The relation between law and care has changed dramatically. Until recently this relation could be characterised as distant, supportive and respectful. This relation has undergone a paradigm shift. More and more and in many areas the notion of care is used by the lawmaker, to impose duties of care combined with enforcement. This implies a change from private law to administrative law. This development is undesirable, because it raises false expectations and, in the end, works counterproductive.

Empirical research on the practice of ‘informed consent’ and the right of complaint of patients shows that these rights are important as guarantees for carefulness and legal certainty. However, at the same time these rights seem to have hardly any effect on the position of the patient in the daily interactions with doctors and other medical personnel. Rather, they seem to have led to a formalization of institutional relations with patients. At the same time, in practice especially hospitals seem to aim at an informal and varied way of dealing with these patient’s rights.

Two types of legalization can be distinguished. In type 1 legal relations between parties are changed, without consequences for others. In legalization type 2 a change in legal positions does have consequences for third parties. The gradual change in the legal position of patients, managerial measures and the transition to ‘demand driven care’ have changed the relations between patients and doctors, nurses etc. But they had also profound external effects. They have influenced especially other interests than the quality of medical care, like equal treatment of patients and professional discretion. Decision making about the granting of rights should incorporate these external effects.

The position of patients facing forced hospitalization in a mental health clinic develops both in a soft and in a hard direction. On the one hand there is a soft current of more empathy with legal protection and on the other hand a harder current that leads to a growing number of forced measures. This involves three dilemmas. First, legal intervention touches only upon the fringe and not upon the core of psychiatric treatment. Second, the problematic relation with the criminal justice sector and third, a lack of concern for what happens after the decision of the judge. Quality based peer review has not developed well in this sector. Forced hospitalization will remain sour for the near future.

The ‘Bureau Jeugdzorg’ is the gatekeeper in the field of youth care policy. From its start the Bureau has faced a difficult combination of empathy and social control. The individual youth was entitled to ‘a right on care’, which in practice was frustrated by long waiting lists. The mental health professionals also resisted the central role of the Bureau. So, soon after its inception Bureau Jeugdzorg is already in jeopardy. It is unlikely that the new political initiatives in this field will improve the legal protection of minors.

Care, self determination and law in child psychiatry is a difficult combination. Three problems arise here: Bureau Jeugdzorg does not have a good working relationship with the doctors, bad coordination between professionals, and finally an unwarranted trust in protection within the family. It is argued that a ‘duty of special care’ for professionals might help. This should prevail over the right of self determination. A second improvement might be a ‘criterion of necessity’ that may overrule a lack of cooperation by the minor.

Various developments since 1960 have lead to a legalization of care, especially the call for individual rights, emancipation, international treaties, the transformation of private problems to public issues and the diminishing authority of professionals. This legalization has important social consequences. Effects are both direct and indirect, positive and negative. The ‘rights revolution’ has gone too far and leads to unrealistic expectations of what law can do. Therefore a down-to-earth and empirical informed perspective on the relation between law and care is of great importance.