Chapter 4: Patient Rights, Ethics and Legal Issues Flashcards
Key values of self determinism:
- personal autonomy
- avoidance of dependence
Self determinism
is the right to choose one’s own health related behaviors, which at times differ from those recommended by health professionals
Advanced Care Directives
Written instructions for healthcare when individuals are incapacitated
Power of attorney aka health proxies
living wills and appointment directives
living will
what treatment should be omitted or refused in the event that a person is unable to make those decisions
Durable power of attorney
A Durable power of attorney appoints a proxy (usually friend or family member), to make healthcare decisions on an individual’s behalf if that person is incapacitated
Special rules for advance directive
it doesn’t need to be written, reviewed or signed by attorney.
It must be witnessed by two people and notarized and applies only if the individual is unable to make their own decisions as a result of being incapacitated or unable to make decisions
Psychiatric Advance Directives (PADs):
allows pts while competent, to document their choices of treatment and care
Mental Health Systems Act
requires each state review and revise its laws to ensure that mental health pts receive these human rights protections and services
American with Disabilities
ensures that people with disabilities, including those with mental illness and addiction, have legal protection against discrimination in the workplace, housing, public protection etc.
The Mental Health Parity and Addiction Equity Act
requires insurance plans to offer comparable benefits and coverage for mental and substance disorders that are offered for medical and surgical coverage
The patient Bill of Rights includes the right for a pt to refuse treatment. But this does not apply in what circumstances?
The right to refuse treatment, except during an emergency situation or as permitted under law in the case of a person committed by a court for treatment
External Advocacy System
Financially and administratively independent from the mental health agencies
these groups advocate through negotiation and recommendation but have no legal authority
Accreditation
The recognition or approval of an institution according to the accrediting body’s criteria
The Centers for Medicare and Medicaid Services (CMS)
sets pt rights standards for institutions seeking Medicare and Medicaid funding
Incompetent
unable to understand and appreciate the info given during the consent process
Competence
or the degree to which the patient can understand and appreciate the info given during the consent process
refers to the pt’s ability to process info at a specific time
When is it possible to force treatement on a pt
when they are judged incompetent
informed consent
a legal procedure to ensure that the pt knows the benefits and costs of treatment
Least Restrictive Environment
which means that an individual cannot be restricted to an institution when they can be successfully treated in the community
A pt cannot be restrained or locked in a room unless
all other less restrictive interventions are tried first
Seclusion
involuntary confinement of a person in a room or an area where the person is physically prevented from leaving
Why is person in seclusion?
for purposes of safety or behavioral management
The most restrictive safety measure
the use of restraints
restraints
any manual, physical or mechanical that immobilizes or reduces the ability of the pt to move
chemical restraints
the use of meds for restricting pt’s behavior or their freedom of movement
includes meds that are not part of their standard psych treatment
Trauma informed care
being aware of, and sensitive to doing no further harm to survivors of trauma
pt needs to feel connected, valued informed and hopeful
How long should seclusion/restraint be used?
must be used for the minimal amount of time necessary to ensure the safety of the pt and others
Voluntary admission
inpt treatment reserved for pts acutely ill.
if hospitalizationis required the person enters, participates and follows through with treatment.
When can a person who was voluntarily admitted leave the hospital?
the individual maintains civil rights and is free to leave at any time even if it AMA
Voluntary commitment
If pt is admitted to a public facility (full legal rights are retained)
Involuntary commitment
is the mandated treatment without a person’s consent but with a court order
Three elements needed to involuntarily commit
- mentally disordered
- dangerous to self or others
- unable to provide for basic needs
Pts who are involuntarily committed have the ________but they also may have the right to ________
right to receive treatment and right refuse it
How long is emergency short term hospitalization?
48 to 92 hours authorized by a certified mental health provider without court approval
At end of 48 to 92 hours, what happens to pt/
at end of time limited period, either individual agrees to voluntary treatment or extended commitment procedure are begun
- judge must order commitment and individual is afforded several legal rights, notice of proceedings a full hearing, in which gov must prove grounds for commitment
Privacy
part of idividuals life not governed by society’s laws and gov intrusion
Confidentiality
pertains to an ethical duty of nondisclosure
Breach of confidentiality
occurs when a nurse divulges a pt’s personal info without pt’s consent
Health Insurance Portability and Accountability Act
provides legal protection in several areas of health care, including privacy and confidentiality
When are health care professionals legally obligated to breach confidentiality?
when there is a judgement that the pt has harmed any person or is about to injure someone, professionals are mandated to report to authorities
Forensic
Pertains to legal proceedings and mandated treatment of persons with mental illness
Fitness to stand trial
Fitness: pt is able to consult a lawyer with a reasonable degree of rational understanding of the facts of the crime and of legal proceedings
Unfit to stand trial
mental or physical condition, they are unable to understand the nature and purpose of the proceedings or to assist in the defense
What is the next step when someone is found unfit to stand trial?
hospitalization in a forensic mental health facility
What is the goal of a hospitalization in a forensic mental health facility
is to help the person become fit to stand trial, not to treat the mental illness
How long can a person be deemed unfit?
not forever
if fitness is not retain within a year, hearing is held during which the facts of the alleged crime are presented to a judge who rules on the case
IF charges aer dismissed by judge for crime done by unfit person what happens?
if charges are dismissed, the judge could order a civil commitment
If there is sufficient evidence to commit an individual who was deemed unfit,
the individual could be sent back to the hospital for further treatment to attain fitness
No guilty by reason of insanity
The accused is judged unable to distinguish right from wrong or to be unable to control their actions at the time of the crime
rationale ruling is fairness
What happens to individuals found NGRI?
Nearly all pts found NGRI are subject to involuntary commitment in a secure setting
Guilty but mentally ill (GBMI)
is a criminal conviction
person is sent to the correctional system
mental illness is considered a factor of the crime but not to the extent that the individual is incapable of knowing right from wrong or controlling their actions
Similarities between NGRI and GBMI persons and difference
Both NGRI and GBMI persons are treated for their mental disorders,
difference between NGRI and GBMI persons
one is treated in jail and the other in a hospital
conditions of release differ
Conditions of release for GBMI
individuals with a GBMI are subject to the correctional system’s parole decisions
Conditions for release of NGRI
those with an NGRI are discharged from the hospital through the courts upon recommendation of the forensic mental health professionals
Probation
is a sentence of conditional or revocable release under the supervision of a probation officer for a specified time
Brady Act
requires background check on people seeking firearm ownership
Torts
a civil wrong not based on contract committed by one person that causes injury to another
a wrongful act, resulting in injury, loss or damage
Two types of unintentional torts
- Negligence
- Malpractice
Elements needed to prove malpractice
Duty
Breach of duty
injury or damage
causation
Types of Intentional torts:
- Assault
- Battery
- False imprisonment
Three elements to prove liability for tort:
- willful, voluntary
- intention to bring about consequences or injury
- act was substantial factor in injury or consequences
Assault
is the threat of unlawful force inflicted bodily injury upon another
Medical battery
intentional, unauthorized harmful or offensive contact, occurs when a pt is treated without informed consent
Example of medical battery
clinician does not get consent before procedure
failure to respect a patient’s advance directives
Negligence
breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries
Five elements needed to prove negligence:
- duty (accepting to care for pt)
- breach of duty (failure to practice according to standards)
- cause in fact (injury wouldn’t have happened if standards were followed)
- cause in proximity (harm actually occurred within the scope of foreseeable consequence)
- damages (physical, emotional injury by breach of care)
Utilitarianism
decisions based on the greatest good for the greatest number
Deontology
decisions based on whether an action is right or wrong
Autonomy
right to self determination
Beneficence
duty to benefit others or promote good
Nonmaleficence:
Nonmaleficence: requirement to do no harm
Justice
Fairness
Veracity
Honesty, truthfulness
Fidelity
obligation to honor commitments and contracts
Deontologic principles
Autonomy
Beneficence
Nonmaleficence
Justice
Veracity
Fidelity
