psych: legal issues

Legal Issues

Commitment Issues

- Concerns with the admission in the hospital

1. Voluntary commitment

• client seeks help or requests the admission voluntarily
• signs consent for treatment
• may refuse any treatment prescribed
• if ready, they may also sign themselves out of the facility
• AMA or involuntary confinement may be issued if the client is assessed to still be needing further treatment


2. Involuntary commitment

• Client has legal capacity to consent to treatment but refuses to do so
• Client is unable to determine the need for examination
• Greatly disabled
• Impose threat to himself or others
• Common categories:
(1) Evaluation and emergency care – 48 to 72 hrs
(2) Certification for observation and treatment
(3) Extended or indeterminate care- needs prolonged psychiatric care typically for 60-180 days

Conservatorship

 Also called guardianship
 Conservators are legally obligated to act in the best interest of their conservatee
 Included are signing of informed consent, contracts, writing of checks, deciding on treatment modalities
 Nurse must gain consent from conservator to prevent legal consequences
 Criteria for having a conservator:
• Gravely disabled
• Unable to provide basic needs although resources exists
• Cannot act in their best own interest
• Incompetent



Patient’s Rights
1. Right to treatment using the least restrictive alternative/environment
• means that the client does not have to hospitalized if they are able to be treated in outpatient basis
2. Right to confidentiality
3. Right to freedom from restrain and seclusion
• restrain- direct application of physical force against will to restrict freedom
• Human or mechanical restrain
• seclusion- involuntary confinement to a specially constructed room with lock, window or camera
• short term use of restrain and seclusion are used only if the client becomes aggressive to himself or environment
• requires physician’s order every 12 hours
• assessed by nurses every 2-4 hours
• checks every 10-15 minutes for skin condition, blood circulation, side effects of medications and emotion
• nurse can approve seclusion and restrain in emergency situations if no physician is available but the client must be seen within 4hours
• document everything especially:
a. type of restraint
b. reason of restraint
c. length of restraint
d. observation to maintain safety
4. Right to give or refuse consent to treatment
5. Right to access to personal belongings
6. Right to daily exercise
7. Right to have visitors
8. Right to use writing materials and uncensored mail
9. Right to use the telephone
10. Right to access courts and attorneys
11. Right to employment compensation
12. Right to be informed of rights
13. Right to refuse electroconvulsive therapy or psychotherapy


Nursing Liability
 Nurses are expected to met the standards of care
 Torts – is a wrongful act which results to injury, damages or losses
 Two types of torts: unintentional and intentional
A. Unintentional – failure to do reasonable and prudent person would do in similar situation
• Negligence - involves causing of harm by failing to do what a reasonable and prudent person would do in a similar condition.
• Elements: 1. duty to care, 2. An obligation of reasonable care, 3. Breach of duty, 4. Actual injury resulting from breach of duty
• Malpractice – is negligence that refers specifically to professionals like nurses and physicians
B. Intentional – voluntary act that cause harm to client
• Assault- involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority
• Battery- involves harmful or not consented contact with the client wherein harm or injury may or may not have happened
• False Imprisonment- defined as the unjustifiable detention of a person examples are inappropriate use of restraint and seclusion

o Ethical Issues
• Important aspects in caring for any client. This may cause conflicts between clients and the medical team
• Ethical issues includes:
a. Utilitarianism
b. Beneficence
c. Nonmaleficence
d. Justice
e. Fidelity
f. Veracity



o Duty to Warn

• Includes threat to self and others
• Tarasoff vs the reagents of University of California
• Nurse should warn the significant others if client’s is seen to have plans of committing suicide
• Also nurses have the responsibility to warn individuals that the client threats to hurt



o Insanity Defense
• M’Naghten rule
• Is an argument that a person accused of a crime is not guilty because that person cannot understand the nature and implications of their actions and is not able to determine between right and wrong
• Upon meeting the criteria, a person may have a verdict of “guilty by reason of insanity”


Patient’s Bill of Rights
1. The patient has the right to considerate and respectful care.
2. The patient has the right and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.
3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides, or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.
4. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment, with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.
5. The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient’s privacy.
6. The patient has the right to expect that all communications and records pertaining to his or her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards, when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.
7. The patient has the right to review the records pertaining to his or her medical care and to have the information explained or interpreted as necessary, except when restricted by law.
8. The patient has the right to expect that, within its capacities and policies, a hospital will make a reasonable response to the request of a patient for appropriate and medically indicated care and services.
9. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient’s treatment and care.
10. The patient has the right to consent or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.
11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.
12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods.
 American Hospital Association. (1992). A patient’s bill of rights. Chicago: AHA

American Nurses Association Code of Ethics for Nurses
1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.