Ethical & Legal Issues in Nursing and Mental Health Care

Values, Morals, Attitudes, Rights

• Values
  • Deeply held convictions about what is acceptable or unacceptable behavior.
  • Not necessarily fact-based; can be inherited or culturally transmitted.
• Attitudes
  • Ideas and mind-sets that shape our outlook (e.g., a “negative attitude” attracts negativity).
• Morals
  • Combination of values + beliefs; guide personal sense of right/wrong.
  • Usually resistant to change.
• Rights
  • A power, privilege, or entitlement one can justly claim.
  • Contain the principle of justice (fairness) and apply equally to all citizens.
  • Come paired with obligations (e.g., respecting others’ rights).

Patient Rights

• Legislative milestones
  • $1972$ Patient Bill of Rights.
  • Patient Care Partnership $2003$ (expansion/modernization).
• Core entitlements
  • Privacy (physical modesty → curtains, draping, private conversations).
  • Confidentiality (HIPAA: no hallway/elevator/social-media talk; no info release without consent).
  • Right to refuse care or treatment.
  • Dignity & respect regardless of diagnosis (e.g., cognitive impairment, STIs, obesity, syphilis).
  • Safety (fall precautions, covering exposed/confused patients, safe environment).

Provider (Nurse) Rights & Workplace Boundaries

• To be fully informed about patients in order to deliver safe care.
• To competent assistance, adequate staffing, clear policies, and mutual respect.
• Do not tolerate abusive behavior (e.g., thrown charts, verbal humiliation).
  • Set boundaries, document, and report (e.g., Midas system).
• Unions & professional organizations often reinforce these rights.

Ethics in Nursing Practice

• Purpose: protect individual rights, provide behavior guidelines, signal standards to the public.
• Ethical principles
  • Autonomy – patient freedom of choice (offer options: shower time, food order, even small choices for dementia clients).
  • Beneficence – act for patient good (give meds/pain relief on time).
  • Non-maleficence – “do no harm” (prevent self-tubing, protect confused patients).
  • Justice – fair & equal treatment (do not delay care because of biases).
  • Confidentiality – safeguard personal information (extends to social media).
  • Fidelity – keep promises (return with meds when stated or delegate update).
  • Veracity – tell the truth; admit when you don’t know, avoid false reassurance.
• Codes of Ethics
  • American Nurses Association (ANA).
  • International Council of Nurses (ICN).

Common Ethical Dilemmas & Scenarios

• Religious refusal of care (e.g., Jehovah’s Witness child with hemoglobin $6$–$7$ → blood transfusion conflict).
• Abortion decisions in cases of incest, rape, or legal restrictions.
• Over-treatment of frail elders (e.g., $95$-year-old with dementia pressured into hemodialysis).
• Rule: Provide full information & options, support decision-makers, avoid imposing personal morals.

Six-Step Framework for Ethical Decision-Making

1. Identify that an ethical issue exists.
2. Assume goodwill of all involved (focus on patient benefit).
3. Gather information (facts, options, patient values, legal data).
4. List & order values/principles relevant to the case.
5. Take action / implement plan.
6. Evaluate outcome & adjust as needed.
   (Usually facilitated by a hospital Ethics Committee for complex cases.)

Law in Health Care

Public (Criminal) Law

• Government vs. citizen; protects society.
• Misdemeanor – crime punishable by <$1$ year jail or fine (e.g., reckless driving).
• Felony – punishable by >$1$ year or death (e.g., murder, major drug diversion).

Private (Civil) Law

• Citizen vs. citizen; includes contracts and torts.

Intentional Torts

• Assault & battery, fraud, invasion of privacy, false imprisonment, defamation (slander = spoken, libel = written).

Unintentional Torts

• Negligence – failure to act as a reasonable professional (e.g., not turning bed-bound patient → pressure ulcer).
• Malpractice – professional negligence causing harm through an act/omission while duty existed (e.g., wrong medication dose → death).

Negligence vs. Malpractice (Key Differences)

• Both require a duty owed, breach, causation, and damage.
• Negligence: failure to meet general standard of care (often omissions).
• Malpractice: failure within professional scope after accepting patient (includes acts & omissions).

Legal Responsibilities & Scope

• Governed by State Nurse Practice Act (defines scope, delegation, standards).
• Must follow institutional policies; what’s allowed at Hospital A may violate policy at Hospital B.
• Never perform tasks outside scope even if physician requests (e.g., pushing anesthesia drugs without credentials).
• Delegate only tasks that match aide’s training (no assessments by CNAs).

Mental Health Specific Law

• Voluntary admission – client seeks help.
• Involuntary (5150 in CA) – initiated when danger to self/others or gravely disabled.
  • Physician order → hold up to $72$ hours; court petition required for longer (short- or long-term).
• Client retains civil rights unless legally suspended; balance safety vs. autonomy.

Potential Legal Liabilities in Mental Health Settings

1. Violating or not protecting client rights (privacy, dignity).
2. Failure to prevent self-harm or violence toward others.
3. Improper use of restraints / false imprisonment.
4. Breach of confidentiality (e.g., casual hallway comments, social media).

Common Crimes in Health-Care Facilities

• Homicide/intentional patient harm (rare but publicized).
• Controlled-substance violations & drug diversion (tracked via Pyxis/ADC audits).
• Theft, fraud, falsification of records.

Protecting Yourself & Your Patients

• Use evidence-based practice and institutional policy as compass.
• Document thoroughly: assessments, education, delegation, follow-up.
• Maintain professional boundaries & respectful communication.
• Report unsafe practice or abuse via chain of command / incident system.
• Stay current on continuing education, certifications, and policy changes.