As soon as Adolf Hitler came to into power in 1933, four laws on racial segregation and race protection were edicted between 1934 and 1935. Schizophrenia, manic-depressive psychoses, epilepsy and alcoholism were regarded as hereditary mental illnesses. These laws were responsible for the sterilisation of 350,000 individuals who were thought to be at the source of the propagation of hereditary illnesses which might endanger the health and the future of the Aryan Germans. On September 1, 1939, Action T4 was launched: it required that all the mentally ill be exterminated. This action, which was run by the highest level of the Reich's chancellery with the help of psychiatrists coming from all backgrounds including university professors, was supposed to grant a serene death to all the mentally ill considered as untreatable. The death sentences were carried out by the medical staff in psychiatric hospitals specially equipped with gas chambers. Following protests, Action T4 was officially stopped on August 24, 1941, but, in reality, continued until the end of the war. The death sentences were carried out using either lethal doses of medication or food deprivation. One hundred and fifty thousand individuals fell victim to that therapeutic extermination which played an economic role as important as the one deemed to social protection. Many German academics, researchers, psychiatrists, geneticians and anthropologists played and active part in these murders which were carried out in the name of Nazi ideology based upon the supremacy of the Northern Germanic race and the necessity to protect it from miscegenation, especially from Jews. In the final part of this paper, the author gives an explanation of the perversion of ethics carried out by German psychiatrists.

Medical research with incompetent patients which is expected to yield only questionable or no individual benefit (and which is often wrongly equated with non-therapeutic research) remains a difficult and controversial problem. This is reflected in the fact that such research is legally admissible in some countries such as France and England, but is questionable or prohibited in other countries, eg, Germany. Such research can only be justified ethically if the need for it is set forth according to defined criteria, and if defined protective criteria are fulfilled, particularly to ensure that the research-related instrumentalisation of the patient is held in check by observing respect for the patient's dignity, to ensure that research does not involve more than minimal risks and negligible stress for the individual participant, and that the patient's refusal to participate is accepted. A broad international consensus exists with regard to these criteria [9, 21, 26, 41]. But concepts and definitions as to what constitutes benefits and risks, as well as criteria and procedures in weighing benefits against risks, and, not least of all, the weighing of individual benefit against societal benefit, require clarification. The question must also be satisfactorily answered: who is to do the weighing? But above all, it must be ensured by professional education that this process of checks and controls is effectively carried out in day-to-day medical-scientific life.

The European Convention of Human Rights recognises a certain number of rights and freedoms for persons within States' jurisdiction. For those confined in psychiatric hospitals, this legal protection concerns first of all the lawfulness of deprivation of liberty, which must conform to the conditions laid down by the Convention as interpreted by the case-law of the Convention organs (the Commission and Court of Human Rights). The Convention also guarantees to person deprived of their liberty further rights: the right to information, the right to appear before a court, the right to compensation and also the right to the respect of privacy and correspondence.

Attention to the legal position of psychiatric patients has greatly increased during the last 25 years. The criteria for a civil commitment have been tightened and procedural guarantees have increased. In many countries major changes and improvements in the area of mental health law took place. In this paper the main developments are discussed. Attention is given to the legal protection in case of civil commitment, to the legal position of the involuntarily admitted patient during his stay in hospital and to the relationship between patients' rights and the availability of mental health care. Furthermore the impact of legal intentions to the field of psychiatry is discussed. It is argued that legal interventions should be closely monitored, in order to prevent negative consequences. Legal interventions may be necessary, but this instrument should be used with great caution.

This article analyses the historical and psychosocial background of the sterilisation of mentally handicapped individuals in France and investigates the relationship between their sexuality and their sterilisation. Sterilisation of the mentally handicapped has been used as a method for controlling their sexual activity. The processes and situations leading to the sterilisation of the mentally handicapped are described and discussed.

The increasing demand for judicial coerced treatment of sexual abusers constitutes a new challenge for mental health professionals. The discussed controversial ethical issues are the influence of coercion on the treatment, the motivation of patient as well as therapist, confidentiality and hormonal treatment. Social control is not the primary concern of therapists and any treatment must be beneficial to the individual patient. The coerced treatment of sexual abusers requests an agreement between psychiatric and judicial authorities with respect for their respective professional ethics.

The problem of contraception, sterilisation and the mentally ill is one of the key questions in medical ethics. Even if these two aspects bring into question a person's autonomy in two of the most intimate and fundamental aspects of life — sexuality and motherhood — they should not be confused as they differ greatly in terms of their reversibility. The essential question is rather one of individual freedom and its defence in situations where the subject is unable to defend himself either temporarily or in the long term. The fine line between individual and collective interests poses questions in terms of where to draw this line and the way in which it is defined in care situations. From this viewpoint, carers — that is, doctors and nurses, but also social workers and the patient's entourage — play an important role, not only in theory but also in day-to-day reality.