Self-determination and forensic addiction treatment : Reflections on the tension between patient autonomy and the preventive function of Sect.64 of the German Criminal Code (StGB) from apsychiatric, ethical and normative perspective

Abstract

Among the current proposals for the upcoming reform of forensic addiction treatment according to Sect.64 of the German Criminal Code (StGB), that of the DGPPN stands out as the most far-reaching. Among other things, it calls for making the ordering of the measure dependent on the consent of the defendant and the regular and voluntary demonstration of the willingness to undergo treatment. Prior to treatment in aforensic addiction facility, those affected should reliably participate in addiction-specific treatment offers in the prison setting. Acritical reflection on the key assumptions and implications of this reform proposal with respect to treatment motivation and the right or ability to self-determination. These assumptions are analyzed and discussed from psychiatric, medical-ethical and legal-normative perspectives. Neither the setting nor the resources of aprison seem to make it asuitable place for the motivationally critical phases of (probationary) addiction treatment. The approach that only those who have previously demonstrated therapy motivation in word and deed should have the "advantage" of forensic withdrawal therapy, would not do justice to the complexity of substance use disorders and would lead to an overestimation of the already elusive concept of therapy motivation in the context of this disorder. Also, from an ethical perspective, self-determination in forensic addiction patients appears too understudied, both conceptually and empirically, to justify such afar-reaching approach. On anormative level, the new approach would remove an effective special prevention instrument from the hand and create an imbalance in the structure of sanctions.