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psycopathology > Laws and ethics > Flashcards

Laws and ethics Flashcards

1
Q

What are the applications of informed consent ?

A
  • IC typically needs to obtained BEFORE a patient is treated
  • IC is the process of providing sufficient and understandable information to a competent patient so that the patient can freely choose to authorize a procedure
  • “Competency” is a pre-requisite for obtaining IC from a patient
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2
Q

What is competence?

A
  • Medical decision-making capacity
  • Presumed in an adult (18 years or older)
  • judgement of incompetence made by a court
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3
Q

Competency determination involves assessment of a patient’s:

A
  • Ability to appreciate one’s medical situation and consequences
  • Rationale for the treatment decision
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4
Q

Explain the Dax Cowart Case

A
  • Right to choose advocate
  • Burn victim from 1973
  • Competent and refused treatment
  • Choice to refuse treatment was not honored by physicians
  • Major shift since this time to honor patient’s autonomy
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5
Q

Do people with mental illness make people unable to make decisions about medical conditions?

A
  • decision making capacity must be established as per the definition of competence
  • many persons with mental illness remain competent, and informed consent must still be obtained from that person
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6
Q

What is a substitute decision maker?

A
  • even if a patient is judged to lack decision making capacity, a physician doesn’t decide for the patient
  • The physician must consult a substitute decision maker to obtain IC
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7
Q

Give the substitution makers in order

A

-Legal guardians or those appointed as power of attorney for healthcare

  • Next-of-kin (order defined by state law)
    • usual order: 1. Spouse ; 2. Adult child ; 3. Parent ; 4. Etc.
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8
Q

How should decision makers make decisions?

A

Decision makers should make decisions based on what the patient would have wanted

  • known as the “substituted judgement “ standard
  • Respects patient autonomy
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9
Q

List the components of informed consent

A
  1. Provision of information
  2. Comprehension
  3. Voluntariness
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10
Q

Explain provision of information as a component of informed consent

A

Doctor must disclose sufficient information (e.g., diagnosis, treatment choices, risks)

Standards of disclosure

  • “reasonable person “ standard
  • Disclosure is based on what a “reasonable person” would want to know to make a prudent decision
  • Respects patient autonomy
    • “Professional Practice” standard
  • Disclosure is based on what a physician determines is customary practices of the medical profession

-Less ethically favored standard

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11
Q

Explain comprehension as a component of informed consent

A

Comprehension -patient understands the disclosed information

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12
Q

Explain voluntariness as a component of informed consent

A

Patient makes that decision voluntarily - free of undue inducement or coercion

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13
Q

What is the ethical requirements of informed consent?

A

IC derives from the ethical principle of “respect for patient autonomy”

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14
Q

What is the legal requirements of informed consent?

A

Without IC a physician is risking the legal charges of “battery” (unwanted touching ) and malpractice

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15
Q

What are the exceptions of informed consent ?

A

Needs to be carefully considered

  • incompetence (lack of decision-making capacity)
  • in some emergencies , IC can be by-passed under the doctrine of “presumed consent “
  • exceptions to IC should be carefully considered
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16
Q

What is confidentiality?

A

The ethical (professional) and legal duty NOT to disclose information about a patient (except with consent from the patient)

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17
Q

How does confidentiality work between family members?

A
  • A spouse (or other family member) is not entitled to patient information without consent
  • In some circumstances and using clinical judgement, providers infer that a patient approves of disclosures to family/friends
  • Providers should be careful about making such inferences
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18
Q

What is the function of confidentiality among patient-physician interactions?

A

Confidentiality within the physician-patient relationship helps to ensure patient disclosure
-facilitates diagnosis and treatment

-confidentiality is a stringent but not an absolute obligation

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19
Q

What are the exceptions to confidentiality?

A

There are 2 important general exceptions to confidentiality:

  • due to protect a specific person
  • due to public welfare
20
Q

Explain protecting a specific person as a means to break confidentiality

A
  • confidentiality may be broken. If there is a real concern for safety (serious bodily harm) of a specific person
    • this determination is made using clinical judgement given the facts of the case
    • judgement of dangerousness is difficult

-the breach in confidentiality is not automatic just because a threat is made

21
Q

Explain physician duty to protect a person

A
  • if a judgement of dangerousness is made, then there is typically a duty to protect the intended target:
  • Actions May include notifying the police, warning the threatened individual and/or other reasonable actions (hospitalizations of the aggressor) to protect the threatened individual
  • The provider’s specific actions to protect the target depends on the circumstances f the case
22
Q

Explain the tarasoff case ( California)

A

The tarasoff case (California) is the major precedent setting legal case regarding confidentiality when a threat is made to an individual

Case: the therapist failed to warn the intended victim (tarasoff) of threats made by patient (Poddar) while in therapy; patient acted on threats and killed tarasoff

23
Q

What is tarasoff 1(1974)?

A

“The duty to warn”

When a doctor or psychotherapist, in the exercise of his professional skill and knowledge, determines, or should determine , that a warning essential to avert danger arising from the medical or psychological condition of his patient, he incurs a legal obligation to give that warning.

  • tarasoff 1 limited possible interventions by mandating confiden
  • Given the importance of confidentiality to psychotherapy, an uproar about the “duty to warn” decision led the California Supreme Court to amend their decision as tarasoff II
24
Q

What is Tarasoff II(1976)?

A

When a therapist determines or pursuant to the standard of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more various steps depending on the nature of the case. Thus, it may call for him to warn the intended victim or others likely to apprise the intended victim of danger, to notify the police, or take whatever steps are reasonably necessary under the circumstances

  • tarasoff II expanded possible interventions
  • warning the victim may be part of the action taken but it is not necessarily mandated
25
Q

Explain the generalizability of the tarasoff II

A
  • the verdict in the California based tarasoff case is often used as a guideline by other
  • other states have the same, different, or no regulations regarding the waiving of confidentiality for these types of cases
26
Q

How can duty to protect public welfare act as a means of exception to confidentiality?

A
  • confidentiality may (or must) be broken if there is real concern for public safety
  • states legally require reporting of certain conditions based on the best interest of the public
  • Some states permit such reporting even when not a legal mandate
27
Q

Duty to protect public welfare includes

A

Mandatory reporting of:

  • communicable diseases
  • child and elder abuse/neglect

Possible reporting if (state dependent):

  • knowledge of a current or past crime
  • cognitive or medical impairment
  • wounds inflicted with a lethal weapon
  • other
28
Q

Describe the legality of involuntary psychiatric hospitalization

A
  • state law allows for involuntary psychiatric hospitalization (“civil commitment”) of mentally ill patients under certain circumstances
  • the right to involuntary hospitalize patients evolved from government’s two basic powers:
  • Police powers: the right of the government to protect its citizens from harmful others
  • Parents patriae(“parent of the country “) power: the governments responsibility to care for its citizens who are unable to care for themselves
29
Q

Explain the LEGAL STANDARDS of involuntary psychiatric hospitalization

A

Legal standards
-due to mental illness, the individual is:

Dangerousness Standard
-A current danger to self or others.

Grave disability
-unable to meet basic needs for food, clothing, or shelter

Serious deterioration

-shows serious mental/physical deteriorationsuch that, without treatment, the dangerousness or the grave disability standard would predictability be met

30
Q

Can you involuntarily hospitalize a person just for being mentally ill?

A

US Supreme Court case O’ Conner vs Donaldson, 1975

-A state cannot confine, without more, a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends

31
Q

Explain the involuntary commitment process

A

Petition for admission
-typically initiated by family member, mental health provider, law enforcement officer

Pre-commitment evaluation (emergency holds)
-occurs in an emergency facility by two physicians who place a “hold” or “detain” a patient, typically for a short time

  • those who clearly do not meet commitment standards are released (often with a referral for community services)
32
Q

Explain: hearing to adjucate commitability

A

Part of the involuntary commitment process

  • a judicial process is required to commit a patient
    • hearings include testimony for/against
    • judge decides whether commitment criteria are met by “clear and convincing “ evidence
33
Q

Explain commitment

A

Judge orders mental health treatment in the least restrictive environment
- outpatient civil commitment ( “Assisted outpatient treatment”): treatment within living in community

-inpatient civil commitment: treatment while hospitalized
34
Q

What are the parts of the involuntary commitment pr8cess?

A
  • petition for admission
  • pre-commitment evaluation
  • hearing to adjucate commitability
  • commitment
35
Q

Describe the 4 phases of the judicial process fir a mentally ill person after a criminal offense

A
  1. Pre-trial : legal issue- competency to stand trial legal question: is the person competent to stand trial?
  2. Trial: legal issue- insanity defense legal question: is the person insane?
  3. Sentencing: legal issue: death penalty legal question: Can the person receive the death penalty?
  4. Punishment(execution): legal issue- competency to die Legal question: if sentenced with the death penalty, is the person competent to be killed on execution day?
36
Q

Explain the pretrial for criminals with mental illnesses

A

Competency to stand trial
-Pretrial assessment of a person’s current mental competence to face criminal charges

-the person’s mental State during the offense is irrelevant

Requirements: person must:
-understanding the legal proceedings (e.g., charges, plea options, verdicts

-reasonably assist in own defense (e.g., recount behavior during offense, interact with attorney, behave in acceptable manner in courtroom)

37
Q

What are the verdicts of the pretrial/ competency to stand trial?

A

Competent: person goes to trial to face charges and enters a plea (e.g., not guilty, guilty, insane)

Incompetent: person undergoes mandatory treatment to restore competence
- If competency restored, the person stands trial

-If competency cannot be restored, then person is assessed for civil commitment (CC) elegibility

- If CC standards are met, the person is hospitalized 
- If CC standards not met dangerous, the person is released
38
Q

Describe the second phase of trial-use of insanity defense

A

Insanity plea asserts:

Person did commit the crime but not blame worthy

-met the definition of insane at the time

If jury rules insane then “ not guilty by reason of insanity”

39
Q

What does insanity mean?

A

A legal term referring to a specific state of mind that a person was in at the time the offense was committed

Common tests of insanity

  • M’Naghten Test*
  • irresistible impulse test
  • Modern penal code (MPC) test by the American law institute(ALI)

Most use M’naughten test, some subtle variant or MPC

40
Q

Describe the M’Naughten test

A

Right or wrong test

-due to the existence of mental disease, the person lacked the capacity to understand the wrongfulness of the act at the time of the act

Standard of ibsanity

41
Q

What is the irresistible impulse test( insanity standard test)?

A

Policeman at the elbow test

-due to the existence of mental disease, the person lacked the capacity to refrain from acting on his/her impulses at the time of the act

42
Q

What is MPC test (standard test for insanity)?

A
  • due to mental disease or defect, a person lacked substantial capacity either to:
  • Appreciate the criminality (wrongfulness) of his conduct (M’Naghten test) or
  • Comform his conduct to the requirements of the law (irresistible impulse test)
43
Q

The insanity defense…

A

Seldom used, rarely successful

Used for crimes such as matter

  • those found insane usually spend at least as much time in a psychiatric facility than in jail serving a criminal sentence
  • not all states offer the insanity defense
44
Q

What is the outcome of the variant of insanity plea:

A
  • guilty by mentally ill plea
  • plea offerred by some states in addition to, or in lieu of, the insanity defense
  • the person is mentally ill, guilty, AND fully blameworthy
  • the person receives psychiatric treatment and then serves out remaining sentencing in person
45
Q

Describe phase 3 of trial

A

Death penalty eligibility

A mentally ill person can be blameworthy of a crime ( I.e. sane) and can be punished by death penalty

-exception:

  • those with intellectual disability (ID)
  • Considered “cruel and unusual punishment” to execute those with ID(us Supreme Court 2002)
46
Q

Describe phase 4

A

Standards for execution

  • immediately prior to execution, a mentally-ill person must be competent to be 3xecuted
  • the individual must:
  • be aware of the impending execution
  • understanding the reason for execution

Otherwise, execution is considered “cruel and unusual punishment “ (Ford vs wainwright, 1986)

47
Q

What happens when deemed incompetent fir execution?

A

Goal is to restore competency

A deathr8w inmate can be forced to take meds to restore competency (possible)

-individual cases decided at state level

psycopathology (23 decks)

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