Transcript LWW PPT Slide Template Master

Chapter 9
Legal and Ethical Issues
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Rights of Patients
• Mental health patients with all civil rights afforded to all
people
– Except right to leave hospital in case of involuntary
commitment
• Principles for Provision of Mental Health and Substance
Abuse Treatment Services (American Psychiatric
Association [APA])
– As mental health patient’s bill of rights (see Box 9.1)
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Involuntary Hospitalization
• Civil commitment
• Laws determined by each state
– Knowledge of laws of state of practice necessary
• Persons held without consent presenting with imminent
danger to self or others
– Proven at hearing if person is to be committed
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Involuntary Hospitalization (cont.)
• Detention in facility for 48 to 72 hours on emergency
basis
– Then hearing to determine possible commitment to
facility
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Release from the Hospital
• Voluntary hospitalization: right to request discharge at
any time
– Release unless danger to self or others; if such
danger present, then commitment proceedings
instituted
• Patients no longer dangerous discharged from hospital
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Mandated Outpatient Treatment
• Conditional release or outpatient commitment
• Continued participation in treatment on involuntary basis
after release from hospital into community
– Examples: taking prescribed medications, keeping
appointments with health-care providers for followup, attending specific treatment programs or groups
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Conservatorship/Guardianship
• Legal guardianship; separate from civil commitment for
hospitalization
– Grave disability
– Incompetency
– Inability to provide self with food, clothing, shelter
– Inability to act in own best interests
• Consent to be obtained from legal guardian who speaks
for patient
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Question
• Is the following statement true or false?
• Mental health patients who are hospitalized voluntarily
give up their right to leave the hospital.
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Answer
• False
• Rationale: Mental health patients who are hospitalized
voluntarily retain all the civil rights afforded to any
person, including the right to leave the hospital.
– However, patients hospitalized involuntarily give up
this right.
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Least Restrictive Environment
• Right to treatment in least restrictive environment
appropriate to meet patient’s needs
• Free of restraint or seclusion unless necessary
• Central philosophy to deinstitutionalization of large state
hospitals, move to community-based care and services
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Least Restrictive Environment (cont.)
• Restraint: application of physical force to person without
permission
– Human
– Mechanical
• Seclusion: involuntary confinement in specially
constructed, locked room equipped with security window
or camera for direct visual monitoring
– Restraint/seclusion only for shortest time necessary
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Least Restrictive Environment (cont.)
• Short-term use of restraints and seclusion
– Face-to-face evaluation in 1 hour, every 8 hours
(every 4 hours for children)
– Physician’s order every 4 hours (every 2 hours for
children)
– Documented assessment by nurse every 1 to 2 hours
– Close supervision of patient
– Debriefing session within 24 hours after release from
seclusion or restraint
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Confidentiality
• Health Insurance Portability and Accountability Act
(HIPAA) of 1996
• Civil (fines) and criminal (prison sentences) penalties for
violation of patient privacy
• Duty to warn third parties: exception to patient
confidentiality
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Insanity Defense
• Insanity
– Legal meaning but no medical definition
– Person unable to control his or her actions or
understand the difference between right and wrong
at time of crime (M’Naghten Rule)
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Insanity Defense (cont.)
• Four states abolished insanity defense
• Argument that verdict absolves legal system of
responsibility
– People do not always receive needed psychiatric
treatment
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Question
• Is the following statement true or false?
• A nurse is required to maintain patient confidentiality
unless the patient threatens a specifically identified
individual or group.
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Answer
• True
• Rationale: In cases where a patient threatens an
identifiable third party, the nurse has a duty to warn that
third party.
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Nursing Liability
• Responsibility for providing safe, competent, legal,
ethical care
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Nursing Liability (cont.)
• Meeting standards of care developed from:
– ANA’s Code of Ethics for Nurses with Interpretive
Statements
– ANA’s Scope and Standards of Psychiatric–Mental
Health Nursing Practice
– State nurse practice acts/federal agency regulations
– Agency policies and procedures/job descriptions
– Civil, criminal laws
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Torts
• Wrongful act resulting in injury, loss, damage
• Unintentional torts
– Negligence
– Malpractice
• Elements to prove malpractice
– Duty
– Breach of duty
– Injury or damage
– Causation
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Torts (cont.)
• Intentional torts
– Assault
– Battery
– False imprisonment
• Three elements to prove liability
– Willful voluntary act
– Intention to bring about consequences or injury
– Act as substantial factor in injury or consequences
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Prevention of Liability
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Question
• Which of the following would be considered an
unintentional tort?
– A. Malpractice
–
B. Assault
–
C. Battery
–
D. False imprisonment
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Answer
•
A. Malpractice
•
Rationale: Malpractice is an unintentional tort.
– Assault, battery, and false imprisonment are
intentional torts.
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Ethical Issues
• Ethics: branch of philosophy dealing with values of
human conduct (rightness and wrongness of actions) and
goodness or badness of motives and ends of such actions
• Utilitarianism: theory that bases decisions on greatest
good for greatest number
• Deontology: decisions based on whether action is morally
right or wrong, with no regard for consequences
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Deontological Principles
• Autonomy: right to self-determination, independence
• Beneficence: duty to benefit others or promote good
• Nonmaleficence: requirement to do no harm
• Justice: fairness
• Veracity: honesty, truthfulness
• Fidelity: obligation to honor commitments, contracts
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Ethical Dilemmas in Mental Health
• Ethical dilemma
– Conflict of ethical principles
– No one clear course of action
• Many dilemmas in mental health involving patient’s right
to self-determination and independence (autonomy) and
concern for “public good” (utilitarianism)
• ANA Code of Ethics for Nurses guides choices about
ethical actions
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Ethical Decision-Making
• Gathering information
• Clarifying values
• Identifying options
• Identifying legal considerations, practical restraints
• Building consensus for decision reached
• Reviewing, analyzing decision
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Question
• Is the following statement true or false?
• The greatest good for the greatest number reflects the
deontologic ethical theory.
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Answer
• False
• Rationale: Deontologic theory bases decisions on
whether an action is morally right or wrong, without
regard for the consequences.
– Utilitarianism bases decisions on the “greatest good
for the greatest number.”
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Self-Awareness Issues
• Talk to colleagues or seek professional supervision.
• Spend time thinking about ethical issues; determine your
values and beliefs regarding situations before they occur.
• Be willing to discuss ethical concerns with colleagues or
managers.
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