Chapter 6

Legal and Ethical Guidelines

for Safe Practice

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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

Ethical Concepts

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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

Five Principles of Bioethics

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Guaranteed the same rights under Federal laws State laws

Civil Rights of Persons with Mental Illness

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Writ of habeas corpus Least restrictive alternative doctrine

Due Process in Involuntary Commitment

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Informal admission – sought by patient Voluntary admission – sought by patient or

guardian Temporary admission

Person confused or demented So ill he or she needs emergency admission

Admission Procedures

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Involuntary admission – without patient’s consent

Long-term involuntary admission Medical certification Judicial review Administrative action

Involuntary outpatient admission

Admission Procedures (Cont.)

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Conditional release Unconditional release Release against medical advice (AMA)

Discharge Procedures

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Right to treatment Right to refuse treatment Right to informed consent

Patients’ Rights Under the Law

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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.

Case Study

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How would you respond to this family?

Case Study (Cont.)

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Rights surrounding involuntary commitment and psychiatric advance directives

Rights regarding restraint and seclusion Right to confidentiality

Patients’ Rights Under the Law (Cont.)

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Legal considerations Health Insurance Portability and Accountability Act

(HIPAA) Confidentiality after death Confidentiality of professional communications Confidentiality and human immunodeficiency virus

(HIV) status

Patient Confidentiality

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Exceptions to the rule Duty to warn and protect third parties Child and elder abuse reporting statutes

Patient Confidentiality (Cont.)

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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 Assault Battery False imprisonment Invasion of privacy Defamation of character (slander or libel)

Tort Law

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Unintentional tort – Unintended acts against another that produce injury or harm Negligence Malpractice

Tort Law (Cont.)

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Duty Breach of duty Cause in fact Proximate cause Damages

Five Elements to Prove Negligence

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Negligence, irresponsibility, or impairment Duty to intervene and duty to report

Guidelines for EnsuringAdherence to Standards 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.

Documentation of Care

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Used by the facility for quality improvement Used as evidence Electronic documentation

Medical Records

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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

Question 1

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Someone who repeatedly phones a national TV broadcasting service with news tips

Question 1 (Cont.)

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1. Legal and clients’ rights are suspended when a client is hospitalized involuntarily.

A. True

B. False

C. Not sure

Audience Response Questions

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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

Audience Response Questions

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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

Audience Response Questions

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