Ethical and Legal Concepts

Ethical Principles

• Autonomy

• Beneficence

• Paternalism

• Nonmaleficence

• Justice

• Veracity

• Fidelity

Autonomy

Individual’s right to self-determination with freedom over oneself and one’s affairs ​

​Beneficence ​

Moral obligation to do good ​

Paternalism

Providers intend to do good ​

Nonmaleficence​

Do no harm

Justice

Fair and equal treatment of patients and others ​

Veracity

Obligation to be truthful, transparent, and forthcoming

Fidelity

Obligation to be dedicated to patients and faithful in the performance of his or her duties ​

Deontology (ethical theories)

Ethical behavior is characterized by adherence to unchanging, self-evident moral duty ​

Utilitarianism (ethical theories)

Focuses on the consequences of an action

Ethics of care (ethical theories)

Identified empathy and emotional connectedness as dictating moral behavior ​

Virtue Ethics (ethical theories)

Asks “What kind of person should I be? Is this action consistent with my being the person I wish to be?” ​

PILLAR

• P- The ability to appreciate how one’s Personal experiences, knowledge, and values may affect patient care​

• I- The ability to Identify ethical issues in patient care ​

• L- The ability to appreciate and work within professional Limitations (scope of practice)​

• L- The ability to Lessen the Likelihood of future ethical dilemmas​

• A- The ability to Anticipate ethical problems ​

• R- The ability to access needed Resources (information/ expertise) to clarify and resolve conflict ​

Ethic Decision Step 1

State the ethical dilemma ​

Ethic Decision Step 2

Identify the stakeholders (who is affected by decisions)​

Ethic Decision Step 3

Collect additional information and analyze the problem​

Ethic Decision Step 4

Develop alternatives and compare them​

Ethic Decision Step 5

Select the best alternative and justify your decision​

Ethic Decision Step 6

Develop implementation strategies and act​

Ethic Decision Step 7

Evaluation​

Federal Laws

• HIPAA ​

• Patient Self-Determination Act​

State Laws

• Nurse Practice Act ​

• Michigan Mental Health Code Rights ​

Right of Patients

• Active Participation in Care​

• Right to self-determination​

• Psychiatric Advance Directives​

• Specific type of advance directive that permits individuals to specify treatment options should they become incapacitated due to mental illness ​

• Disclosure of medical errors​

• Privacy and confidentiality ​

Duty to Warn

Patients are granted total confidentiality, unless they threaten to harm someone else. In which the potential victim will be notified

Informed Consent

1) Patient’s (or patient surrogate’s) role in the decision-making process is discussed.​

2) Clinical issue (diagnosis or suspected diagnosis) is discussed.​

3) Proposed treatment is discussed.​

4) Alternative treatments (including the option of no treatment) are discussed.​

5) Risks and benefits of the proposed treatment, and alternative treatments (including no treatment) are discussed.​

6) Probable course of recovery and related uncertainties are discussed.​

7) Patient’s (or surrogate’s) understanding is assessed,​

8) Patient’s preference is conveyed and consent is thereby obtained​

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Competency or Not

• Whether the patient has a mental disease or disorder​

• Whether the patient’s judgment is impaired​

• Whether the mental disease or disorder significantly interferes with the patient’s ability to reason ​

Voluntary Admission

• Patient recognizes need for treatment and submits to agreed-upon treatments ​

Involuntary Admission

• Due process​

• Individual typically must 1) pose a danger to self or others, 2) suffer from a mental illness and need immediate treatment, and/or 3) is gravely disabled and unable to provide for his or her basic needs ​

Involuntary Admission Length

is reversed by only court order, limited to 60 days and is then reviewed. long term involuntary is 60-180 days