Federal Constitutional Court: Karlsruhe overturns strict hospital obligation to take coercive measures

The absolute ban on coercive medical measures outside of hospitals is partly unconstitutional. This was decided by the Federal Constitutional Court in Karlsruhe. The legal regulation in question is partly incompatible with the fundamental right to physical integrity, said court president Stephan Harbarth when the verdict was announced. (Af. 1 BvL 1/24)

Medical measures against the will of patients should only ever be the ultima ratio – i.e. the last resort, the First Senate in Karlsruhe emphasized several times. The relevant law sets certain requirements and currently stipulates that these measures may only be carried out “as part of an inpatient stay in a hospital in which the appropriate medical care for the person being cared for, including any necessary follow-up treatment, is guaranteed”.

Senate calls for exceptions

In principle, the Karlsruhe judges ruled that tying the coercive medical measure to an inpatient stay in the hospital is permissible. However, the absolute requirement that this only take place in the hospital is not constitutionally justified. The Senate obliged the legislature to adopt new regulations by the end of 2026. Until then, the previous law continues to apply.

According to the highest court, the hospital reservation is disproportionate if certain conditions are met. The first is that the person concerned is at risk of significant impairment of their physical integrity. In addition, this impairment must be able to be avoided or at least significantly reduced in the facility in which those affected are housed. It is also a condition that the standard of the facility is almost similar to a hospital in terms of the necessary medical care.

In this specific case, the Federal Constitutional Court examined the situation of a woman from North Rhine-Westphalia who, according to the Federal Court of Justice (BGH), was suffering from, among other things, paranoid schizophrenia. She lives in a residential complex and regularly receives compulsory treatment in a nearby hospital.

In 2022, her carer reportedly requested that the woman be given medication at the residential complex ward. He argued that in the past, transport to the clinic was sometimes only possible by restraining the patient. This regularly leads to retraumatization for her. Courts rejected the application, so this case ultimately ended up at the BGH.

The BGH had referred the issue to the Federal Constitutional Court because it considered the current legal situation to be incompatible with Article 2 of the Basic Law. This article entails a duty of the state to protect against impairments of physical integrity and health. The Federal Constitutional Court now followed this assessment.

According to the Senate, the legislature has various options to eliminate the identified constitutional violation. Either it abolishes the requirement for an inpatient hospital stay and replaces it with a regulation that is more flexible for all cases of application, or it fundamentally maintains the ban on coercive medical measures outside of hospitals and supplements it with an exception regulation.

The Federal Association of Experienced Psychiatrists was dismayed after the verdict. The state’s duty to protect its citizens is “perfidiously turned into the opposite”. Violations of the UN Convention on the Rights of Persons with Disabilities are inevitable. The association announced that it would, if necessary, bring cases of compulsory outpatient treatment to the UN Committee on the Rights of Persons with Disabilities in Geneva.

“We are not pleased with today’s verdict because it creates mistrust in the patient-therapist relationship,” explained Rüdiger Hannig from the Federal Self-Help Association after the hearing. “The clinic’s high protective fence” will be torn down. “On the other hand, we see that the possibility is kept very small. It depends on the legislature how it is formulated now.”

Andrea Gerlach, the head of the housing association where the woman in the specific case is housed, once again welcomed the Senate’s decision. A new regulation would mean less suffering for the patient, said Gerlach. Until now, she had to be driven to the clinic under “extremely high” levels of coercion. A new solution could reduce this pressure for the patient.