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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9: Legal and Ethical Issues.

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Presentation on theme: "Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9: Legal and Ethical Issues."— Presentation transcript:

1 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9: Legal and Ethical Issues

2 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Rights of Clients Mental health clients 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 clients bill of rights (Box 9.1)

3 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

4 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Involuntary Hospitalization (contd) Detention in facility for 48 to 72 hours on emergency basis –Then hearing to determine possible commitment to facility

5 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Clients no longer dangerous discharged from hospital

6 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mandatory 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 follow-up, attending specific treatment programs or groups

7 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Conservatorship 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 conservator who speaks for client

8 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Mental health clients who are hospitalized voluntarily give up their right to leave the hospital.

9 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Mental health clients who are hospitalized voluntarily retain all the civil rights afforded to any person, including the right to leave the hospital. –However, clients hospitalized involuntarily give up this right.

10 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Least Restrictive Environment Right to treatment in least restrictive environment appropriate to meet clients needs Free of restraint or seclusion unless necessary Central philosophy to deinstitutionalization of large state hospitals, move to community- based care and services

11 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Least Restrictive Environment (contd) 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

12 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Least Restrictive Environment (contd) Short term use of restraints and seclusion –Face-to-face evaluation in 1 hour, every 8 hours (every 4 hours for children) –Physicians order every 4 hours (every 2 hours for children) –Documented assessment by nurse every 1-2 hours –Close supervision of client –Debriefing session within 24 hours after release from seclusion or restraint

13 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Confidentiality Health Insurance Portability and Accountability Act (HIPAA) of 1996 Civil (fines) and criminal (prison sentences) penalties for violation of client privacy Duty to warn third parties: exception to client confidentiality

14 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 (MNaghten rule)

15 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Insanity Defense (contd) Four states abolished insanity defense –Thirteen states with guilty, but insane verdict Argument that verdict absolves legal system of responsibility –People do not always receive needed psychiatric treatment

16 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: A nurse is required to maintain client confidentiality unless the client threatens a specifically identified individual or group.

17 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True In cases where a client threatens an identifiable third party, the nurse has a duty to warn that third party.

18 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Liability Responsibility for providing safe, competent, legal, ethical care

19 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Liability (contd) Meeting standards of care developed from: –ANAs Code of Ethics for Nurses with Interpretive Statements –ANAs 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

20 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Torts Wrongful act resulting in injury, loss, damage Unintentional torts –Negligence –Malpractice Elements to prove malpractice –Duty –Breach of duty –Injury or damage –Causation

21 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Torts (contd) Intentional torts –Assault –Battery –False imprisonment 3 elements to prove liability –Willful voluntary act –Intention to bring about consequences or injury –Act as substantial factor in injury or consequences

22 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevention of Liability

23 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would be considered an unintentional tort? A.Malpractice B.Assault C.Battery D.False imprisonment

24 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A.Malpractice Malpractice is an unintentional tort. –Assault, battery, and false imprisonment are intentional torts.

25 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

26 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

27 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Dilemmas in Mental Health Ethical dilemma –Conflict of ethical principles –No one clear course of action Many dilemmas in mental health involving clients right to self-determination and independence (autonomy) and concern for public good (utilitarianism) ANA Code of Ethics for Nurses guides choices about ethical actions

28 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Decision-Making Gathering information Clarifying values Identifying options Identifying legal considerations, practical restraints Building consensus for decision reached Reviewing, analyzing decision

29 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: The greatest good for the greatest number reflects the deontologic ethical theory.

30 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False 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.

31 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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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