In recent years, political events have reignited contentious debates about psychiatry and democratic governance. This discourse has largely centred around the ethics and morality of public commentary, particularly in relation to the American Psychiatric Association's Goldwater Rule. Yet, few studies have examined the practical implications of health-related limitations due to mental illness in national leadership and the constitutional and legal provisions that surround these issues, including voluntary or involuntary proceedings. Accordingly, this theoretical paper analyses these topics in a German context using the position at the head of the executive: the chancellorship. Germany was selected as a case example as the biggest democracy in Europe with modern legal frameworks representative of the post-World War Two era in European constitutionalism, and for its economic and political influence within the European Union. Throughout this paper, we do not speculate on the mental health of any individual (past or present), but instead explore jurisdictional mechanisms around health-related limitations in German high office. Consequently, we outline relevant constitutional and legal scenarios, and how short- or long-term medical incapacity may determine requisite responses and contingent complexities. This underpins our discussion, where we consider legal ambiguities, functional capacity, and ethical concerns in psychiatric practice.

近年来，政治事件重新引发了有关精神病学和民主治理的争议。这种讨论主要集中在公众评论的伦理和道德上，特别是与美国精神病学协会的戈德华特规则有关的评论。然而，很少有研究探讨国家领导层因精神疾病而造成的与健康相关的限制的实际影响，以及围绕这些问题的宪法和法律规定，包括自愿或非自愿程序。因此，本文利用行政首脑的职位：总理职位，在德国背景下分析了这些主题。德国被选为欧洲最大的民主国家，其现代法律框架代表了第二次世界大战后欧洲宪政时期的情况，并因其在欧盟内的经济和政治影响力而被选为案例。在本文中，我们不会推测任何个人（过去或现在）的心理健康状况，而是探讨德国高级职位中与健康相关的限制的管辖机制。因此，我们概述了相关的宪法和法律情景，以及短期或长期的医疗丧失能力如何决定必要的反应和偶然的复杂性。这支撑了我们的讨论，我们在讨论中考虑了精神病学实践中的法律模糊性、功能能力和道德问题。