The role of patient competence in the new Dutch statute concerning involuntary treatment in psychiatry
Background In the new Compulsory Mental Health Care Act (Wvggz), patient competence has a more central position.
Aim To describe the new position of patient competence in the Wvggz and to reflect on related moral questions.
Method Discussion of relevant legal texts and publications.
Results In case of incompetency of a patient, a surrogate decision-maker has to attempt what decision the patient would make if he or she were competent. A new element in the Wvggz is that grandparents and grandchildren can also act as surrogate decision-makers. A competency judgment is mandatory in every decision on involuntary treatment, with the exception of involuntarily commitment. Competent refusal of care has to be respected, unless the patient is in a life threatening situation or there is a risk of other people getting harmed.
Conclusion The question is whether the changed position of patient competence in the new law will contribute to the aim of maintaining and enhancing patients’ autonomy. Due care in competency judgments is complex and remains important.