Textbook of psychiatry
H35 Psychiatry and the law
Psychiatric patients are vulnerable:
1) The psychiatric illness may affect their legal capacity
2) They can be subjected to involuntary admission and compulsory treatment
Import to respect their rights as far as possible!
Wet geneeskundige behandelovereenkomst (WGBO): applies to all physical and psychiatric
treatments that patients undergo voluntarily
It may also apply to physical treatments that patients do not undergo voluntarily
but are not included in a care plan as referred to in the Wvggz or the Wzd.
The Wet zorg dwang (Wzd) and the Wet verplichte GGZ (wvggz) allow for involuntary
physical care to be provided if the patient’s refusal of physical care is caused by its
psychiatric disorder or psychogeriatric disorder or intellectual disability (included in a care
plan/authorization).
WGBO:
In principle, an examination or treatment may only take place under the WGBO once the
patient’s consent has been obtained. The doctor must have provided sufficient information
and must have made certain what the patient’s wishes are. If there is reason to doubt a
patient’s legal capacity assessment of the capacity: is the patient capable of…
1) Expressing a choice
2) Understanding the information provided
3) Realizing and evaluating the significance of the information provided for their own
situation
4) Reasoning logically and taking the information provided into account when weighing
up treatment options
Psychiatric illness may harm the capacity to make decisions, but certainly not always. The
capacity to make decisions may also vary over time (delirium for example).
If a patient is legally incapable, substitute consent must be obtained from a representative:
1) A guardian or mentor (appointed by court)
2) An individual authorized by the patient in writing
3) The spouse or life partner
4) A parent, child, brother, sister, grandparent or grandchild
If a legally incapable patient refused treatment, that refusal may only be bypassed under the
WGBO if the treatment is clearly necessary to avoid serious harm to the patient. If a patient
does not cooperate with treatment because of a comorbid psychiatric disorder Wvggz.
both compulsory psychiatric and physical care may be provided under the Wvggz
H35 Psychiatry and the law
Psychiatric patients are vulnerable:
1) The psychiatric illness may affect their legal capacity
2) They can be subjected to involuntary admission and compulsory treatment
Import to respect their rights as far as possible!
Wet geneeskundige behandelovereenkomst (WGBO): applies to all physical and psychiatric
treatments that patients undergo voluntarily
It may also apply to physical treatments that patients do not undergo voluntarily
but are not included in a care plan as referred to in the Wvggz or the Wzd.
The Wet zorg dwang (Wzd) and the Wet verplichte GGZ (wvggz) allow for involuntary
physical care to be provided if the patient’s refusal of physical care is caused by its
psychiatric disorder or psychogeriatric disorder or intellectual disability (included in a care
plan/authorization).
WGBO:
In principle, an examination or treatment may only take place under the WGBO once the
patient’s consent has been obtained. The doctor must have provided sufficient information
and must have made certain what the patient’s wishes are. If there is reason to doubt a
patient’s legal capacity assessment of the capacity: is the patient capable of…
1) Expressing a choice
2) Understanding the information provided
3) Realizing and evaluating the significance of the information provided for their own
situation
4) Reasoning logically and taking the information provided into account when weighing
up treatment options
Psychiatric illness may harm the capacity to make decisions, but certainly not always. The
capacity to make decisions may also vary over time (delirium for example).
If a patient is legally incapable, substitute consent must be obtained from a representative:
1) A guardian or mentor (appointed by court)
2) An individual authorized by the patient in writing
3) The spouse or life partner
4) A parent, child, brother, sister, grandparent or grandchild
If a legally incapable patient refused treatment, that refusal may only be bypassed under the
WGBO if the treatment is clearly necessary to avoid serious harm to the patient. If a patient
does not cooperate with treatment because of a comorbid psychiatric disorder Wvggz.
both compulsory psychiatric and physical care may be provided under the Wvggz
