Particularly in inpatient facilities, measures can be observed which, due to their coercive character, represent a serious infringement of the fundamental rights of the person concerned. Therefore, it is especially important that such measures are ethically and legally justified. Coercive measures include, among others, the custodial placement of persons in hospitals and other inpatient facilities, the treatment of mental and somatic illnesses without the person’s consent, restraint through medication in cases of challenging behaviour, as well as custodial measures such as the use of bed rails or restraint belts and structural coercion.
The German Ethics Council is currently preparing an Opinion on the following questions: which forms of coercion can be identified; what role coercive measures play in fields such as psychiatry, nursing, social work, child and youth services as well as disability welfare; to what extent these measures are ethically and legally problematic; and what need for change exists for practice and legal regulation. Of particular interest to the Ethics Council are those coercive measures that are carried out based on the justification of ensuring the self-protection of the person concerned (so-called “benevolent coercion”).
The second hearing on the topic will focus on coercive measures used in child and youth services and will seek expertise from educational science, law, administrative practice and selected facilities. Children and adolescents are subjected to coercion, e.g. through measures involving deprivation of liberty, but also through forced medication or other coercive treatments, contact bans as well as the use of reward and punishment systems and similar restrictive pedagogic measures.
At the hearing, the German Ethics Council intends to inquire about experiences with forms of benevolent coercion in child and youth services, address the state of research in this area and discuss measures to promote the self-determination of children and youths, as well as mechanisms to control coercive measures and possible alternatives. The German Ethics Council will also question young people who have experienced such a situation. In order to protect those affected, this part of the hearing will not be public.
The first hearing concerning the different fields in which benevolent coercion plays a particular role covered the field of psychiatry and took place on 23 February 2017. The third hearing will be held on 19 May 2017 on elderly and disability care. In addition, the German Ethics Council is conducting an online survey on all three areas, which is open to all interested individuals and institutions.