Ethical and Legal Issues

• 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 society

• ethics: branch of philosophy that deals with distinguishing right from wrong
• bioethics: term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health

• moral behavior: conduct that results from serious critical thinking about how individuals ought to treat others
• values: personal beliefs about what is important and desirable
• values clarification: a process of self exploration by which people identify and rank their own personal values

• right: 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: where there is no restriction whatoever on the individual's entitlement
• legal right: a right on which the society has agreed and formalized into law

• ethical dilemmas are situation that require individuals to make a choice between two equally unfavorable alternatives
• taking no action is considered an action taken

• Autonomy: emphasizes the status of persons as autonomous moral agents whose right to determine their destines should always be respected
• beneficence: refers to one's duty to benefit or promote the good of others

• nonmaleficence: abstaining from negative acts toward another, includes acting carefully to avoid harm
• justice: 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: principle that refers to one's duty to always be truthful

• assessment
• problem identification
• plan
• implementation evaluation

• the right to refuse medication
• the right to the least restrictive treatment alternative

• healthcare persona; must attempt to provide treatment in a manner that is least restrictive
• the 'restrictiveness' of psychiatric therapy described on a continuum based on severity of illness
• ex:

• is part of the OBRA (Omnibus Budget Act Reconcilation Act of 1990)
• requires healthcare facilities to provide clear written information regarding his/legal right to healthcare decisions including accepting and refusing information
• p 64 box 4-3 pt rights affirmed by this law

• called for constuction of comprehensive community mental health centers
• cost shared federal and state
• state did not have funds to match federal
• in 1980 the community mental health systems act rendered and played a role in renovation of mental health care would serve HR (high risk) populations, rape research, and services but before enacted project terminated 1984

• the lanterman developmental disabilities services act, known as the lanterman act
• an important piece of legislation passed 1969
• california law that says people with developmental disabilities and their families have a right to get the services and supports to live like people without disabilities
• equal rights regardless of disability

• forcible medication administration is justified in an emergency to prevent violence and to prevent patient deterioration
• medication must have a reasonable chance to help the pt
• pt must be judged incompetent by court to continue medication

• 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

• confidentiality and right to privacy:
• HIPPA
• Doctrine of privileged communication
• exception: a duty to warn and protect
• - Tarasoff v Roger of university of cali
• (in school, he said he would stab his girlfriend, the psych called the campus police they let him go and he killed her, fam sued)
• document: who you release info, valid, pt has to have a negative effect

• Informed Consent- rn witness
• restraints
• seclusion
• - safe contained environment
• - false imprisonment (rationale: contain, isolate, decre stimuli- going crazy)

• Chemical- raped tranquilization
• - something 2 calm pt- in geri no no, know facility policy
• Physical- straps to restrain limbs
• - not always early
• - could be dangerous

• Commitment issues:
• voluntary admissions
• involuntary commitments
• - emergency commitments
• - the mental ill person in need of tx
• - involuntary outpt commitment
• - the gravely disable client (can't take care of their basic needs- court determines they can't take care of themselves)

• individuals makes direct application to the institution for services
• stays as long tx necessary
• dont force
• no coerce
• willing to be admitting

• signs him/herself into psych facility
• notice of intent to leave facility (3 day notice)
• a pt, admitted under conditional voluntary status may have their petition for discharge delayed for up to 3 h business days dependent upon pt condition (ex suicidal, homicidal)
• pt is able to cancel their 3 day notice and continue to be a conditional voluntary pt
• if pt is not safe can keep them for 3 days, more than 3 days become involuntary

pt is assessed by interdisciplinary tema for mental illness and suicidality, homicidality, inability to care for self

• US supreme court recognizes involuntary commitment based on 2 legal theories
• 1. to protect the public
• 2. provide for citizens that cannot care for themselves

• made various reasons
• 2 types
• one for observation and tx
• - in emergency situation danger to self or others
• - observation and tx for mental illness
• - when unable to care for basic personal need (gravely disable)
• - loss of right to immediate freedom
• based on what they observed

• behavior that is clearly and imminently dangerous self or others
• done by friends, relatives, police court, health care providers
• time limited usually 72 hours then court hearing
• most cases another hearing is scheduled 7 to 21 days

• 1. threats or attempts at suicide/bodily harm
• 2. threats or attempts violence to others
• 3. individual unable to care for self
• 3 day commitment

• court order to get tx on an outpt basis
• Kendra law
• - NY
• - schizo pt man push girl onto the train tracks
• - he never displayed s/s

• competence: the degree to which a person is able to understand/appreciate information. his/her cognitive ability to process information at a specific time
• rationality: characteristic of person's decision. an irrational decision involves hurting oneself pointlessly
• a competent person may make an irrational decision

• incompetence must be determined by courts
• to prove incompetence must show
• - person has a mental disorder
• - disorder causes defect in judgement
• - defect makes the person in capable of handling personal affairs

• used to prepare for times when psych pts are unable to make competent decision
• pts with mental illness can state tx preferences or dislikes, designate a proxy decision maker or make other advance decisions about care
• - not in mass

• malpractice/negligence
• types of lawsuits that occur in psych nursing
• - breach of confidentiality
• - defamation of character
• -- libel: written
• -- slander: spoken
• - invasion of privacy
• - assault and battery
• - false imprisonment

• respond to client
• educate pt
• comply with standard of care
•  supervise care
• adhere to nx process
• document carefully
• f/u required
• develop and maintain a good interpersonal relationship with client and fam