Transcript Chapter 007

Chapter 6
Legal and Ethical Guidelines
for Safe Practice
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Ethical Concepts
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Ethics: The study of philosophical beliefs about
what is considered right or wrong in a society
Bioethics: Used in relation to ethical dilemmas
surrounding health care
Ethical dilemma: Conflict between two or more
courses of action, each with favorable and
unfavorable consequences
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Five Principles of Bioethics
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Beneficence: The duty to promote good
Autonomy: Respecting the rights of others to
make their own decisions
Justice: Distribute resources or care equally
Fidelity (nonmaleficence): Maintaining loyalty
and commitment; doing no wrong to a patient
Veracity: One’s duty to always communicate
truthfully
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Civil Rights of Persons
with Mental Illness
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Guaranteed the same rights under
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Federal laws
State laws
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Due Process in
Involuntary Commitment
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Writ of habeas corpus
Least restrictive alternative doctrine
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Admission Procedures
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Informal admission – sought by patient
Voluntary admission – sought by patient or
guardian
Temporary admission
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Person confused or demented
So ill he or she needs emergency admission
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Admission Procedures (Cont.)
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Involuntary admission – without patient’s
consent
Long-term involuntary admission
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Medical certification
Judicial review
Administrative action
Involuntary outpatient admission
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Discharge Procedures
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Conditional release
Unconditional release
Release against medical advice (AMA)
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Patients’ Rights Under the Law
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Right to treatment
Right to refuse treatment
Right to informed consent
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Case Study
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A 27-year-old male is court committed by his
parents to your unit with a diagnosis of paranoid
schizophrenia. He lashes out at staff when they
attempt to give him his medications. He states,
“You are trying to poison me.” His family asks if
you can “force” him to take his medications.
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Case Study (Cont.)
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How would you respond to this family?
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Patients’ Rights Under the Law (Cont.)
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Rights surrounding involuntary commitment and
psychiatric advance directives
Rights regarding restraint and seclusion
Right to confidentiality
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Patient Confidentiality
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Legal considerations
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Health Insurance Portability and Accountability Act
(HIPAA)
Confidentiality after death
Confidentiality of professional communications
Confidentiality and human immunodeficiency virus
(HIV) status
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Patient Confidentiality (Cont.)
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Exceptions to the rule
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Duty to warn and protect third parties
Child and elder abuse reporting statutes
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Tort Law
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Tort – A civil wrong for which money damages
may be collected by the injured party (plaintiff)
from the responsible party (the defendant)
Intentional tort – Willful or intentional acts that
violate another person’s rights or property
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Assault
 Battery
 False imprisonment
 Invasion of privacy
 Defamation of character (slander or libel)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Tort Law (Cont.)
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Unintentional tort – Unintended acts against
another that produce injury or harm
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Negligence
Malpractice
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Five Elements to Prove Negligence
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Duty
Breach of duty
Cause in fact
Proximate cause
Damages
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Guidelines for Ensuring
Adherence to Standards of Care
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Negligence, irresponsibility, or impairment
Duty to intervene and duty to report
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Documentation of Care
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A record’s usefulness is determined by
evaluating—when the record is read later—how
accurately and completely it portrays the
patient’s behavioral status at the time it was
written.
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Medical Records
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Used by the facility for quality improvement
Used as evidence
Electronic documentation
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Question 1
Which individual with mental illness may need
involuntary hospitalization?
A. A person with alcoholism who has been sober
for 6 months but begins drinking again
B. An individual with schizophrenia who stops
taking prescribed antipsychotic drugs
C. An individual with bipolar disorder, manic
phase, who has not eaten in 4 days
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Question 1 (Cont.)
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Someone who repeatedly phones a national TV
broadcasting service with news tips
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Audience Response Questions
1. Legal and clients’ rights are suspended when a
client is hospitalized involuntarily.
A. True
B. False
C. Not sure
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Audience Response Questions
2. A client plans to have electroconvulsive therapy
(ECT). Which member of the team is
responsible for obtaining the client’s informed
consent?
A. Physician
B. Psychologist
C. Case manager
D. Registered nurse
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Audience Response Questions
3. A nurse was the case manager for a client with serious
mental illness for 6 years. The client died by suicide 1
week ago. Today, the client’s spouse asks, “I always
wondered if my spouse was a victim of sexual abuse in
childhood. What can you tell me about that?” Can the
nurse disclose information to the surviving spouse?
A. Yes
B. No
C. Not sure
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