Legal & Ethical Considerations

Psych

Ethics

• The study of philosophical beliefs about what is considered right or wrong in a society.

• Because ethics involves values and morals, there is often no clear-cut, simple resolution to an ethical dilemma.

Bioethics

• Used in relation to ethical dilemmas surrounding health care. 

Ethical Dilemma

• Conflict between two or more courses of action, each with favorable and unfavorable consequences.

Autonomy

• Respecting the rights of others to make their own decisions. 

Beneficence

• The duty to promote good. 

Non-maleficence

• Doing no harm to the patient.

Justice

• Distributing resources of care fairly.

Fidelity

• Maintaining loyalty and commitment, doing no wrong to a patient. 

Veracity

• Truthfulness; always telling the truth. 

Confidentiality

• Avoiding the disclosure of privileged information without patient consent 

Pharmacogenetic Testing

• DNA testing to choose antidepressants.

• Limited evidence; may risk harm if inaccurate.

Predictive Psychiatry & Stigmatization

• Genetic info could affect employment; raises autonomy concerns. 

Voluntary Admission

• Patient/guardian consents; patient can request release.

• Adolescents between 16 and 18 you may seek admission independently 

Involuntary Commitment

• Patient admitted against their will for safety; requires professional evaluation or legal documentation

• anyone can admit themselves if they have the ability to do it (mentally)

Emergency Commitment

• Short-term (24-96 hours) to assess safety and provide treatment. 

at risk to harm yourselves or mental situaton where you could hurt yourselves

Writ of habeas corpus

• Is a court order compelling authorities to bring a detained person before a judge to determine if their detention in the facility is lawful.

• In simple terms, it's a way to challenge an illegal or unjustified commitment

Least restrictive alternative doctrine

• Care providers should take the least drastic action to achieve a specific purpose.

• For example, treating depression outpatient may be preferable to hospitalization if safe. 

 

Conditional release

• A court-ordered discharge from an inpatient mental health facility into mandated outpatient treatment. Nonadherence can result in involuntary commitment.

Unconditional release

• Termination from the facility without restrictions, though outpatient treatment may be recommended (your free to go)

Release against medical advice (AMA)

• Patients refuse treatment. This can create ethical dilemmas—supporting patient autonomy versus beneficence (protecting the patient). 

Patient Rights

• Right to Treatment: Humane environment, qualified staff, individualized care. 

• Right to Refuse Treatment: Can withhold or withdraw consent. Exceptions exist in emergencies. 

• Right to Informed Consent: Patients must understand risks, benefits, and alternatives before procedures. 

• Psychiatric Advance Directives: Patients can outline treatment preferences when well. 

• Restraints & Seclusion: Last resort, used for safety. Always aim for the least restrictive intervention. 

Alternatives Before Restraints or Seclusion

• Verbal de-escalation 

• Reduce environmental stimulation (lights, noise, TV) 

• Active listening and empathy 

• Diversion activities 

• PRN medications if necessary 

Health insurance portability and accountability act 

• HIPAA applies to mental health nursing care, protecting patient privacy by regulating how sensitive Protected Health Information (PHI) is shared, with special rules for psychotherapy notes.  

• Nurses and other providers must follow the HIPAA Privacy Rule to safeguard patient information, requiring authorization for some disclosures while allowing others, such as for care coordination or when a serious and imminent threat of harm to self or others exists.  

 

Failure to protect patients leads to:

• Self-harm / Suicide → If nurses fail to conduct adequate suicide risk assessments, omit safety checks, or do not remove harmful objects. 

• Violence / Assault → If patients are left in unsafe situations where another patient may attack them. 

• Negligent Monitoring → If staff do not maintain required levels of observation (e.g., 1:1 or q15-minute checks). 

• Improper Use of Restraints/Seclusion → Failure to follow protocols can cause injury and legal liability. 

• Elopement (Leaving Against Safety Needs) → If the nurse fails to prevent a patient from leaving when they are legally committed or at high risk of harm. 

Torts

• Any wrongful act, intentional or accidental, causing harm 

• Intentional: Assault, battery, false imprisonment, invasion of privacy, defamation 

• Unintentional: Negligence, malpractice 

• Negligence Elements: Duty, breach, cause, proximate cause, damages

Tarasoff Ruling

• Duty to Protect – Tarasoff Case

• Key Points:
  — A patient told a therapist they planned to harm someone.
  — The therapist warned police but not the potential victim.
  — Tragically, the threat became real.
  — Court ruling: Mental health professionals must protect potential victims when there is a serious, foreseeable threat.
  — Takeaway: Safety can override confidentiality
  

Tort Law Applications in Mental Health Settings 

• Duty to protect (Tarasoff ruling) – If a patient threatens to harm someone, the nurse has a legal duty to warn the potential victim or notify authorities. 

•  Involuntary commitment – Patients have rights; holding someone without legal justification can lead to false imprisonment claims. 

• Use of restraints or seclusion – Must follow strict guidelines; improper use may result in a tort claim. 

• Failure to prevent suicide or self-harm – Can be seen as negligence or malpractice if standards of care aren’t met. 

 

State Boards of Nursing

Each state has a Nurse Practice Act (NPA) that defines the scope of practice for nurses 

• The Board of Nursing enforces the NPA, sets rules/regulations, and issues/renews licenses. 

• BONs also have the authority to discipline nurses for unsafe, unethical, or illegal practice

Professional Associations

• Authoritative statements by the American Nurses Association (ANA) and American Psychiatric Nurses Association (APNA) that describe a competent level of nursing care and professional performance

Institutional Policies & Procedures

• Hospital policies & procedures define criteria for care. If policies are outdated or substandard and harm results, the nurse may still be held liable. 

• Customary practices (e.g., emergency restraint use). Following a “customary practice” that is unsafe does not protect a nurse from liability. 

 

 

Acting on Questionable Practice

• Nurses have an ethical and legal duty to take action if they witness unsafe, illegal, or unethical practice by another professional. 

• Ignoring questionable practice can make the nurse liable if harm occurs. 

Examples of Questionable Practice

• A staff member administering the wrong medication dose. 

• Failure to follow suicide precautions or safety checks. 

• Improper use of restraints or seclusion. 

• Breach of confidentiality (e.g., discussing patient info in public). 

• Discriminatory, abusive, or neglectful behavior toward patients. 

Documentation of Care 

• Serves as the legal record of nursing care. 

• Provides evidence in cases of negligence or malpractice. 

• Ensures continuity of care among the health care team. 

— Reflects the standards of professional nursing practice. 

Documentation: Legal & Ethical Principles

“If it wasn’t charted, it wasn’t done.” 

Documentation must be: 

• Accurate – factual, objective (no personal opinions). 

• Timely – chart as soon as care is provided (not hours later). 

• Complete – include assessments, interventions, responses, teaching, and communication. 

• Legible – readable and free of vague or misleading terms. 

Violence in Psychiatric Settings 

• Prioritize safety 

• Document all observations 

• Communicate findings to colleagues 

• Mentally impaired patients rarely prosecuted; family may be held accountable