Transcript Chapter 9
Chapter 9: Legal and Ethical Aspects in Clinical Practice Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Historical Review Roman Law Concerned with legal status of mentally disabled Middle Ages Incompetence decided by jury Mentally ill committed to care of friend Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2 Historical Events United States 1600s 1752 1841 Late 1800s 1900–1950s Cared for by families or wandered First hospital for mentally ill Dorothea Dix crusades Civil commitment State hospital populations Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3 Historical Events, cont’d. 1963: Community Mental Health Act Deinstitutionalization Lack of community treatment resources Expanded commitment laws Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4 Historical Events, cont’d. Managed Behavioral Health Treatment access restricted Carve outs to control costs Insurance benefits meager Premature discharges Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 Commitment Voluntary Patient consents to admission Patient may request discharge Emergency Risk of harm to self or others Short term Longer-term judicial or civil Protects community from persons posing a threat Mandatory outpatient treatment Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6 Least Restrictive Alternative Use least restrictive environment Use least restrictive treatment Evolved to: Use least restrictive environment Use most clinically appropriate treatment Use most cost-effective interventions Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 Confidentiality and Privileged Communication Confidentiality Protection and privacy of health information guaranteed by HIPAA Signed release necessary Privileged Communication No forced disclosure in court of certain information given to professionals Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 Tarasoff Duty to Warn and Protection A treating mental health professional has a duty to warn potential identifiable victims. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 Rights of Patient Vote Manage financial affairs Make contracts Seek advice of attorney Send and receive unopened mail Wear own clothes Receive visitors Make phone calls Have Informed consent regarding treatment and research participation Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 Right to Be Restraint Free Seclusion and Restraint CMS standards: Client right to be restraint free is paramount Use only when less restrictive alternatives fail One hour rule Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 Right to Treatment A nondangerous individual cannot be hospitalized without being provided with some form of treatment. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 Right to Refuse Treatment Medications Voluntary and involuntary patients can refuse medication. In emergency situations, if potential danger is present, patient can be medicated against his or her will. ECT Requires informed consent. State laws vary regarding refusal. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 Right to Advocacy Nursing Responsibilities Obtain authorization for treatment. Inform client of right to appeal for denial of care. Provide data for utilization review. Report violation of rights. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 Competency to Stand Trial Does the person understand: The criminal charges? The legal process? The consequences of the charges? Can the person advise an attorney and defend the charges? Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 Criminal Responsibility M’Naghten Rule (Insanity Defense) Refers to person’s state of mind at the time of the offense. To be found guilty, person must be able to form intent. If unable to form intent because of mental illness, person cannot be found guilty. If not guilty, person is usually evaluated for commitment to a hospital for treatment. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16 Guilty but Mentally Ill Possible plea in some states Person found guilty, but mental illness caused commission of offense Sent to prison and treated for mental illness Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17 Malpractice A health professional omits or commits an act that a reasonable prudent professional would not do. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18 Elements of Malpractice Suit Based on Negligence Legal duty to provide a certain standard of care Breach of duty Proximate cause “But-for” test Substantial factor test Proven injury Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19 Documentation in the Medical Record Legal document Communication with other professionals Validation that professionals adhered to scope of practice Validation for reimbursement Support for ongoing care/chosen care level Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20 Other Malpractice Lawsuits Involving Health Professionals Sexual misconduct Wrongful death actions for: Suicide Homicide Injury to third party Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21 Ethics Explores moral problems raised about specific issues. Ethical dilemmas in psychiatric nursing often relate to conflicts between mental health law and nurses’ personal beliefs. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22 Ethical Principles Autonomy Beneficence Distributive justice Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23