisionmaking functions of psychiatrists which up to now have not been controlled by law. The proposed general regulation concerning treatment and rehabilitation, as well as the provision of care and welfare assistance, are based on four main principles, namely: the principle of self-determination, the principle of informing the patient, the principle of respecting the patient’s person, and the principle of freedom of contact and correspondence. The fundamental axiom in the new regulation is the principle of self-determination. It requires that examination, treatment, rehabilitation care and assist