[Significance of a recent amendment on advance directives for psychiatric patients in Germany]

Current legal regulations concerning the right of self-determination of subjects who are not competent to give consent have been in force since 2009. According to the new regulations, such subjects can exercise their right of self-determination through a legal guardian who will assess and impose their will. If there is an operative advance directive covering the specific case, the guardian is bound by the provisions laid down in it. Although primarily intended for end-of-life decisions, the law applies in all cases of a subject's inability to give consent, including the context of mental illness. It allows the persons concerned to define certain aspects of medical treatment in advance. On the one hand, the right of self-determination of mentally ill people is thus strengthened. On the other hand, the new regulations can also cause significant ethical conflict involving patients and their representatives as well as family members and practitioners. The present contribution presents the consequences of the amendment for the treatment of mentally ill people. Case studies are described in order to illustrate the new regulations in clinical situations.