Ethical & Legal Issues in Psychiatry Flashcards
What is competency?
Cognitive ability to understand and weigh up the key issues relevant to the decision.
What was the reason for the Mental Health Act (MHA)?
The reasons for the Mental Health Act was that competency can be affected by mental illness.
How does mental illness affect decision making?
Mental illness may affect the process of decision making in a way other than cognitively; for example, moderate depression may alter values but the person may still have good cognitive abilities.
How can overruling the refusal of treatment be justified?
- Argue that the illness interferes with their normal values – so respecting the patient’s autonomy is to respect what that person wants when free from depressive illness.
- Argue that it is right because it is in their best interests (and others) to do so and they are suffering from a mental illness.
English law takes this second (paternalistic) approach, at least about the treatment of the mental (not physical) illness.
Should capacity be referenced when testing patients under the MHA?
A person can be treated for a mental disorder under the MHA without reference to their capacity.
What are the ethical problems of this approach?
- It is possible, with the MHA, to override a competent patient’s refusal: Either it assumes that the presence of a mental illness automatically renders someone incompetent (false) OR it simply discriminates between the physically and mentally ill.
- Protection of others (family members) as well as the patient: Mental illness can change someone else’s behaviour and may put other people at risk.
What is the question of capacity central in?
The question of capacity is central to overriding refusal for the sake of the person himself.
What is the main method by which society protects itself from dangerous individuals?
The main method by which society protects itself from those dangerous to others is through the criminal law; however, it may be inappropriate to use the criminal law in the case of some mentally ill as they are not responsible for their dangerous acts
What are the issues of discrimination under the MHA?
- It allows a competent patient’s refusal to be overruled.
- Gives society much wider powers forcibly to restrain, for the protection of others, in the case of mentally disordered people compared with those without mental disorder.
For example, dangerous mentally ill can be detained almost indefinitely, but those without mental disorder cannot be kept in a secure place if they have not yet committed a crime or have served their prison sentence.
What is the MHA 1983 predicated on?
The Mental Health Act 1983 is predicated on an individual suffering from a mental disorder who must be ‘dangerous’ to either themselves or others.
What are the 3 routes that lead to compulsory admission?
- Admission of patient for assessment of their mental disorder under Section 2 of MHA.
- Emergency assessment of patient’s mental disorder under Section 4 of MHA.
- Admission for treatment under Section 3 of MHA.
What are the grounds for detaining someone for assessment under Section 2 (S.2)?
A: Patient has a mental disorder of a ‘nature and degree’ which warrants detention for assessment AND B: They are dangerous (to self or others).
Who can do the application in S.2?
Application for an admission under Section 2 can be undertaken by their nearest relative or an approved mental health professional.
What does the application need to be supported by in S.2?
Application needs to be supported by 2 doctors (1 psychiatrist).
How long can S.2 last?
S.2 can last for up to 28 days.
What are the grounds for emergency assessment S.4?
Grounds are the same as S.2: A: Patient has a mental disorder of a ‘nature and degree’ which warrants detention for assessment AND B: They are dangerous (to self or others).
How many doctors does the application under S.4 require?
Application requires only 1 doctor.
How long can S.4 last?
Can only last for up to 72 hours.
When is S.4 used?
Used in an emergency where the usual procedures of a MHA assessment can’t be followed, e.g., only one doctor available.
What are the grounds for admission for treatment under S.3?
A: Patient has a mental disorder of a ‘nature and degree’ which warrants detention for assessment AND B: They are dangerous (to self or others) AND C: Mental illness is ‘treatable’.
What does treatment under S.3 involve?
Treatment includes medication, psychological treatment, nursing care or support to maintain safety.
What is the application for S.3 like?
Application similar to Section 2 – although where a social worker makes the application, the nearest relative must be consulted.
How long can S.3 last?
Can last up to 6 months; however, the period is renewable if the patient remains unwell or continues to be a risk to themselves or others.
What can detainment under S.3 not be used for?
Cannot be used to enforce treatment on an out-patient basis – only treatment in hospital.
