Ethical and Legal Issues in PsychiatricMental Health Nursing

1
Chapter 5

• Ethical and Legal Issues in Psychiatric/Mental
  Health Nursing

2
Introduction

• 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 a society.

3
Definitions

• Ethics - the science that deals with the
  rightness and wrongness of actions
• Bioethics - term applied to ethics when they
  refer to concepts within the scope of medicine,
  nursing, and allied health

4
Definitions (cont.)

• Values ideals or concepts that give meaning to
  the individuals life
• Moral behavior conduct that results from
  serious critical thinking about how individuals
  ought to treat others
• Values clarification a process of
  self-exploration through which individuals
  identify and rank their own personal values

5
Definitions (cont.)

• 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 when there is no restriction
  whatsoever on the individuals
• entitlement
• Legal right a right on which
• society agrees and has
• formalized into law

6
Ethical Considerations

• Theoretical Perspectives
• Utilitarianism an ethical
• theory that promotes actions
• based on the end results
• that produce the most good
• (happiness) for the most people
• Kantianism suggests that
• decisions and actions are
• bound by a sense of duty

7
Ethical Considerations (cont.)

• Theoretical Perspectives (cont.)
• Christian ethics - do unto others
• as you would have them do unto
• you alternatively, do not do unto
• others what you would not have them do unto
  you.
• Natural law theories do good and avoid evil.
  Evil acts are never condoned, even if they are
  intended to advance the noblest of ends.
• Ethical egoism decisions are
• based on what is best for the
• individual making the decision.

8
Ethical Dilemmas

• Ethical dilemmas occur when moral appeals can be
  made for taking either of two opposing courses of
  action.
• Taking no action is considered an action taken.

9
Ethical Principles

• Autonomy This principle emphasizes the status
  of persons as autonomous moral agents whose
  rights to determine their destinies should always
  be respected.
• Beneficence This refers to
• ones duty to benefit or
• promote the good of others.

10
Ethical Principles (cont.)

• 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 ones duty to be truthful always.

11
A Model for Making Ethical Decisions

• Assessment
• Problem identification
• Plan
• Implementation
• Evaluation

12
Ethical Issues in Psychiatric/Mental Health
Nursing

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

13
Legal Considerations

• Nurse Practice Act defines the legal parameters
  of professional and practical nursing.
• Types of Laws
• Statutory law
• Common law

14
Classifications Within Statutory and Common Law

• Civil Law protects the private and property
  rights of individuals and businesses
• Tort
• Contracts
• Criminal law provides
• protection from conduct
• deemed injurious to the
• public welfare

15
Legal Issues in Psychiatric/Mental Health Nursing

• Confidentiality and right to privacy
• Doctrine of privileged communication
• Informed consent
• Restraints and seclusion
• False imprisonment

16
Legal Issues in Psychiatric/Mental Health Nursing
(cont.)

• Commitment issues
• Voluntary admissions
• Involuntary commitment
• Emergency commitment
• The mentally ill person in need of treatment
• Involuntary outpatient commitment
• The gravely disabled client

17
Legal Issues in Psychiatric/Mental Health Nursing
(cont.)

• Malpractice and negligence
• Types of lawsuits that occur in psychiatric
  nursing
• Breach of confidentiality
• Defamation of character
• Libel
• Slander

18
Legal Issues in Psychiatric/Mental Health Nursing
(cont.)

• Assault and battery
• False imprisonment
• Invasion of privacy

19
Avoiding Liability

• Respond to the client
• Educate the client
• Comply with the standard of care
• Supervise care
• Adhere to the nursing process
• Document carefully
• Follow up and evaluate
• Maintain a good interpersonal
• relationship with client and
• family