Chapter 7: Legal and Ethical Aspects of Practice

Question 1

Human rights and mental health legislation

Answer 1

Human rights are the recognition of the dignity and worth of every human being. Key rights and principles include equality and non-discrimination the right to privacy an individual autonomy freedom from inhumane and degrading treatment the principle of the least restrictive environment and the right to information and participation.
Canada is committed to ensuring the promotion and protection of the human rights of all persons with disabilities.

Question 2

Mental health legislation in Canada

Answer 2

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Each province and territory has its own mental health act which provides a framework for the delivery of mental health services and establishes rules and procedures cover me the commitment a person suffering from mental disorders. The act permits certain infringement on a person’s right to ensure that the person receives required care safeguards are outlined when this happens.
Mental health acts can allow involuntary admission of a person to a designated facility. This is when the person has a mental disorder and is likely to cause harm to self or others or cause substantial mental and physical deterioration or physical impairment and is unsuitable for admission to a facility other than as a formal patient.
An admission certificate allows the person to be conveyed to mental health facility and to be detained and cared for during a 24 hour period. Two admission certificates are required for the first and to remain a formal patient otherwise they are released. These two certificates detain the person for a period of one month. Renewal certificates can extend the formal patient designated for another month. The competence of the person to make decisions must be assessed. Competence means being able to be informed and to understand matters relevant to the decision and to understand the consequences of the decision. A substitute decision-maker can be sought when a person is unable to consent to treatment.
Criteria for substitute desvion making:
Best interests means The treatment will make the person less ill the person will get more ill without
treatment and the benefits outweigh any risks.
Capable wishes with the person expressed well capable even if not in current best interest.
Modified best interests follow expressed wishes except if they would endanger the person or others.

Question 3

Mandatory outpatient treatment

Answer 3

In some jurisdictions an involuntary patient may return to the community on a conditional leave if adminission criteria are met and stipulations for treatment followed
If stipulations example taking medication or meeting with the physician or not followed the person can be returned to the hospital.
Mandatory outpatient treatment involves legal provisions requiring people with a mental illness to comply with the treatment plan for living in the community. The community treatment order is in order to provide a comprehensive plan of community based treatment to someone with a serious mental disorder.(a form of MOT)
CT owes are less restrictive and being detained and serve as an alternative to hospitalization. The plan identifies the conditions that must be met by the individual and support system in order to stay out of the hospital.
All jurisdictions have a check on the involuntary aspects of mental health legislation usually a review panel. The panel excepts applications for review by formal patients persons subject to a CTO and physicians of a formal patient. The panel reviews if the patient is competent and should be detained. Usually after six months of detainment review is conducted regardless of an application from the patient

Question 4

Canadian nurses responsibility regarding mental health legislation

Answer 4

Nurses must explain the acts basic provisions to people with mental illness and their families. Nurses must keep track of certificate expiry dates, report to review panels, supervise CTO’s and provide information to clinicians and family members. Nurses have an important advocacy role ensuring that’s the right of the person coming under mental health act are protected.

Question 5

The criminal code and mental disorders

Answer 5

The law allows for persons to be found not criminally responsible due to a mental disorder for an offence if they are suffering from a mental disorder that makes them in capable of appreciating the act or knowing what they did was wrong. In this case offender must comply with treatment monitored by the criminal code review boards.

Question 6

Medical assistance in dying

Answer 6

MA ID is defined as the administrating by a medical practitioner or nurse practitioner of a substance to a person at the request that causes their death. Or prescribing or providing a medical substance to a person at the request so that they may self administer the substance and in doing so caused their own death.
Eligibility:
-They have a serious an incurable illness disease or disability
-They are in an advanced state of irreversible decline in capability
-Illness disease or disability or that state of decline causes them in during physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable
-Their natural death has become reasonably foreseeable taking into account all of their medical circumstances without a prognosis necessarily having been made as to the specific length of time that they have remaining.
This means that persons for which mental illness is the sole underlying medical condition or not eligible.

Question 7

Health ethics

Answer 7

Ethics is a consideration of the way a person should act to live a good life with and for others.
Contemporary ethics is shaped by factors such as intense individualism individual coming for the common good, corporatism dominance of business interests, unprecedented advances in science and technology, the power of the media, increased use of law as mean to resolve disputes that are inherently about values, and the loss of a sense of the sacred.
To absolute values profound respect for life and commitment to the human spirit will allow us to make ethical societal choices.

Question 8

The ethical nurse

Answer 8

Nurses are trusted to be ethical. Nurses are consistently rated the most honest and ethical professionals. When nurses and act their professional responsibilities they are active as moral agents. Being a nurse requires the every day expression of a commitment to the well-being of those in their care.

Question 9

The Canadian nurses association’s code of ethics for registered nurses

Answer 9

The Canadian nurses association’s code of ethics for registered nurses is framed by seven values with related ethical responsibilities. Providing safe compassionate competent and ethical care, promoting health and well-being, promoting and respecting an informed decision making, honouring dignity, maintaining privacy and confidentiality, promoting justice, and being accountable.
There’s a glossary of important terms in an example of an ethical model to help with reflection and decision making. There are ways to apply the code in certain circumstances. Conscientious objection is defined as a situation in which a nurse informs their employer about a conflict of conscience and they need to refrain from providing care because a practice or procedure conflicts with the nurses moral beliefs.

Question 10

Ethics guidelines for registered psychiatric nurses

Answer 10

Nurses are guided by code of ethics designed by the provincial colleges or associations. The principles of benefits, non-maleficence, integrity, Fidelity, respect for autonomy, and justice. The values framing the code of ethics in Manitoba are safe competent and ethical practice to ensure the protection of the public, respect for the inherent worth right of choice and dignity of persons, health mental health and well-being, and quality practice.

Question 11

Virtue ethics

Answer 11

Core Elements: Character of the moral agent. A virtuous person is one who without strict reliance on rules is wise enough to perceive how to act well in a particular situation. We learn virtues through relationships. A virtual virtue must become habitual to acquire it. Some virtues are honesty courage compassion and practical wisdom.

Proponents: Aristotle (Practical wisdom having the sensitive imagination and experience to do what is ethically fitting in difficult situations) and Alasdair MacIntyre.

Critiques: they are the exclusive focus on the agent.

Question 12

Deontology

Answer 12

Core Elements: Duty-based. Some acts are wrong in themselves. Universally. Do not treat others as a means to an end (respect, based for informed consent).

Proponents: Immanuel Kant

Critiques: disregard of consequences, impartially over the relationship, emotion = irrationality.

Question 13

Utilitarianism

Answer 13

Core Elements: Consequence based. Actions are right if they promote the best outcome (eg. happiness, pleasure satisfaction) for most people

Proponents: Jeremy Bentham, John Stuart Mill

Critiques: Utility as the only principle. Majority rules.

Question 14

Principlism

Answer 14

Core Elements: Based on a set of principles compatible with most moral theories. Nonmaleficence (Do no harm), beneficence (When should do or attempt to do good and make things better promote the benefit for others when one can), respect for autonomy(Also considered as respect for persons means an obligation to respect a person’s right to be self governing and his or her ability to make decisions), Justice (Obligations of fairness in the distribution of benefits and risks).

Proponents: Tumble camp and James Childress.

Critiques: too abstract, which has priority when principles complete. Four principles cannot sufficiently capture moral norms.

Question 15

Casuistry or care-based ethics

Answer 15

Core Elements: Care-based. Use of paradigm causes to identify issues in courses of action for a new case. Uses case comparisons to facilitate moral reasoning and decision making. (Identify the main ethical values. Identify the main alternative courses of action. Identify the causistic factors. Compare the case with relevant cases)

Proponents: Albert Jonsen, Stephen Toulmin

Critiques: Keeps the status quo. Can miss the broad issues

Question 16

The ethics of care

Answer 16

Core Elements: Care-based. Connection/responsibility for others. Emotional responsiveness.

Proponents: Carol Gilligan, Ned Noddlings

Critiques: Creates a dichotomy between ‘care’ (feminine) and ‘justice’ (masculine) approaches to ethics. Valorizes women as caregivers

Question 17

feminist ethics

Answer 17

Core Elements: Addresses power inequalities, dominance and depression. (Political offers insight into oppression)

Proponents: Annette Baier, Susan Sherwin

Critiques: Lacks impartiality. Lacks universal norms.

Question 18

Relational ethics

Answer 18

Core Elements: Ethical action involves relationships. Context matters emotion accepted. Dialogue is supported. Aims for the ‘fitting’ response. Court elements are mutual respect, engagement, embodied knowledge, attention to the inter-dependent environment, and uncertainty/vulnerability.

Proponents: Vangie Bergum, John Dossetor

Critiques: Too relativistic. Lacks impartiality. Lacks universality.

Question 19

Human rights

Answer 19

Core Elements: Rights based, negative (Civil or political such as freedom of speech or freedom of worship) and positive (Social or cultural such as the right to health or the right to education). Every person is entitled to certain basic rights.

Proponents: John Locke, Thomas Paine, United Nations

Critiques: As a concept, it is ‘nonsense’. Too legislative. Too individualistic.

Question 20

Ethical practice environments

Answer 20

A culture of questioning must be actively nurtured. Ethical questions are to be expected not perceived as challenging or troublesome. Consultation with an ethics committee should be acceptable. Getting along with colleagues can jump doing the right thing.

Question 21

Moral dilemmas and moral distress

Answer 21

A moral dilemma is a morally relevant conflict. A situation in which one has an obligation to act but must choose between two incompatible alternatives. Decision making frameworks our tools to guide ethical deliberation based on particular or compass it approaches. Moral distress is the embodied response such as frustration anger sleeplessness headache nausea anxiety anguish of an individual to a moral problem for which the individual assumes some moral responsibility,Make some moral judgement about the appropriate ethical action to be taken but, due to real or perceived constraints, participants by act or omission in what they regard as moral wrongdoing.

Question 22

Threats to dignity

Answer 22

Violating dignity can lead to suffering and a loss of self-worth. Nurses describe being present with patients example supporting a patient through emotions like anger and being their advocate. It can be in the small things for dignity arises such as awareness of patients as more than their illness, in choice language and tone of language, and in gestures and courtesies. Threats can be patients being ignored or not taken seriously, being physically violated through restraints, being betrayed by broken promises, and being exposed example giving medication in front of others personal history shared with the entire team. The power differential between staff and patients is a potential source for loss of dignity.

Question 23

Behaviour control, seclusion and restraint

Answer 23

Mental health care demands that the least intrusive and restrictive interventions are used in protecting and reducing risk to patients. Restrictive measures are to be used only when absolutely necessary and then with sensitivity and great caution.

With proportion and control,Expressing moral doubt can be difficult because it can lead to being viewed as inexperienced or weakness it can be taken as criticism of colleagues or leaders and it can delay rapid response to a clinical situation.

Question 24

Psychiatric advance directives

Answer 24

Psychiatric advanced directives are legal resources for people to use for times when their decision making ability is compromised by mental illness. Involves a surrogate decisionmaker. It can communicate with physicians avoid side effects by identifying specific medications that an individual wishes to avoid prevents involuntary treatment. These give patients a sense of control and increases he use of treatments and lower need for coercive interventions

Question 25

Relational engagement: ‘Boundaries”

Answer 25

Boundaries are used to describe the limits of therapeutic relationships they imply clear firm borders that should not be crossed. Real life is often more gray. Example is refusing a small homemade gift from a grateful patient may be a hurtful act. Excepting a significant gift from a vulnerable patient may be viewed as theft. Declining a friend invitation on a social networking site can be a complex ethical issue. Use of social media was found to possibly correlate with students and ethical behavior. Internet security will be a domino concern such as the use of email and virtual home visits. One of the most serious types of boundary violation is sexual harassment and abuse of patients. The argument that it was a mutual decision is unacceptable due to the power dynamic. Under involvement can also be an ethical issue. Lack of time to engage with patients can cause nurses moral distress. A negative response can be invoked when a patient rejects care or is abusive. When nurses have difficulty connecting to a patient they choose three options to emotionally distance themselves, to transfer the patient to another nurse, or make a conscious effort to be respectful and provide good care.

Question 26

Confidentiality and privacy

Answer 26

Privacy is a basic human right. The privacy act and personal information protection and a lot electronica documents act help regulate peoples right to privacy.A new privacy concern is
The merging of information technology and information about our bodies such asdigital measurements of vital signs biomedical electronics automatic medical records. Disclosure of information within the healthcare team occurs as necessary for treatment and care, but when patients can find information that’s not relevant to their health this information is not shared. There are situations that legally require the reporting of information received in a patient care situation. Mandatory reporting of child abuse and abusive adults and Care.

Question 27

Advances in neurotechnology

Answer 27

Advances in Nuro technology bring new threats to privacy as the use is being explored include detection of lying lying and prediction of violent or criminal behaviour but it also brings possible threats to autonomy through invasive and non-base of ways in influencing the brain. Nuro ethics studies this area.Manipulation of memory is made possible through TNS deep brain stimulation and pharmacological agents.

Question 28

Advances in genetics

Answer 28

Eugenics was a movement that began at the offset of the 20th century. It involves preventing the physically and mentally disabled from reproducing sterilization was a favourite strategy. New eugenics can involve genetic testing during pregnancy genetic profiles may lead to discrimination. Confidentiality remains an issue. Look at the 21 and me tests.

Question 29

Social justice

Answer 29

Justice a principle of fair treatment of individuals and groups and a promotion of the common good within society is a core value underpinning the code of ethics. To address social inequalities nurses can advocate for policies and laws support promote environmental preservation and restoration.

Question 30

Research ethics

Answer 30

Informed consent is key to the protection of research subjects. Consent must be voluntary ongoing and informed. There’s some debate over whether the research participation of hospitalized persons who are currently deemed not competent is ethical. Informed consent may also be questionable in cases of research on cravings the individual may dismiss the risks for the potential access to the drug of addiction. Study designs that raise particular ethical concerns include 1 placebo controlled studies studies that deprive participants in the placebo arm of the research 2 washout studies in which subjects medications are discontinued 3 challenge studies such as pharmaceutical or psychological challenges administered under controlled conditions usually with some deception so that subjects response may be observed these can cause adverse effects.