Psych and Law Flashcards
What is the difference between informed consent and simple consent?
Informed- patient knows risk/benefits
Simple- doc “do whatever you like”
Informed consent is founded on two legal principles:
autonomy (right to self determination)
fiduciary (person with duty act in way that benefits someone else)
(cannot be coerced)
Exceptions to needing informed consent
Emergency: must have mental illness and be treating it. failure to treat->death or exacerbation that endangers people
waiver
lack of capacity (specific decision at specific time)
What are two strategies to reduce forced mediation in emergencies?
behavioral de-escalation
offer PO med first
What is an advance directive?
aka durable power of attorney
someone to make healthcare decision if incapacitated. Can articulate wishes
this POA has no standing if person is healthy
What qualities must be assessed if someone has the capacity to make healthcare decisions? What is the Appelbaum criteria?
fully informed, uncovered, without health problems to impart judgement
Appelbaum: consistent preference, factual understanding of the situation, appreciate significance, use info in rationale manner, without coersion
In NC, at age 12, individuals ______
Get their own healthcare record access and parents are no longer allowed to see
Lack of capacity for one question (does/does not) translate to other situations and questions
does not
What is dimensional capacity? How does this play into capacity eval?
How well someone manages money or can recall things.
This is not subjected to the capacity eval, not a decisional capacity
If a patient is determined to lack capacity, the decision falls to _____ or _____
Healthcare power of attorney
Next of Kin
Before capacity assessments, patients must be educated about what?
rationale, risk and benefits of care vs no care
Even if a patient does not have capacity, they cannot be forced to _____, ______, ______
dialysis, PO meds w no IV/IM/transdermal equiv, engagement in OT/PT
_____ is a legal term referring to individual’s mental ability and cognitive bailies to execute a legal act
Competency.
Adults >18yo are considered competent
The _____ must determine whether or not someone is competent
judge
Not a psychiatrist but they can write affidavit to support case for incompetency
If someone has been legally determined to be incompetent, ____ is assigned
guardian
guardianship orders are specific and individualized (healthcare, financial, etc decisions)
Difference between capacity and competency
capacity: physician, in a clinical setting, goes to HCPOA
competency: judge determined, can reflect voting, medical, finances, court appointed guardian
______ is a procedure used to hold people in location that proves mental health or SU treatment against will. Why would someone have this happen?
Commitment
acutely dangerous to self or others, or bc substance use
This is not the same as capacity (only capacity to leave) and is state dependent
What is the legal justification of involuntary commitment?
Parens patriae- power of state to protect mentally ill
Police power of the state- power of the state to protect the society
Mental illness is a condition that lessens capacity of individual to use:
self control, judgement, discretion in conduct of affairs
-> to make it advisable for them to be under treatment, care, supervision, guidance
How to demonstrate dangerous to self
- acted in a way unable to exercise self control, judgement, discretion and probability that there will be serious physical debilitation in near future w/o treatment OR
- attempted or threatened suicide OR
- mutilated or attempted mutilation
How to demonstrate dangerous to others
- completed or threatened harm
- ongoing risk of harm
- destruction to property
