Legal and ethical issues in psychiatric nursing pdf
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- Ethical and Legal Issues in Mental Health Nursing
- Ethical Practice: NCLEX-RN
- Ethical and Legal Issues
- Ethics in Mental Health Care: A Public Health Perspective
Utilitarianism teleology or situational ethics. Symptoms may include anger, anxiety, frustration, powerlessness, and fatigue. About Moral Distress Project : core multidisciplinary experts discuss moral issues and distress from across the country in a documentary-style interviewing media project.
Ethical and Legal Issues in Mental Health Nursing
The Mental Healthcare Act MHCA ,[ 1 ] explicitly talks about the rights of patients with mental illness PWMI and lays down the ethical and legal responsibilities of mental health professionals and the government. The rights of PWMI are at par with the fundamental rights of human beings and need to be clearly talked about as they belong to a vulnerable group from evaluation, treatment, and research perspectives.
Such rights translate into the ethics of psychiatric care that relate to respect for autonomy; the principle of non-maleficence, beneficence, and justice; confidentiality and disclosure ; boundary violations; informed consent and involuntary treatment ; etc. They also mention the non-representation of the Indian Psychiatric Society and inadequate address of the burden of care experienced by the caregivers.
The caregivers of PWMI are the real ambassadors of mental health; they sincerely understand the genuine service that psychiatrists have provided in this country over many decades. No doubt, human rights of PWMI have to be protected at all times; however, it cannot be one-sided.
There is an equal and strong need to involve the caregivers in framing mental health policies that are ethically and legally sound and at the same time tailoring to their needs and the ground realities of this developing country, such as poverty, illiteracy, unawareness regarding mental illness, stigma, discrimination, etc. In view of the new challenges thrown by MHCA , such as mental health capacity assessment, advance directive, nominated representative, etc.
However, when it comes to medical ethics, these are essential not desirable requirements based on which a physician is mandated to act. The legal aspects of patient care are determined by country-specific regulations, which in turn are governed by medical ethics. The patient—physician relationship is bound by the moral and ethical sanctity of confidentiality, more so in mental health. This is one of the fundamental responsibilities of the psychiatrist.
Few PWMI wants their information and diagnosis to be disclosed to such caregivers. Considering this as implied consent, till some time back, such disclosure was done in the absence of an explicit written informed consent. A typical scenario would be a lady under treatment for psychiatric illness for the previous 10 years suddenly turns up to the treating psychiatrist and discloses that she got married around a month back and now plans to conceive.
Her spouse also wants to discuss regarding the diagnosis, treatment, and the need for and the safety of psychotropics in pregnancy. The spouse may, unfortunately, use the disclosed information for any purpose including divorce and the lady may sue the treating doctor for breaching the confidentiality. Hence, as the lady herself wants her information to be shared with her spouse and the confidentiality clause is going to being breached, written informed consent should mandatorily be obtained from her, including permission as to how much can be disclosed and this should be documented in the patient's notes.
Such written authorization from the patient may protect the psychiatrist in the Court of Law. It is interesting to know the sociodemographic variables that determine such disclosure. Gupta et al. The authors recommend that these factors may be considered when making ethical decisions. Diagnosis is of paramount importance to manage psychiatric patients effectively which rests on adequate history from significant others, as psychiatrists cannot rely solely on mental status examination.
When individuals are admitted involuntarily through Honorable courts and prisons into tertiary level public hospitals, there is a lack of adequate history. This is more common with those referred from prisons.
Attempts are made to discuss with the prison medical officer and caregivers. The caregivers are either untraceable or unwilling to discuss. Also, because of unawareness regarding mental disorders, the only history obtained from the medical officer is of the patient being irritable or displaying suicidal threats. This is not enough to arrive at a diagnosis. Thus, the lack of adequate history is a major problem in a forensic psychiatric setting.
The management of such patients, thus, is mostly based on inpatient observation. In recent times, in India, there is an increased focus on training of judiciary and prison medical officers which is a welcome step.
With this background, a retrospective chart review was conducted on female forensic inpatients. In view of the alleged crime, Majority of them On retrospective evaluation, approximately half of the study sample had an illness at the time of occurrence of the crime. About It remains to be seen whether the improvement gained persist in the long term, especially those referred from prisons.
Also, how such patients fare after discharge from the psychiatry hospital and after release from prisons, because of treatment nonadherence and other prognostic factors? This study focused only on female gender; do male forensic patients fare differently? First, many residents get trained in General Hospital Psychiatry Units especially, private colleges that are not directly attached to forensic psychiatry units.
They have a peripheral posting of just around 2—4 weeks to such centers. Second, the residents, being doctors-in-training, work under the supervision of faculty; hence, the Honorable courts do not consider them competent to give evidence. Third, the faculty members may not involve them in legal aspects of patient care, believing it is not their responsibility.
In my place of work, which is a tertiary level teaching public hospital, the psychiatry residents are routinely involved in legal aspects of patient care.
The faculty should make sure that the residents are actively involved in the legal aspect of patient care, such as medical boards, discharge committee meetings, certification, etc. Only when they are exposed at this stage of their career, once out of residency, they would be in a position to manage such issues independently. The psychiatrists appear in Honorable courts as an expert witness and give evidence but are unaware as to what happens later.
I commend the investigators for researching a hitherto underresearched topic in Indian scenario,[ 10 ] relating to insanity pleas. Both in those cases where the Honorable Court did not feel the need for psychiatrist's evidence 24 cases or in those six cases where the psychiatrist opined that there was no mental illness, the accused was not acquitted on the grounds of mental illness.
Also, the 16 out of 56 accused The 18 The results strongly point toward the need for proper documentation. When PWMI abscond from psychiatric hospitals, especially closed wards, it places an enormous burden on the hospital staff in terms of the legal implications.
The absconders may not take care of self and may be at risk of harm to self, others, and property. Though absconding from psychiatric hospitals or nursing homes is quite common, no Indian data are available in the published literature, probably because of the concern that it may reflect negatively onto the staff and hospital administrators.
Though this is an unfortunate event, we need not feel inhibited researching this as absconding is common in any closed setting including high secure prisons[ 12 ] and general hospitals,[ 13 ] and psychiatric hospitals worldwide,[ 14 , 15 , 16 ] and in India,[ 17 ] are no exception.
It is heartening to note that an article dealing with this important, albeit unaddressed issue is published. They were mostly males, with a diagnosis of schizophrenia or mood disorder with comorbid substance-use disorder, with impaired insight and high perceived coercion being the predictors of absconding behavior.
A previous history of self-harm and wandering away from home in those absconded points toward the need to inquire regarding this as part of history taking. This study focused on open wards where PWMI consent for admission and the caregivers who stay are responsible for patient care. There is a dire need to employ polices to prevent such incidents by rationalizing pharmacotherapy; adequate use of restraints and seclusions as per guidelines;[ 1 ] electroconvulsive therapy for agitated patients; strengthening the hospital security by constructing stronger wards with tall walls and fencing, adequate personnel, sophisticated gadgets, and alarms; timely discharge from the hospital; etc.
It also points to the need for prison mental health services where forensic patients can be managed securely in the prison itself. For patients with severe mental retardation, dementia, and severe and enduring obvious mental illnesses, such as severe psychosis, who are at risk of absconding behavior, few of my psychiatry colleagues as part of informal discussion suggested use of metal bracelets kadas that are religiously acceptable with details engraved names, phone numbers, and address of patient and caregiver ; bands; and implants, gadgets, watches, and chips with GPS location device and trackers.
However, these need to be used after obtaining written informed consent, but the concerns expressed are cost, need for battery charging, can be thrown away, technology not so advanced for universal application, etc. Other concerns expressed were ethical and legal issues, stigma, restriction of civil liberties, violation of privacy, infringement to capacity, practicality, etc.
The tattoos with name, phone, and address of the caregiver seem to be a reasonable option, as these cannot be discarded and may have a fashion statement, the future suggestion being tattoos with radioactive but safe traceable ink material that can be tracked in a conversation with Live CME Psychiatry WhatsApp group members: Feb. However; based on ethical and legal guidelines, these need further discussion before implementation. Disability in mental illness is a state where the patient has shown symptomatic recovery with the available treatment modalities, however, has deficits that lead to significant problems with self-care, interpersonal, social, and occupational functioning, and impaired quality of life that may need aggressive rehabilitation.
They point toward the ambiguity related to screening instruments, resource allocation, and the need for inclusive education. They recommend increased focus and reservation for patients who have a disability due to mental illnesses and specific learning disorders; and decentralization of the disability certification, for example, certification of severe or profound intellectual disability at the primary health center PHC itself.
This would prevent inconvenience to end users, reduce workload at tertiary level psychiatric centers, would be cost-effective and less time consuming, and would lead to higher recruitment of mental health professionals, especially qualified psychiatrists and clinical psychologists at PHC itself.
However, such certification should be done by a medical board mandatorily comprising a qualified psychiatrist and clinical psychologist and not by other professionals such as pediatricians.
The poverty of our patients may sometimes override our clinical assessment; however, it is the State's responsibility to take care of the financial status of its citizens.
Psychiatrists should only be concerned about mental illness and the resulting disability. Thus, even a rich person who has a disability due to mental illness should get disability benefits. The disability benefits must be independent of the financial status of PWMI.
A limited budget is allocated for disability benefits, and improper certification may prevent benefits to really deserving PWMI; such individuals should be carefully evaluated. This is of paramount importance in general hospital psychiatry units where the nonpsychiatric medical professionals may not be aware of the real concept of disability due to mental illness, hence may fail to understand as to why a particular procedure is being followed by the psychiatrists.
We need to educate them regarding the legal intricacies of dealing with PWMI. Every PWMI is a potentially medicolegal case unless proved otherwise.
However, we need not be fearful but cautious while evaluating and treating them and be aware of the legal angle which ultimately boils down to the ethical aspects. This means that above all, good medical ethics is clinically relevant.
National Center for Biotechnology Information , U. Indian J Psychol Med. Rajshekhar Bipeta. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: ni. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4. Confidentiality and disclosure The patient—physician relationship is bound by the moral and ethical sanctity of confidentiality, more so in mental health.
Lack of adequate information regarding forensic patients with mental illness Diagnosis is of paramount importance to manage psychiatric patients effectively which rests on adequate history from significant others, as psychiatrists cannot rely solely on mental status examination.
Outcome of insanity pleas The psychiatrists appear in Honorable courts as an expert witness and give evidence but are unaware as to what happens later. Absconding behavior in patients with mental illness When PWMI abscond from psychiatric hospitals, especially closed wards, it places an enormous burden on the hospital staff in terms of the legal implications.
Ministry of Law and Justice. The Mental Healthcare Act. Gazette of India. Ethics in psychiatry. Textbook of Postgraduate Psychiatry.
Ethical Practice: NCLEX-RN
Psychiatrists should only be concerned about, mental illness and the resulting disability, a rich person who has a disability due to mental illness. Principles of Biomedical Ethics. Every PWMI is a potentially medicolegal case unless, proved otherwise. Demonstrate ethical professional boundaries. Ethical and legal responsibilities and role of a psychiatric nurse Clarify personal values concerning working with patients experiencing psychiatric disorders.
This chapter explores ethical issues in mental health policy from a public health perspective, with a focus on the United States. Ethical discourse about mental health treatment has typically focused on paradigmatic concepts of individual autonomy, competence, paternalism, and appropriate justifications for overriding individual decision-making and restricting individual liberty. This chapter focuses on overarching ethical challenges in mental health policy at the population level—enhancing access of persons with mental illness to preventive services and community supports, and facilitating their successful community integration. Achieving these goals can reduce the need for coercion and ameliorate the social burden and stigma of mental illness. Shifting ethical discourse to the population level is an important step in the continuing transformation of mental health care and policy in the twenty-first century.
In the correctional setting, the patient is at the core of professional nursing practice. The fact that the patient is incarcerated is only a circumstance of his or her situation and does not, and should not, change how the nurse practices or how the nurse views the patient. Correctional nursing allows the nurse to practice the essence of nursing while recognizing that all patients have intrinsic value. Achieving and staying true to professional nursing values while practicing in the correctional setting can create a unique set of ethical, legal and professional issues for the nurse. This article will examine some of the ethical and legal issues correctional nurses must address in their practice. Ethical Concerns For the nurse in a traditional medical setting, ethical decisions occur occasionally and at times the nurse may face ethical dilemmas.
PDF | Ethical issues in Mental Health Nursing | Find, read and cite all the research you Identify legal considerations and practical restraints.
Ethical and Legal Issues
The application of physical restraint for patients represents ethical dilemmas for psychiatric nurses in terms of maintaining the safety of all clients and staff while at the same time curtailing the individual's autonomy. This article aimed to provide a sound knowledge of ethical positions and strategies for psychiatric nurses to address ethical issues of physical restraint according to the ethical principles of autonomy, beneficence, nonmaleficence, and ethical theories. Given that nursing workforce was limited and workload among psychiatric nurses was heavy, physical restraint was one of the coercive interventions managing aggressive behavior. In relation to address ethical dilemmas, it was proposed to acquire informed consent of physical restraint from the individuals and provide person-centered care.
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to:. Ethics, simply defined, is a principle that describes what is expected in terms of right and correct and wrong or incorrect in terms of behavior. For example, nurses are held to ethical principles contained within the American Nurses Association Code of Ethics. Ethics and ethical practice are integrated into all aspects of nursing care. The two major classifications of ethical principles and ethical thought are utilitarianism and deontology.
Is it not, then, an atrocious anomaly that the treatment often meted out to insane persons is the very same treatment which would deprive some sane persons of their very reason?
Ethics in Mental Health Care: A Public Health Perspective
Ethical issues are wide-ranging, from organ donation, genetic engineering, assisted suicide, withholding treatment in end-of-life care, or simple procedures requiring consent. This influence may be seen in the expanding autonomous roles of nurses in a variety of clinical settings, changes in the health care deliv- Physicians who provide care for nursing home residents are regularly challenged by ethical and legal issues. It reflects the continuing influence that the law, legal issues, and the field of ethics have on the professional practice of nursing.
The Mental Healthcare Act MHCA ,[ 1 ] explicitly talks about the rights of patients with mental illness PWMI and lays down the ethical and legal responsibilities of mental health professionals and the government. The rights of PWMI are at par with the fundamental rights of human beings and need to be clearly talked about as they belong to a vulnerable group from evaluation, treatment, and research perspectives. Such rights translate into the ethics of psychiatric care that relate to respect for autonomy; the principle of non-maleficence, beneficence, and justice; confidentiality and disclosure ; boundary violations; informed consent and involuntary treatment ; etc. They also mention the non-representation of the Indian Psychiatric Society and inadequate address of the burden of care experienced by the caregivers.
Moral behaviour: is defined as conduct that results from serious critical thinking about how individuals ought to treat others Moral behavior reflects the way a person interprets basic respect for other persons, such as the respect for autonomy, freedom, justice, honesty, and confidentiality Values: are ideals or concepts that give meaning to the individuals life Right: is absolute when there is no restrictions whatsoever on the individuals entitlement. These principles provide guidelines for ethical decision-making i. Ethical Relativism: right and wrong are determined by what my society believes Divine Command Theory: right and wrong are determined by God. Ethical Egoism: a descriptive theory which states that people always act to maximize their self-interest. Utilitarianism or Consequentialism: right and wrong are determined by the utility or consequences of an action; in most versions of this theory, actions are right if they produce happiness or reduce pain. Deontological or Rights-Based Ethics or Kantian Ethics : right and wrong are determined by whether the action is consistent with duty and done from a motive of fulfilling ones moral obligation; moral obligation is defined as respect for persons. Theories of Justice: determines just actions to be those that emerge from the correct use of principles that have been agreed to under conditions that are fair ETHICAL DILEMMA occurs when there are conflicting moral claims a situation that requires an individual to make a choice between two equally unfavorable alternatives no one good solution the decision made often has to be defended against those who disagree with it.
Definition and legal and ethical rights of mentally ill patients · Medical laws for psychiatric patients · Ethical and legal responsibilities and role of a psychiatric nurse.
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