Can you make contraception mandatory for psychiatric patients? Students learn about the health rights of people with disabilities

André den Exter

How can we safeguard the rights of people with disabilities and where do we draw the line when it comes to self-determination for this group? These are the central questions in André den Exter’s International Health Law course. “This course give me a broader view of the law.”

"What have you seen in the news over the past week?” lecturer André den Exter asks his students. He always kicks off this course with an overview of current events in the field of health law. “I read that the case against the nurse who was suspected of killing twenty COVID patients has been dropped”, says a student.

Duty of confidentiality

The case against nurse Theodoor V. had been initiated on the basis of information from the mental health service in Drenthe. Because the nurse had turned off ventilators and administered extra morphine, twenty COVID patients reportedly died. V. himself allegedly confessed this to counsellors of the mental health service in Drenthe, where he was undergoing therapy for mental health issues. The counsellors passed on the information to Wilhelmina Hospital in Assen, where V. worked. The hospital then filed a complaint against the nurse.

“But can you just pass on information your client shares with you during a therapy session?” Den Exter asks the students. He gives them a hint: “Think about the Mandatory Mental Healthcare Act.”

“I understand that psychologists have a duty of confidentiality, but what V. is said to have done put other people at risk. So I guess it’s possible in this case?”, one student says uncertainly.

“I think you’re only allowed to breach confidentiality if you think the danger still exists and there’s a risk of the act being repeated in the future”, another student says.

“Exactly”, the lecturer nods. “That’s the key point: the risk of repetition of the offence.”

Legal issues

In the course, the lecturer discusses a variety of legal issues in the field of care for people with disabilities: from the right to termination of life to the shackling of psychiatric patients in Asian countries and the restraining of Brandon, a patient with an intellectual disability.

The story of Lena is also examined. Lena is a 25-year-old woman from the United States. She is a patient in a mental institution. Given her past drug use and abortion, she is being given contraception without her consent. According to the psychiatrist, pregnancy would worsen her mental state. Lena does not want contraception, but the Supreme Court has allowed the compulsory treatment to go ahead.

“How do you feel about this?”, the lecturer asks. “Is forced contraception a violation of her health rights?”

“It’s difficult”, responds one student. “On the one hand, it’s obviously an infringement of her bodily autonomy, but on the other hand, she’s a patient with a mental disability. I don’t know where to draw the line in terms of self-determination.”

“Clearly, to answer the question we’d need access to Lena’s full medical records”, the lecturer says. “But if you had to represent Lena, you could bring up the United Nations Convention on the Rights of Persons with Disabilities. You could also look at sexual and reproductive rights in the United Nations Convention on the Elimination of All Forms of Discrimination against Women.”

Real-life cases 

One of the students, Cuno, says that examining and discussing these cases is what makes the course fun. “I don’t have courses like this in my degree programme”, says the exchange student from the Republic of Ireland. “We’re just given the theory and have to memorise laws. I love that we’re talking about real-life cases here.”

Another student, Kyara, agrees. “The topics in this course are not covered in other courses. The cases are varied and socially relevant. They’re usually about topics that are in the news or are being discussed a lot on social media.”

The logic behind the law is what Bernardo finds most interesting about the course. “The lecturer is good at explaining the legal framework behind a law, which gives me a broader view of the field. I think that’s really cool.” Fellow student Mariline adds: “He also tries to keep the course interactive and does a great job of leading the discussion. He provides context and explanations where necessary.”

More information

Written by Feba Sukmana

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