Are psychiatrists there for themselves

Psychiatry, Psychosomatics & Psychotherapy

Self-determination means the ability and ability to freely decide and act according to one's own will. It is an elementary right of all people and is guaranteed in the first two articles of the German Basic Law. The patient's right to self-determination is also at the center of medical decisions. In concrete terms, it means that a patient has the right to agree to or reject any examination method as well as surgical, medicinal or other therapy or care measures. His will goes beyond what the doctor sees as best for his patient. If a doctor were to treat a patient despite his refusal, he would even be liable to prosecution under German law, i.e. he could be accused of bodily harm.

The doctor has the obligation to inform his patient in as much detail as desired in a form adapted to the understanding (patient education). This includes a statement about the most appropriate method for the situation, whereby financial restrictions may initially not play a role. On the basis of this information, the patient can then make his own decision.

Self-determination has its limit if the person concerned lacks the ability to discern, i.e. he is neither able to understand the doctor's explanation nor to make a comprehensible decision. This is especially true for a number of mental illnesses. If the doctor comes to the conclusion that his patient is incompetent, he must apply to the court for a legal guardian (right to care). In cases of doubt, a psychiatric or neurological report may be necessary.

Possibilities of expression of will

The self-determined decision can be expressed in the following ways:

  • If the patient is able to make decisions himself, orally or in writing
  • If the patient is unable to make a decision, by means of his written living will, which was drawn up during healthy times

If the patient is incapable of making a decision and there is no living will, a decision is made by someone else:

  • By a person named in a power of attorney
  • If there is no power of attorney by a court-appointed supervisor
  • Otherwise, the presumed will of the patient is asked of the relatives or other close reference persons
  • If this is ultimately not possible, the doctor will make a decision based on the best medical judgment

The basis for decision-making is to be recorded in the patient file, also known as the patient file (right to inspect medical records).


Against the background of self-determination, the subject of euthanasia is discussed again and again. Euthanasia is the support in the subjective reduction of suffering. The prerequisite is that no further medical measure brings a cure or at least a halt to the disease.

According to their professional code of conduct ((model) professional code for doctors working in Germany), doctors have the task of maintaining life, alleviating suffering and providing support in the event of dignified dying. This does not include any measures that merely delay death, but also no specific assistance in the event of suicide.

Passive euthanasia

Within the framework of the right to self-determination, everyone can determine the type and goal of their treatment. He can also reject therapy that merely postpones death. However, it is important to record this in a living will in good time so that the doctor refrains from all life-prolonging measures if the patient is unable to make a decision. At the same time, the order gives the doctor the guarantee that he will not be liable to prosecution for failure to provide assistance.

Active euthanasia

It is a criminal offense in Germany. It is irrelevant whether the killing occurs at the request of the dying person or without his request. The latter can even be punished as murder.

Indirect euthanasia

It is exempt from punishment if the patient either agrees in the current situation or a corresponding living will is available. These are strong drugs (e.g. morphine) that are administered in palliative therapy to relieve pain or other ailments. At the same time, however, they carry the risk that the patient may die earlier, for example because they flatten the cardiovascular system or breathing.

Assistance to suicide

If someone gives a dying person a means of suicide, this basically remains unpunished. Within the framework of his professional code, the doctor may only prescribe medication to his dying patient with the aim of alleviating the suffering, even if these are suitable for suicide.