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.

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.

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.

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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: 100-101 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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.

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.