Psych and Law

Question 1

What is the difference between informed consent and simple consent?

Answer 1

Informed- patient knows risk/benefits

Simple- doc “do whatever you like”

Question 2

Informed consent is founded on two legal principles:

Answer 2

autonomy (right to self determination)
fiduciary (person with duty act in way that benefits someone else)
(cannot be coerced)

Question 3

Exceptions to needing informed consent

Answer 3

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)

Question 4

What are two strategies to reduce forced mediation in emergencies?

Answer 4

behavioral de-escalation

offer PO med first

Question 5

What is an advance directive?

Answer 5

aka durable power of attorney
someone to make healthcare decision if incapacitated. Can articulate wishes
this POA has no standing if person is healthy

Question 6

What qualities must be assessed if someone has the capacity to make healthcare decisions? What is the Appelbaum criteria?

Answer 6

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

Question 7

In NC, at age 12, individuals ______

Answer 7

Get their own healthcare record access and parents are no longer allowed to see

Question 8

Lack of capacity for one question (does/does not) translate to other situations and questions

Answer 8

does not

Question 9

What is dimensional capacity? How does this play into capacity eval?

Answer 9

How well someone manages money or can recall things.

This is not subjected to the capacity eval, not a decisional capacity

Question 10

If a patient is determined to lack capacity, the decision falls to _____ or _____

Answer 10

Healthcare power of attorney

Next of Kin

Question 11

Before capacity assessments, patients must be educated about what?

Answer 11

rationale, risk and benefits of care vs no care

Question 12

Even if a patient does not have capacity, they cannot be forced to _____, ______, ______

Answer 12

dialysis, PO meds w no IV/IM/transdermal equiv, engagement in OT/PT

Question 13

_____ is a legal term referring to individual’s mental ability and cognitive bailies to execute a legal act

Answer 13

Competency.

Adults >18yo are considered competent

Question 14

The _____ must determine whether or not someone is competent

Answer 14

judge

Not a psychiatrist but they can write affidavit to support case for incompetency

Question 15

If someone has been legally determined to be incompetent, ____ is assigned

Answer 15

guardian

guardianship orders are specific and individualized (healthcare, financial, etc decisions)

Question 16

Difference between capacity and competency

Answer 16

capacity: physician, in a clinical setting, goes to HCPOA
competency: judge determined, can reflect voting, medical, finances, court appointed guardian

Question 17

______ is a procedure used to hold people in location that proves mental health or SU treatment against will. Why would someone have this happen?

Answer 17

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

Question 18

What is the legal justification of involuntary commitment?

Answer 18

Parens patriae- power of state to protect mentally ill

Police power of the state- power of the state to protect the society

Question 19

Mental illness is a condition that lessens capacity of individual to use:

Answer 19

self control, judgement, discretion in conduct of affairs

-> to make it advisable for them to be under treatment, care, supervision, guidance

Question 20

How to demonstrate dangerous to self

Answer 20

1. 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
2. attempted or threatened suicide OR
3. mutilated or attempted mutilation

Question 21

How to demonstrate dangerous to others

Answer 21

1. completed or threatened harm
2. ongoing risk of harm
3. destruction to property