Ch 4 Ethical & Legal Issues - Chapter 4 Patient Rights...

Unformatted text preview: Chapter 4: Patient Rights Ethical and Legal Issues Patient Rights Bill of rights Necessary because of vulnerability to abuse and mistreatment Universal Bill of Rights for Mental Health Patients Americans with Disabilities Act (ADA) Outlaws discrimination against individuals with disabilities Protects people with mental disorders Issues of Consent Self-determinism: Empowerment or having free will to make moral judgments Internal motivation to make choices based on personal goals Key values: Personal autonomy Avoidance of dependence on others A basic and fundamental psychological need Issues of Consent (con’t) Right to choose one’s own healthrelated behaviors Possibly different from those recommended by health professions Self-Determination Act Advance care directives Protection of Patient Rights Patient Self-Determination Act Question on admission about having an advanced care document Information about advance care documents Information about rights to complete advance care documents Advance care directives in mental health Living will, durable power of attorney Psychiatric advance directives Issues of Consent Competence: degree to which the patient is able to understand and appreciate the information given during the consent process Informed consent: the right to determine what shall be done with body and mind Protection of Patient Rights (cont’d) Bill of Rights for Mental Health Patients (refer to Box 4.1) Americans with Disabilities Act (ADA) and job discrimination Internal rights protection systems (Public Law 99-319) External advocacy systems Accreditation NAMI Do patient’s with mental illness have rights? And what kind of rights do they have? NAMI is a non-profit organization that advocates for the mentally ill. Question Which of the following is a key value associated with self-determination? A. Dependency B. Advocacy C. Consent D. Personal autonomy Answer D. Personal autonomy and the avoidance of dependence on others are two key values of selfdetermination. Advocacy and consent are not values involved with self-determinism. Question Is the following statement true or false? The Patient Self-Determination Act ensures that a person with a mental illness is not discriminated against the workplace. Answer False. The Patient Self-Determination Act requires that agencies receiving Medicare and Medicaid reimbursement to inform patients at the time of admission of their right to be a central part of any and all health care decisions made about them or for them. Types of Treatment Voluntary admission or commitment Person retains full civil rights Free to leave at any time, even against medical advice Types of Treatment (cont’d) Involuntary commitment: court ordered; without person’s consent Three common elements: Mentally disordered Dangerous to self or others Unable to provide for basic needs Right to receive treatment; possible right to refuse treatment Provisions for emergency short-term hospitalization of 48 to 92 hours Least Restrictive Environment Patients have the right to refuse treatment or medications A person cannot be restricted to an institution when he or she can be successfully treated in the community Medication cannot be given unnecessarily Use of restraints or locked room only if all other “less restrictive” interventions have been tried first Promotion of Patient Safety Observation De-escalation Seclusion Restraints Question Is the following statement true or false? Involuntary commitment requires a court order. Answer True. Involuntary commitment is the confined hospitalization of a person without the person’s consent but with a court order. Issues of Confidentiality Privacy: part of person’s life not governed by society’s laws and government intrusion Confidentiality: ethical duty of nondisclosure (provider has information about patient and should not disclose it) Breach of confidentiality: release of patient information without the patient’s consent in the absence of legal compulsion or authorization Health Insurance Portability and Accountability Act (HIPAA) Requires patient authorization for the release of information with the exception of that required for treatment, payment, and health care administrative operations Mandates to Inform A legal obligation to breach confidentiality “Duty to warn”: when there is a judgment that the patient has harmed someone or is about to injure someone (based on Tarasoff v. Regents of University of California ) Accountability Legal liability in psychiatric nursing practice Assault Battery Medical battery False imprisonment Negligence Common areas for lawsuits: Patients who are suicidal or violent Question A part of a patient’s life that is not governed by society’s laws and government intrusion is referred to as: A. Confidentiality B. Privacy C. Informed consent D. Competency Answer B. Privacy refers to that part of an individual’s personal life that is not governed by society’s laws and government intrusion. Confidentiality is an ethical duty of nondisclosure. Informed consent is a legal procedure to ensure that a patient knows the benefits and costs of treatment. Competency refers to the patient’s cognitive ability to process information at a specific time. Documentation Handwritten or electronic It is common for all disciplines to record on one progress note Patients have access to their records Nursing documentation is based on nursing standards Documentation Documentation is mandatory for patients who are suicidal, homicidal, aggressive, or restrained in any way Always write in pen Corrected entries are initialed Avoid judgmental statements (i.e., “patient manipulating staff”) Documentation (cont’d) Required nursing documentation Observations of subjective and objective physical, psychological, and social responses Interventions implemented and patient's response Observations of medications’ therapeutic and side effects Evaluation of outcomes of interventions Forensic Mental Health Legal proceedings and mandated treatment of persons with a mental illness County jails Correctional facilities Psychiatric hospitals Community Crimes most often misdemeanors against person and property and crimes again public decency Majority of encounters with justice system: individuals with mental illness as victims of crimes Perspectives on Mental Illness and Criminal Behavior Three views of mental illness and criminal behavior Mental illness as the cause for criminal behavior Person with criminal behavior also has mental illness Development or exacerbation of mental illness after being committed to jail Dual stigma: mental illness and criminality Interruption in coordinated humane treatment caused by conflict between inpatient facility and community (refer to Box 41.1) Question Is the following statement true or false? Most individuals with mental illness who are involved with the judicial system commit felonies. Answer False. Crimes involving individuals with mental illness are usually misdemeanors against person or property and crimes against public decency. Individuals with mental illness are often victims of crimes. Laws and Psychiatry NGRI - Not Guilt by Reason of Insanity GBMI - Guilty but Mentally Ill Forensic Commitment . Misconceptions about the Insanity Plea Very few insanity pleas are successful (less than 2%). Insanity is usually determined by whether the person has substantial appreciation or understanding of the criminality (wrongfulness) of his or her conduct. Public safety? Patients are more likely to be the victims than the perpetrators. ...
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