Nutzen und Risiken psychiatrischen Handelns und das Selbstbestimmungsrecht des Patienten

The history of psychiatry shows that a right of self-determination of the mentally ill was widely unknown in the nineteenth century and became known in medicine through the juridical concept of informed consent as late as in the second half of the twentieth century. Since the beginning of the twenty-first century this human right has been increasingly recognized and respected in medical practice. This change of recognition is contributing to a change from a paternalistic to a participative medical attitude. In the context of an emancipatory development of society the increasing possibilities of effective therapies, which are rarely without risks, stimulate the necessity to inform the patient about the intended benefits and the potential risks of the recommended intervention. This gives the patient the opportunity to exercise the right of self-determination. Furthermore, by the transition from very successful acute medicine, although often with only short-term contact between physician and patient to long-term therapies of chronic diseases, the possibilities to understand the patient are increased, particularly in the mentally ill patient. This also enables the individual characteristics to be recognized better, both the restrictions and capabilities, to experience the patient as an individual, as a human being with individual peculiarities and to respect the right of self-determination by helping the patient to understand the benefits and risks of a recommended intervention and to balance them in a self-determined mode.