[Coercion in psychiatry: practical consequences of ethical aspects].

Within the framework of the legal and ethical requirements of the application of coercion in psychiatry, the perspective of its prevention is discussed. Coercion is permissible exclusively in cases of incapability of self-determination and immediate specific danger for the patient's physical integrity or life. Practical difficulties in assessing these criteria are illustrated by means of case examples. Preventive procedures for avoidance of coercion (advance directives, trust-building procedures, recognition of influence of context, sensitization against coercion) as well as clarification of indications and control of the application of coercion and a change of attitude toward assistance of decision aim at strengthening respect for the right to self-determination of the mentally ill and thereby to fairly balance the psychiatrist's conflict between responsibility for care and respect for the right of self-determination of the patient.