Coercive medical measures also possible outside the clinic in individual cases Federal Constitutional Court strengthens patients' rights in care law

The legal background

Coercive medical measures, such as the administration of vital medication or other medical treatment against the will of the person being cared for, concern one of the most sensitive areas of adult protection in terms of fundamental rights. According to the previous legal provisions of Section 1832 (1) sentence 1 no. 7 BGB (Section 1906a (1) sentence 1 no. 7 BGB, old version), coercive medical measures could only be carried out following a court order to protect the patient in the context of an inpatient stay in a hospital. In practice, this strict concept was often criticized as inflexible and potentially burdensome. The background to this is that patients can be additionally burdened or their health impaired by the necessary transportation and hospital stays, for example due to prolonged fixation or a change of location that is detrimental to dementia patients.

The specific initial proceedings at the Federal Court of Justice (BGH) that led to the current decision concerned a woman with paranoid schizophrenia who was under care and had to be repeatedly transferred from her residential facility to a hospital for her compulsory medical treatment with a neuroleptic. Her carer argued that it must also be possible to administer medication in the residential facility, as the hospital stays were disproportionately stressful due to re-traumatization and outpatient treatment in familiar surroundings would be much gentler.

The decision of the BVerfG

Following a referral to the Federal Constitutional Court, the constitutional judges ruled (case reference: 1 BvL 1/24) that mandatory hospitalization without exception does not in every case safeguard the interests and fundamental rights of the persons concerned, in particular the physical integrity under Art. 2 para. 2 sentence 1 alt. 2 GG, and must be modified.

In future, coercive medical measures will therefore also be possible in assisted living facilities or in the home environment, provided that a comparable medical standard is guaranteed there as in hospitals. Two key criteria must be met for this:

1. significant burden due to hospitalization:
In the case of hospital treatment, considerable health impairments are to be expected that can be avoided or at least significantly reduced by outpatient treatment. Other impairments of physical integrity or another position protected by fundamental rights of comparable weight may also be threatened.

2. ensuring the medical standard:
In the case of treatment at an alternative treatment location, the hospital standard in terms of the specific medical care required, including adequate follow-up care, must be expected to be almost achieved and the medical requirements fulfilled.

Legal consequences and future challenges

The written reasons for the judgment are not yet available. Until a new ruling is issued, the previous law will continue to apply. The Federal Constitutional Court has given legislators until the end of 2026 to adapt the relevant legal regulations and create a constitutional legal framework that allows coercive outpatient measures without violating the fundamental rights of those affected. This opens up scope for reforms to strike a balance between protecting physical integrity and respecting patients' right to self-determination and could also be an impetus to strengthen psychosocial support systems in the long term and promote alternatives to coercive measures.

The Federal Constitutional Court's ruling is also an important step towards taking greater account of the rights and individual needs of vulnerable people and guaranteeing appropriate treatment, even in challenging situations, in the context of the current trend towards outpatient treatment. This is because coercive measures remain the exception and must be examined with particular care, both ethically and legally. The future will show whether the new regulation meets expectations and whether a fair approach to coercive medical measures can be established.

Verena Hagen, lawyer