1. Legal and Ethical Guidelines for Safe Practice
Chapter 6
Legal and Ethical Guidelines
for Safe Practice
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Ethical Concepts
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
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Five Principles of Bioethics
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
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4. Civil Rights of Persons with Mental Illness
Guaranteed the same rights under
Federal laws
State laws
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5. Due Process in Involuntary Commitment
Writ of habeas corpus
Least restrictive alternative doctrine
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Admission Procedures 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
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Admission Procedures (Cont.)
Involuntary admission – without patient’s consent
Long-term involuntary admission
Medical certification
Judicial review
Administrative action
Involuntary outpatient admission
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Discharge Procedures Conditional release Unconditional release
Release against medical advice (AMA)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Patients’ Rights Under the Law
Right to treatment
Right to refuse treatment
Right to informed consent
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Case Study
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.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Case Study (Cont.) How would you respond to this family?
Patients who have been committed retain their right to refuse treatment; however, in an emergency, to prevent a person from causing serious and imminent harm to himself or herself or others, the individual may be medicated without a court hearing.
Following a court hearing, a person can be medicated if he or she meets all of the following criteria:
the person has a serious mental illness
(b) the person’s ability to function is deteriorating or he or she is suffering or exhibiting threatening behavior
(c) the benefits of treatment outweigh the harm
(d) the person lacks the capacity to make a reasoned decision about the treatment; and
(e) less restrictive services have been found inappropriate.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Patients’ Rights Under the Law (Cont.)
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.

13. Patient Confidentiality
Legal considerations
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.

14. Patient Confidentiality (Cont.)
Exceptions to the rule
Duty to warn and protect third parties
Child and elder abuse reporting statutes
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Tort Law
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)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Tort Law (Cont.)
Unintentional tort – Unintended acts against another that produce injury or harm
Negligence
Malpractice
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17. Five Elements to Prove Negligence
Duty
Breach of duty
Cause in fact
Proximate cause
Damages
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

18. Guidelines for Ensuring Adherence to Standards of Care
Negligence, irresponsibility, or impairment
Duty to intervene and duty to report
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

19. Documentation of Care
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.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

20. Medical Records Used by the facility for quality improvement
Used as evidence
Electronic documentation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

21. Question 1
Which individual with mental illness may need involuntary hospitalization?
A person with alcoholism who has been sober for 6 months but begins drinking again
An individual with schizophrenia who stops taking prescribed antipsychotic drugs
An individual with bipolar disorder, manic phase, who has not eaten in 4 days
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

22. Question 1 (Cont.)
Someone who repeatedly phones a national TV broadcasting service with news tips
ANSWER : C
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

23. Audience Response Questions
Legal and clients’ rights are suspended when a client is hospitalized involuntarily.
True
False
Not sure
ANS: B
Involuntary admission requires that the client retain freedom from unreasonable bodily restraints, the right to informed consent, and the right to refuse medications, including psychotropic or antipsychotic medications. Other rights are preserved as well.
REF:
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

24. Audience Response Questions
A client plans to have electroconvulsive therapy (ECT). Which member of the team is responsible for obtaining the client’s informed consent?
Physician
Psychologist
Case manager
Registered nurse
ANS: A
The informed consent of a client must be obtained by the physician before a treatment or procedure is performed.
REF: 103
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

25. Audience Response Questions
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?
Yes No
Not sure
ANS: B
A person’s reputation can be damaged even after death. Therefore, it is important that nurses not divulge information after a person’s death that could not be legally shared before the death.
REF: 105
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.