Re: beste wensen - Notes for judges, guardians and psychiatrists - German shrinks are informed
René Talbot
Kris Reekmans wrote:
Thanks for your good wishes.hallo,hierbij wensen ikzelf,en Psychepax , vereniging voor en door psychose- en schizofreniepatienten en hun zelfhulpgroepen ,u prettige eindejaarsfeesten en een gezond nieuwjaar toe !
I have good news from Germany!
The new law on advance (medical) directives entered into force on the 1st of September, 2009.
On this occasion we published "Notes for judges, guardians, psychiatrists" (see translation below) to educate these professions and the public about the consequences of the new law in detail and about our special advance directive (which we call a "PatVerfue") against any forced psychiatry. For promotion we added as subtitle to "PatVerfue": "Insane? Your own decision!" We also sent the "Notes for judges, guardians, psychiatrists" to some prominent people for comment and the most interesting answer we got from Prof. Edzard Schmidt-Jortzig, Chairman of the German Ethics Council (appointed by the Federal Parliament), a former federal justice minister, who also teaches law at the University of Kiel. He comments:
I find your „Notes for judges, guardians and psychiatrists" extremely helpful…
Additionally we faxed these "Notes for judges, guardians, psychiatrists" to all psychiatries with locked wards in Germany, so the doctors of all these institutions are now aware that we have confirmation of their knowledge about them.
The German-speaking shrinks are now having their big annual shrink conference in Berlin and proudly announced that about 8,000 participants will come. What a great occasion for us to supply all of them without any further expenses with a "Notes for judges, guardians, psychiatrists" flyer. Because the venue is on a "traffic island" and the only access for pedestrians is via an underpass, we have a perfect public place for our demonstration: all of the participants have to enter the venue through this underpass, where we can furbish them with our flyer, sell our magazines "Zwang" and "Irren-Offensive" and show our good mood because their system of violence has been cracked by our "PatVerfue" which is by now also a registered trade mark so the shrinks can not use any deceptive means. (Here are some photos of our demonstration: .....). More good news is that up to now there are also three lawyers among the publishers of the PatVerfue. Jan has created an English forum on facebook about the PatVerfue : http://www.facebook.com/group.php?gid=96315707940
Our task now is to campaign for the use of the PatVerfue. We are trying to raise funds for a professional advertising video clip to screen in cinemas and on youtube.
I report about this action because I think it is important to spread the news about another path to abolish forced psychiatry as, at least here in Germany, the UN disability convention turned out to be a complete failure (read here: Deception failed ) The hopes built on the convention were perhaps disappointed, because the aim of abolishing the violence in psychiatry all at once is too far reaching, as we could achieve this only with an implicit statement in such a convention. So our consideration here in Germany after the failure of the convention was to lobby for a law on advance directives, which indeed allows us to opt out of the psychiatric coercion system. This is a very important step in between, because it enables us to opt out of being diagnosed by the simple use of a signed sheet of paper. This can now be done successfully and the result is that the psychiatric lie of being able to detect an objective "mental" illness proves to be a myth, comparable with the "emperor without clothes". Because we do not want to be mentally ill, we cannot be mentally ill, being protected simply by a sheet of paper :-)
An illness which can disappear just by a declaration of the person concerned can never fulfill the criteria of an illness as an objective fact.
I hope my explanations are an incentive for other groups to intensify their activities for a change in the national law to end the cruelties the psychiatrists commit as state protected criminals.
Best regards
rene talbot
(secretary of IAAPA and
board member of "Bundesarbeitsgemeinschaft Psychiatrie-Erfahrener", a national organization of German survivors, English websites)
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Notes for judges
Judges may only make a judgement on those who are unable to give
informed consent. One must distinguish the following facts:
a) If there is no known advance directive and there is neither a
privately named representative nor a legal guardian.
In this case, the presumed will must be determined and obviously it is
the natural will not to be locked up because the person would otherwise
have voluntarily entered into a psychiatric ward or would stay there.
Physicians need to refute this (natural) will (which was strengthened
by the legislature in as much as that an advance directive may actually
be revoked) by proving a previously expressed desire to be locked up.
This is actually only possible with a positive
psychiatric advance
directive, having been expressly approved in the presence of
witnesses
(if this is in writing, case b) applies).
b) There is an advance directive without guardians or privately
named representatives.
In this case, the text in the advance directive must apply.
Interpretations are only possible with contradictory instructions in
the advance directive, or if the advance directive - as opposed to a PatVerfü is very general
and vague.
c) There is a guardian or a privately named representative and there is
no known advance directive.
In this case, the guardian or named representative must determine the
presumed will, see a), and make this known to the judge in case the
doctor says he knows the will of the person concerned better and
objects. The following must always be observed: the will of a person
overrides his well-being and/or is determined by the subjective will of
the person concerned and in that respect these are identical. This was
decided by the legislature on 18/6/2009.
d) There is an advance directive and a guardian or privately named
representative.
In this case, what stands in the advance directive must be the
determining factor. Interpretations are possible only with
contradictory statements in the advance directive or if the advance
directive - as opposed to a PatVerfü - is very general
and vague. In
particular, there shall be no psychiatric diagnosis without the
informed consent in an advance instruction, the requirement for
informed consent being explicitly stated by the legislature on
18/6/2009:
§ 1901a (1): ... When an adult, who is able to consent, puts
in writing that, in the event of his inability to consent whether he
approves or prohibits certain therapeutic or medical examinations
of
his state of health …
A judge must therefore:
1) determine whether there is an incapacity to give consent.
This requires a psychiatric assessment, which would violate a PatVerfü
and which is therefore impossible! On the basis of his own experience,
a judge can only determine an incapacity to give consent of a person in
a coma. This means a PatVerfü is a primary
protection from unwanted
psychiatric measures!
2) ascertaining if there is a coma case.
In this case, the court must first check the register of the federal
chamber of notaries for advance directives and representanion
agreements. For if there is a registered privately named
representative, then the fact itself and the name of the representative
must be immediately reported to the doctor so that he contacts the
representative and learns the likely wishes the patient had documented
in his advance directive in order to be able to act on it - preferably
by the advance directive being quickly faxed to the hospital. Any
judge´s decision is most probably then not necessary - the
"privatization" of a medical decision intended by the legislature takes
place.
3) determine whether there is an inability to give consent and
whether
there is no privately named representative or legal guardian.
If so, then the doctor or the hospital is asked whether the patient
presented an advance directive, or if he had an advance directive with
him.
If so, see b).
If not, in this case, with a coma patient maximum medical
treatment
must be the presumed will. Excluded, however, is psychiatric treatment
against his will, if no previous statement of intent for this exists,
see a).
4) determine whether there is a PatVerfü.
If so, it is very simple for the judge. As soon as a PatVerfü is presented, the
procedure can immediately be stopped.
(Therefore this information for everyone: the best is to always have an
original PatVerfü with you because
then doctors will know even before a
judge "what's going on“ and that makes their decision easy :-) )
Notes for legal guardians
Since 1/9/2009 the new legislation on advance directives is in force.
The legislature has by law made a person's will or their informed
consent to medical treatment as the relevant and decisive criterion for
this. This becomes clear in the wording of the bill:
§ 1901a Advance directives
(2) If there is no advance directive or should the specifications of
the advance directive not be in accordance with the current living and
treatment situation, the guardian must find out the wishes for
treatment or the presumed intention of the person under guardianship to
determine and decide on that basis if he consents to or prohibits a
medical action under paragraph 1. The presumed will is to be determined
on the basis of actual evidence. Considerations include particular
previous oral or written statements, ethical or religious beliefs and
other personal values of the person under guardianship.
A court-appointed guardian thereby has the duty to ascertain the wishes
of a person under care or to determine his presumed will on the basis
of concrete evidence if there is not already e.g. a PatVerfü, a
psychiatric will, or an advance directive with similar goals. A
decision without a thorough investigation would be negligent (if not
grossly negligent) if however, on the basis of a lack of knowledge, no
intent can be imputed. Confinement in a psychiatric hospital, or even
forced treatment due to a negligent investigation or even against a
better knowledge may be legally punished if the person concerned should
prosecute. Since the guardian now more than ever is in charge of the
process, he also has a special responsibility for careful
investigation.
If a guardian should ever learn of the existence of an advance
directive, whether it had been declared in writing or orally in the
presence of witnesses, in which psychiatric forced incarceration,
coercive treatment or even just a psychiatric diagnosis without mutual
agreement has been prohibited, the new law now obliges him to do
everything in his power so that these unwanted medical interventions
are not undertaken. Only if he has received an up to date signed
statement from the person concerned that there is no such oral or
written order, or one that might ever have been made is now definitely
no longer valid, is forced incarceration a possible option at all, as
the current will of the person concerned is not to be locked up because
this person would otherwise voluntarily enter or stay in a psychiatric
ward.
A person can only be detained or even treated against his current will,
if earlier such treatment was explicitly approved and such an approval
has also never been revoked (see e.g. positive
psychiatric advance
directive), or it is documented in writing that he/she has
never had an
advance directive and in addition the person concerned has committed
himself to informing the guardian accordingly about issuing a new
advance directive.
Without such a written statement about the nonexistence of an advance
directive, a guardian is always in danger, perhaps through an oversight
not to have noticed that the person he is the guardian of once said
that he had an advance directive. If the person in guardianship has a
witness for this statement, the guardian could quickly have a criminal
and also a civil law problem due to compensation claims for pain and
suffering of the person under guardianship. This would be the case if
the guardian should apply for forced incarceration or even coercive
treatment in the court, simply because a doctor sees a need for
treatment and maybe even wants to prevail with this by an alleged
„danger to oneself or others“.
For the prevention of endangerment, it is the police who is in charge,
resticted by the law to criminal investigations, not a preventive
medical oracle.
For judging a situation, it is therefore NOT important, what doctors
think is advisable and necessary, or what prognosis they make, rather
the current will of the person under guardianship has priority. Only
when the person under guardianship has been judged by a court as having
an „inability of informed consent due to illness" must his previous
wishes or interdictions be determined and only then, if on the basis of
concrete evidence his informed consent to use coercion can be
documented, a guardian can consider a forced incarceration because only
then will a medical judgement come into play.
Notes for psychiatrists
On 18/6/09, the legislature made a far-reaching and radical decision with regard to psychiatry because, by this new law, the will of the patient is given priority over his well-being, which reduces psychiatric paternalism to a residual category. This is done by the fact that now the well-being of adults is defined subjectively by themselves, in accordance with their wishes and volition, even if it can only be speculated about his will. Up till now, the determination of well-being was left to expert opinions by doctors, whose judgement was almost always confirmed by the judges. For legitimation the decision should appear as "objective" or "rational", but in fact this only documents a governing power structure: psychiatric paternalism.It becomes a residual category because only if it is established that:
a) a person has no PatVerfü, and
b) knowingly and willfully approved psychiatric diagnosing, namely after having been extensively informed about its potential effects, consequences and side effects and any potential further uses of this diagnosis,
may a psychiatric diagnosis be made at all.
The legislature has specially also included this first step of medical procedures in the new Civil Code § 1901a and placed under the condition of the approval of the person concerned that:
(1 When an adult, who is able to consent, puts in writing that, in the event of his inability to consent whether he approves or prohibits certain therapeutic or medical examinations of his state of health…
For the very reason that for judges, the law is a guideline and yardstick for the decision, courts can only then order the making of a psychiatric diagnosis by force, when in doing so the notes for judges [see here] are observed *. Psychiatric diagnoses without informed consent of the person concerned can therefore only become legal by his prior approval of this first medical step being documented in writing or proven by witnesses. Illegal investigations are a violation of Personal Rights and can lead to serious penalties - for example: illegally made HIV or genetic tests. They are incompatible with medical ethics.
We make the following recommendations although we are convinced that there is no such thing as a mental illness and therefore nothing can be psychiatrically diagnosed anyway. But because doctors (so far!) do not share this premise, the following advice is made assuming the fiction that it does exist and psychiatric specialists could offer help.
The violence inherent in all psychiatric measures, either as direct coercion, or only as implicit, structural threat of imprisonment in a "locked ward" and the coercive treatment in them, has to be replaced by persuasion:
The patient must be convinced by factual proof that a psychiatrist´s suggestions in no case are followed by any non consensual act by him. The informed consent of the patient should be documented each time anew e.g. by his signature. The patient´s right to say "no" must be valid not only at any time, but should also be believed and felt by him to be the case. A tool of persuasion could be e.g. the offer of the physician to document his rigorous and strict observance of medical confidentiality, especially with regard to all state institutions and courts, by a written confirmation given to the patient. Of course any expert opinion delivered to a court for a forced incarceration of a patient according to any mental health act is completely incompatible with such a confirmation and should even be unthinkable.
It is very convincing for the patient if he is repeatedly offered the option to also say "no" and that he can leave whenever he wants, and other outpatient aid is offered to him.
Given that the history of psychiatry is a history of the cruel use of violence and the most brutal of human rights violations, only in a long-lasting and irreversible process of absolute non-violence can trust in psychiatric specialists develop at all. The alternative is the complete abolition of this profession.
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* If a patient remains persistently silent, (illegal) torture methods would have to be used to make the patient speak. This is why the best advice to a person in this situation is stony silence with regard to any psychiatrist.
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These notes are also published in the internet: http://www.zwangspsychiatrie.de/non-german/notes-for-judges-guardians-and-psychiatrists