Lecture 2 Unified Ethical Consideration in Psych Nursing

Legal and Ethical Issues in
Psychiatric Nursing
Patient’s Bill of Rights
◼ Civil Rights
◼ Client Consent
◼ Communication
◼ Freedom from Harm
◼ Dignity and Respect
◼ Confidentiality
◼ Participation in Their Treatment Plan
Legal and Ethical Concepts
◼ Ethics
◼ Study of philosophical beliefs about what is considered
right or wrong in society
◼ Bioethics
◼ Ethical questions arising in health care
◼ Principles of bioethics
◼ Beneficence: duty to act to benefit others
◼ Autonomy: respecting rights of others to make
decisions
◼ Justice: duty to distribute resources equally
◼ Fidelity: maintaining loyalty and commitment to patient
◼ Veracity: duty to communicate truthfully
Mental Health Laws:
Civil Rights and Due Process
Civil rights: people with mental illness are
guaranteed same rights under federal/state laws
as any other citizen
◼ Due process in civil commitment: courts have
recognized involuntary commitment to mental
hospital is “massive curtailment of liberty”
requiring due process protection, including:
◼ Writ of habeas corpus: procedural mechanism used
to challenge unlawful detention
◼ Least restrictive alternative doctrine: mandates
least drastic means be taken to achieve specific
purpose
Mental Health Laws:
Admission to the Hospital
◼ Voluntary: sought by patient or guardian
◼ Patients have right to demand and obtain release
◼ Many states require patient submit written release notice to staff
◼ Involuntary admission (commitment): made without patient’s
consent
◼ Necessary when person is danger to self or others, and/or unable to
meet basic needs as result of psychiatric condition
◼ Emergency involuntary hospitalization
◼ Commitment for specified period (1-10 days) to prevent dangerous
behavior to self/others
◼ Observational or temporary involuntary hospitalization
◼ Longer duration than emergency commitment
◼ Purpose: observation, diagnosis, and treatment for mental illness
for patients posing danger to self/others
Patient Confidentiality
◼ Ethical considerations
◼ Confidentiality is right of all patients
◼ ANA Code of Ethics for Nurses (2001) asserts duty of nurse to protect
confidentiality of patients
◼ Legal considerations
◼ Health Insurance Portability and Accountability Act (HIPAA), 2003
◼ Health information may not be released without patient’s consent, except to those
people for whom it is necessary in order to implement the treatment plan
◼ Exceptions
◼ Duty to Warn and Protect Third Parties
◼ Tarasoff v. Regents of University of California (1974) ruled that psychotherapist has
duty to warn patient’s potential victim of potential harm
◼ Most states have similar laws regarding duty to warn third parties of
potential life threats
◼ Staff nurse reports threats by patient to the treatment team
Client’s Rights Under the Law
◼ Right to Treatment
◼ Right to Refuse Treatment
◼ Right to Informed Consent
◼ Rights Regarding Restraint and Seclusion
Right to Treatment
◼ Clients have the right to receive treatment

for psychiatric problems
◼ Rx must meet the following criteria:
◼ The environment must be humane
◼ Staff must be qualified and sufficient to provide
adequate Rx
◼ The plan of care must be individualized
Right to Refuse Treatment
◼ When forcible medication is used to prevent

violence to third parties, to prevent suicide, or to
preserve security, the court noted that the med is
being used as a chemical restraint—changes from
individual rx to public protection
◼ If it is deemed that an individual is unable to make
a competent, informed, and voluntary decision re:
rx,courts have stated that the med determinations
and rx plans are best left to the professionals
Rights Regarding Seclusion and
Restraint
◼ Legally, behavioral restraint and seclusion are
authorized as an intervention when:
◼ The particular behavior is physically harmful to the
client or a 3rd party
◼ The disruptive behavior presents a danger to the facility
◼ Alternative or less restrictive measures are insufficient
in protecting the client and others from harm
◼ When a decrease in sensory over stimulation (seclusion
only) is needed
◼ When a client requests seclusion
Restraint (cont)
◼ The use of seclusion and restraint is permitted
only:
◼ On the written order of a physician
◼ Must be face-to-face exam by MD within 1 hr of the
application
◼ Next 4 hrs can have phone order
◼ Next 4 hrs need to have face-to-face exam…etc
◼ Clients should be assessed q 15 min
◼ Restraints must be rotated q2h
◼ Food and fluids should be offered at least q2h
Restraint (cont)
◼ Documentation—
◼ Should reflect that lesser restrictive methods
were tried
◼ The behavior leading to restraint/seclusion
Principles of Bioethics
◼ Nonmaleficence: the obligation never to

deliberately harm anyone.
◼ Beneficence: the obligation to promote the

welfare of others, to maximize benefits and
minimize harm.
◼ Respect to autonomy: the obligation to
respect, and not to interfere with, the choices
and actions of autonomous individuals.
◼ Justice: the obligation to be fair in the
distribution of burden and benefits and in the
distribution of social goods such as health care
or nursing care
Tort Law
◼ Torts are civil wrongs for which money damages
are collected by the injured party (plaintiff) from
the wrongdoer (defendant)
◼ Civil liability for nsg practice falls in the area of
tort law
◼ 3 types of torts:
◼ Intentional
◼ Quasi-intentional
◼ Unintentional
Intentional
◼ Assault
◼ An act resulting in a person’s apprehension of an
immediate harmful or offensive touching (battery)
◼ Battery
◼ Harmful or offensive touching
◼ False imprisonment
◼ An act with intent to confine a person to a specific area
◼ The use of seclusion or restraint that is not defensible as
being necessary or in the pt’s best interest
Quasi-Intentional
◼ Defamation is made up of 2 torts:

◼ Slander or oral communication
◼ Libel or written communication
◼ Breach of confidentiality
Unintentional
◼Professional negligence
◼Involves harm resulting from the failure
of a person to conduct himself or herself
in a reasonable and prudent manner.
◼Malpractice: involves failure to exercise
an acceptable degree of professional skills
that result in injury, loss, or damage.
Unintentional
◼ Professional negligence
◼ 4 items needed to prove negligence are:
◼ Duty—measured by standard of care
◼ Breach of duty—conduct that exposes the client
to an unreasonable risk of harm
◼ Proximate cause—Intervening actions or
persons that were, in fact, the causes of harm to
the client
◼ Damages—pain and suffering
Duty to Warn Third Parties
A duty to warn third parties

exists when a therapist
determines that the pt presents a
serious physical danger to
another person

Lecture 2 Unified Ethical Consideration in Psych Nursing

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Lecture 2 Unified Ethical Consideration in Psych Nursing

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Legal and Ethical Issues in

◼ Clients have the right to receive treatment

◼ When forcible medication is used to prevent

◼ Nonmaleficence: the obligation never to

◼ Beneficence: the obligation to promote the

◼ Defamation is made up of 2 torts:

A duty to warn third parties

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