Legal and Ethical Issues

1
Legal and Ethical Issues

• Kimberley Clow
• kclow2_at_uwo.ca
• http//instruct.uwo.ca/psychology/155b/

2
Outline

• Legal Issues
• Criminal Commitment
• Tests of Mental State
• Civil Commitment
• Rights of Patients
• Ethical Issues
• Privacy
• Confidentiality
• Limitations
• Dual Relationships

3
Criminal Commitment

• Being incarcerated for committing a crime
• We have free will
• Responsible for our choices
• Suffer the consequences of our actions
• Issues arise when individuals
• Arent aware of the consequences to their actions
• Are not freely choosing to perform certain actions

4
Mental State of Defendant

• Insanity Defence
• MNaughten Rule
• Durham Rule
• Irresistible Impulse Test
• American Law Institute Rule
• Competency to Stand Trial
• Factual understanding?
• Rational understanding?
• Able to consult with counsel?

5
Little Known Facts

• The Insanity Defence is used lt 1
• Most often rejected
• Judges reject the plea about 50
• Juries reject the plea 85
• When plea is successful
• lt15 are murder charges
• Not guilty by reason of insanity
• Do NOT go free!
• Confined to mental hospital

6
The Defense is Misperceived
7
Reforms

• Since the Hinckley case
• Rather than prove a defendants sanity, must now
  convince judge or jury that clients are insane
• Restrict use of defense
• Connecticut doubled the average term spent in
  institutions
• Idaho, Montana, Utah abolished the defense!
• Guilty but Mentally Ill Plea has emerged

8
Civil Commitment

• But you can be committed to an institution
  against your will even if you didnt commit a
  crime or do anything wrong
• Criteria for Civil Commitment
• Person presents clear and imminent danger to self
  or others
• Inability to care for self
• Inability to make responsible decisions
• Procedure
• Petition court for examination
• Formal hearing is held

9
Rights of Treatment

• The Right to Treatment
• The Least Restrictive Alternative to Treatment
• The Right to a Humane Environment
• Protection and Advocacy for Mentally Ill
  Individuals
• The Right to Refuse Treatment
• Must have informed consent before conducting
  treatment
• Especially risky or intrusive treatments
• Cannot force people to take antipsychotic
  medication in order to be competent to stand trial

10
Ethics

• What are the potential issues?
• Do no harm
• Do not exploit
• Practice only within your competence
• Treat people with respect and dignity
• Protect confidentiality
• Obtain informed consent first
• Practice within the framework of social equity
  and justice

11
Other Ethical Issues

• Privacy
• Limiting others access to information
• Assuring freedom from intrusions
• Confidentiality
• Refers to legal rules and ethics that protect
  individual from unauthorised disclosure of this
  information
• Privilege
• An exception to the general rule that the public
  has a right to relevant evidence in a court
  proceeding

12
Limits on Confidentiality

• Confidentiality, however, is not a RIGHT
• We strive to provide confidentiality, because it
  is important, but there are a number of
  situations that can arise where confidentiality
  is broken
• Limits on Confidentiality
• Mandatory Reporting
• Duty to Warn
• Duty to Protect
• Legal System Exceptions

13
How to Act?

• Consider the following
• Describe parameters of situation
• Define the potential issues involved
• Consult any existing guidelines
• Evaluate the rights, responsibilities, and
  welfare of all affected parties
• Generate alternatives for each issue
• Calculate consequences of all alternatives
• Based on evidence, not just conjecture!
• Choose the lesser of the evils

14
Dual Relationships

• Dual Relationships
• When the therapist is in another, significantly
  different relationship with one of his or her
  clients
• social, financial, professional, sexual
• Problems with Dual Relationships
• Conflict of interest
• Power differential
• Sexual relationships are NOT permitted!!!

15
Therapist Sex Differences
Behaviour Sex Difference
Hugging a client FgtM
Having client use your first name FgtM
Say to client, "Im sexually attracted to you" MgtF
Treating homosexuality as pathological MgtF
Engaging in sexual fantasy about client MgtF
Directly soliciting person to be client MgtF