Psychiatrische Patientinnen in der Geburtsmedizin in Deutschland – die juristischen Grundlagen und eine thematische Analyse von Fallbeispielen

Zusammenfassung

Die Betreuung von erwachsenen Patientinnen mit insbesondere schwersten psychiatrischen Erkrankungen im klinischen geburtshilflichen Alltag ist selten, stellt aber aufgrund ihrer Komplexität eine große Herausforderung für alle beteiligten Professionen dar. Die Krankheitsbilder sind sehr variabel. In der Versorgung gibt es eine Reihe von Zuständigkeiten, die ineinandergreifen. Für die Geburtsplanung ist die medizinisch-fachliche Zusammenarbeit von Psychiatrie, Geburtsmedizin und Pädiatrie notwendig. Die Patientinnen werden oftmals durch gesetzliche Betreuer*innen vertreten. Für das Wohl der Familie und der Kinder ist das Jugendamt zuständig. Die rechtlichen Grundlagen liefern im Wesentlichen das Bürgerliche Gesetzbuch, das Strafgesetzbuch und spezifisches Landesrecht, deren Einhaltung durch Gerichte überwacht wird. Anhand von Fallbeispielen werden typische psychiatrische Krankheitsbilder exemplarisch vorgestellt. Juristisch definierte Anwendungen wie Unterbringung, unterbringungsähnliche freiheitsentziehende Maßnahmen, ärztliche Zwangsmaßnahmen und rechtfertigender Notstand werden erläutert. Im Sinne einer thematischen Analyse werden diese auf die Fallbeispiele angewendet und das peripartale Management wird vor dem rechtlichen Hintergrund diskutiert. Die genaue Kenntnis der juristischen Hintergründe erleichtert Geburtsmediziner*innen die Handlungsabläufe und die interdisziplinäre Zusammenarbeit insbesondere an perinatologischen Zentren.

Abstract

The care of adult patients with particularly severe psychiatric illnesses in the daily routine of inpatient obstetrics is rare, but due to its complexity it represents a great challenge for all professions involved. The clinical pictures are very variable. There are a number of interlocking responsibilities in the provision of care. For planning of the birth, the medical-professional cooperation of psychiatry, obstetrics and pediatrics is necessary. Patients are often represented by legal guardians. The Youth Welfare Office is responsible for the welfare of the family and the children. The legal basis is essentially provided by the Civil Code, the Criminal Code and specific state laws, compliance with which is monitored by the courts. Typical psychiatric clinical pictures are presented by means of case reports. Legally defined applications such as accommodation, measures similar to deprivation of liberty, compulsory medical measures and justifiable necessity are explained. In the sense of a thematic analysis, these are applied to the case reports and peripartum management is discussed against the legal background. The precise knowledge of the legal background makes it easier for obstetricians to follow the procedures and interdisciplinary cooperation, especially at perinatalogical centres.

Schlüsselwörter

Ethik - Geburtshilfe - interdisziplinäres Vorgehen - mütterliche Risiken - Rechtssprechung

Keywords

ethics - obstetrics - interdisciplinary process - maternal risks - medico legal problems

Publication History

Received: 26 February 2021

Accepted after revision: 18 June 2021

Article published online:
07 September 2021

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