1. Kommentar I zum Fall: Ethisch vertretbare Anwendung freiheitsentziehender Maßnahmen zur Durchführung einer Chemotherapie?

    Gather, J. K. Hoffmann 2018. Kommentar I zum Fall: Ethisch vertretbare Anwendung freiheitsentziehender Maßnahmen zur Durchführung einer Chemotherapie? Ethik in der Medizin 30 (4): 367-​369. https://doi.org/10.1007/s00481-​018-​0504-​x

  1. Interviewing a Person With Bipolar Disorder Under Involuntary Commitment: A Case Report

    Gather, J. J. Kalagi I. Otte G. Juckel 2019. Interviewing a Person With Bipolar Disorder Under Involuntary Commitment: A Case Report. Journal of Empirical Research on Human Research Ethics. https://doi.org/10.1177/1556264619847322

    In this case report, we report an ethical problem that we faced in the course of an interview study on open-door policies in psychiatry with persons under involuntary commitment. One of the interviewees was a young woman with bipolar disorder who was under involuntary commitment at the time of the interview. While the woman had been assessed as competent and gave informed consent to research participation, her manic symptoms increased when the interview became increasingly distressing for her. Because of this, we decided to break off the interview and resume it at a later point of time. Within the research team, we raised the following ethical questions: (1) Was the participant, contrary to the initial assessment, unable to give consent for the study? (2) Was the voluntariness of her research participation compromised by her manic symptoms and involuntary commitment? (3) Should the participant have been excluded from the study against her expressed wish? (4) Should we have refrained from interviewing persons who were still under involuntary commitment?
  1. Qualitative research with vulnerable persons: How to ensure that burdens and benefits are proportional and fairly distributed

    Gieselmann, A. S. Efkemann M. Scholten 2019. Qualitative research with vulnerable persons: How to ensure that burdens and benefits are proportional and fairly distributed. Journal of Empirical Research on Human Research Ethics. https://doi.org/10.1177/1556264619847322b

    This case commentary investigates whether the risks and benefits of an interview study with persons under involuntary commitment on open-door policies in psychiatry were proportional and fairly distributed. Given that there is little data available on the views of service users on open-door policies, the study had significant social value. Because the individual benefits are limited in studies like this, we recommend that special measures be taken to forestall what has been called the “therapeutic misconception.” The study imposed burdens on individual research participants, as evidenced by the distress that a woman with bipolar disorder experienced during the interview. Risks and burdens must be actively monitored in qualitative studies with persons under involuntary commitment. If the actual burdens are disproportional, interviews must be interrupted and risks must be reassessed. A common principle for the fair distribution of the risks and burdens of research participation says that a research study may be carried out with vulnerable persons only if the research aims cannot be attained by including only persons who are not vulnerable. In the study under discussion, both persons who were still involuntarily committed and persons who were no longer committed were included. This indicates that either the aforementioned principle is not fully satisfied or the validity of the study is somewhat compromised. Judging that the latter option is more likely, we contend that this compromise is ethically defensible.
  1. Wodurch wird die geschlossene Tür ersetzt? Konzeptionelle und ethische Überlegungen zu offenen Unterbringungsformen und psychologischem Druck

    Gather, J. M. Scholten T. Henking J. Vollmann G. Juckel 2019. Wodurch wird die geschlossene Tür ersetzt? Konzeptionelle und ethische Überlegungen zu offenen Unterbringungsformen und psychologischem Druck [What replaces the locked door? Conceptual and ethical considerations regarding open door policies, formal coercion, and treatment pressures]. Der Nervenarzt 90 (7): 690-​694. https://doi.org/10.1007/s00115-​019-​0717-​3

  1. Psychiatric advance directives under the Convention on the Rights of Persons with Disabilities: Why advance instructions should be able to override current preferences

    Scholten, M. A. Gieselmann J. Gather J. Vollmann 2019. Psychiatric advance directives under the Convention on the Rights of Persons with Disabilities: Why advance instructions should be able to override current preferences. Frontiers in Psychiatry 10 (631). https://doi.org/10.3389/fpsyt.2019.00631

    Psychiatric advance directives (PADs) are documents by means of which mental health service users can make known their preferences regarding treatment in a future mental health crisis. Many states with explicit legal provisions for PADs have ratified the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). While important UN bodies consider PADs a useful tool to promote the autonomy of service users, we show that an authoritative interpretation of the CRPD by the Committee on the Rights of Persons with Disabilities has the adverse consequence of rendering PADs ineffective in situations where they could be of most use to service users. Based on two clinical vignettes, we demonstrate that reasonable clinical recommendations can be derived from a more realistic and flexible CRPD model. Concerns remain about the accountability of support persons who give effect to PADs. A model that combines supported decision making with competence assessment is able to address these concerns.
  1. Ist Forschung in der forensischen Psychiatrie ethisch zulässig?

    Gather, J. K. Radenbach A. Jakovljevic 2019. Ist Forschung in der forensischen Psychiatrie ethisch zulässig? Ethik in der Medizin 31: 201-​205. https://doi.org/10.1007/s00481-​019-​00540-​7

  1. Nieuwe ggz-​wet tast privésfeer van patiënten ernstig aan

    Scholten, M. 2020. Nieuwe ggz-​wet tast privésfeer van patiënten ernstig aan [The new Dutch law on compulsory mental healthcare violates service users’ right to privacy]. NRC Handelsblad.

    The new Dutch law on compulsory mental healthcare allows for ambulatory coercion. It grants mental health professionals not only permission to apply involuntary medication and physical restraint in people's homes, but also to do body and home searches and to keep people under surveillance. This opinion piece criticizes the new law.