1. Ethical and Legal Issues in Psychiatric/ Mental Health Nursing
Chapter 5
Ethical and Legal Issues in Psychiatric/ Mental Health Nursing

2. Introduction
Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death.
Legislation determines what is “right” or “good” within a society.

3. Core Concepts
Ethics is a branch of philosophy that deals with distinguishing right from wrong.
Bioethics is a term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health.

4. Core Concepts (cont.)
Moral behavior is conduct that results from serious critical thinking about how individuals ought to treat others.
Values are personal beliefs about what is important and desirable.
Values clarification is a process of self-exploration by which people identify and rank their own personal values.

5. Core Concepts (cont.)
Right is a valid, legally recognized claim or entitlement encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service.
Absolute right is when there is no restriction whatsoever on the individual’s entitlement.
Legal right is a right on which the society has agreed and formalized into law.

6. Ethical Considerations
Theoretical Perspectives
Utilitarianism is an ethical theory that promotes action based on the end result that produces the most good (happiness) for the most people.
Kantianism suggests that decisions and actions are bound by a sense of duty.

7. Ethical Considerations (cont.)
Theoretical Perspectives (cont.)
Christian ethics emphasize doing unto others as you would have them do unto you.
Natural law theories refer to doing good and avoiding evil. Human knowledge of the difference between good and evil directs decision making.
Ethical egoism refers to decisions that are based on what is best for the individual making the decision.

8. Ethical Considerations (cont.)
An operating room nurse asks a psychiatric nurse, “How can you work with the mentally ill day in and day out?” The psychiatric nurse replies, “It's just the right thing to do.” The psychiatric nurse is operating from which ethical framework?
A. Kantianism
B. Christian ethics
C. Ethical egoism
D. Utilitarianism

9. Ethical Considerations (cont.)
Correct answer: A
Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse’s response indicates a Kantian perspective.

10. Ethical Dilemmas
Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action.
Taking no action is considered an action taken.

11. Ethical Principles
Autonomy emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected.
Beneficence refers to one’s duty to benefit or promote the good of others.

12. Ethical Principles (cont.)
Nonmaleficence is abstaining from negative acts toward another, includes acting carefully to avoid harm.
Justice is a principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly.
Veracity is a principle that refers to one’s duty to always be truthful.

13. A Model for Making Ethical Decisions
Assessment
Problem identification
Plan
Implementation
Evaluation

14. Ethical Issues in Psychiatric Mental Health Nursing
The right to refuse medication
The right to the least restrictive treatment alternative

15. Legal Considerations
The Nurse Practice Act defines the legal parameters of professional and practical nursing.
Types of Laws
Statutory law
Common law

16. Classifications Within Statutory and Common Law
Civil law protects the private and property rights of individuals and businesses.
Torts
Contracts
Criminal law provides
protection from conduct
deemed injurious to the
public welfare.

17. Legal Issues in Psychiatric Mental Health Nursing
Confidentiality and Right to Privacy
HIPAA
Doctrine of privileged communication
Exception: A duty to warn
Informed Consent
Restraints and Seclusion
False imprisonment

18. Legal Issues in Psychiatric Mental Health Nursing (cont.)
Commitment Issues
Voluntary admissions
Involuntary commitments
Emergency commitments
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client

19. Legal Issues in Psychiatric Mental Health Nursing (cont.)
Nursing Liability
Malpractice and negligence
Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
Defamation of character
Libel
Slander

20. Legal Issues in Psychiatric Mental Health Nursing (cont.)
Nursing Liability (cont.)
Invasion of privacy
Assault and battery
False imprisonment

21. Legal Issues in Psychiatric Mental Health Nursing (cont.)
As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, “I’ll sue you for assault and battery.” The unit manager determines that the nurses are protected under which condition?
A. The client is voluntarily committed and poses a danger to others on the unit.
B. The client is voluntarily committed and has a history of being a danger to others.
C. The client is involuntarily committed because of a history of violent behavior.
D. The client is involuntarily committed and is refusing treatment.

22. Legal Issues in Psychiatric Mental Health Nursing (cont.)
Correct answer: A
As a threat to others, the client can be restrained despite objections and voluntary commitment.

23. Legal Issues in Psychiatric Mental Health Nursing (cont.)
A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client’s chart was clearly stamped “Allergic HALDOL.” The client suffered anaphylactic shock and died. How would the nurse’s actions be labeled?
A. Intentional tort
B. Negligence
C. Battery
D. Assault

24. Legal Issues in Psychiatric Mental Health Nursing (cont.)
Correct answer: B
The nursing action was an unreasonable and careless act. The nurse was negligent and could be held liable for the client’s death. 

25. Avoiding Liability Respond to the client. Educate the client.
Comply with the standard of care.
Supervise care.
Adhere to the nursing process.
Document carefully.
Follow up as required.
Develop and maintain a good interpersonal relationship with client and family.