Legal duties of psychiatric patients

Hastings Center Report, 2020

New directions for mental health services, 1994

Any contemporary textbook on inpatient psychiatry would be incomplete without a substantial section devoted to the legal issues that exert an impact on inpatient clinicians. The past twenty years have spawned a changing but increasingly expanding body of legislation and case law regarding the rights, care, and treatment of the mentally ill. One result of this growth has been an expansion of the contact points between psychiatry and the law, especially in the areas of criminal, victim compensation, and family law. Since numerous books have been written on these classical contact points, I will focus on the emerging areas of contact, where the inpatient psychiatrist's understanding of medicolegal issues is also critical to the care of any hospitalized patient. In particular, the exercise of good judgment and careful understanding of today's most pressing legal issues regarding informed consent, liability, and patient rights is a must if developments around these issues are to enhance rather than compromise the quality of hospitalized patients' care. Therefore, this chapter will focus on integrating emerging legal requirements into the clinical process.

Advances in Psychiatric Treatment, 1999

International Review of Psychiatry, 2010

Indian Journal of Psychological Medicine, 2019

Current Psychiatry Reports, 2013

The Health Insurance Portability and Accountability Act (HIPAA) is routinely cited as the reason physicians cannot share critical medical information about patients' condition, even when doing so could save the life of the patient or others. However, this is only one of the many factors that interfere with appropriate communication among all of people trying to help patients remain safe and well. The result of these various factors for families of people with schizophrenia is a devastating lack of ability to care for people, some of whom, realistically lack the capacity to care for themselves. The heart of the matter is that people with schizophrenia retain their right to make decisions, even when their illness may result in behaviors that are based on false beliefs, false sensory experiences and a fundamental lack of insight. Clinicians who treat schizophrenia patients are all too familiar with the daily experience of watching a patient discontinue care due to lack of insight, coupled with persistence or exacerbation of symptoms. Under these circumstances, the patient becomes increasingly disorganized, disconnected from society and in many cases dangerous. Worse yet, this cyclic pattern of disengagement, followed by deterioration, leading to hospitalization and recovery is often highly predicable. Yet, even under these circumstances, it is practically impossible to reach out and take benevolent control of the individual's choices until they have already demonstrated a clear and present danger. The same would not be true for any other form of medically-induced disruption of brain function. Rather, a patient with encephalitis or brain malignancy that alters their capacity to make rational decisions would be cared for by surrogate decisions makers until such time that they could responsibly make their own choices. The three cases noted below illustrate how this dichotomy between so-called "organic" brain disorders and schizophrenia should be abolished. A more civilized and humane system would require that physicians, family members and governing bodies provide benevolent intervention to care for symptomatic schizophrenia patients long before they either harm themselves or someone else. Each of the cases is true, although demographic details have been sufficiently altered to protect the privacy of the patients and their families. Case Study 1: A 21 year old young woman was seen in consultation at the behest of her family. They described that their daughter had been popular in high school, but had become increasingly isolative and disengaged from friends over the past 1.5 years. She remained in her room, refusing to interact with anyone outside the family. However, she ate meals when prepared for her, bathed and was neither agitated nor aggressive to anyone at home. She had

JOURNAL OF PSYCHIATRIC NURSING

Responsibility is often defined in terms of accountability for actions based on ethical and legal norms. However, the concept is multidimensional and is relevant to many disparate disciplines. The concepts of responsibility and responsibility ethics are central to the context of disease/healthcare and the delivery psychiatric care services. The vulnerability of the patient as well as legal and institutional factors contribute to a variety of potential ethical dilemmas for caregivers. A thorough understanding the concept of responsibility and its ethical dimensions is very important to providing psychiatric care of high quality that protects patients and healthcare providers. This review examines the definition, application, and effects of the concept of responsibility and the ethics of responsibility in the practice of psychiatric nurses.

Oxford Handbook of Psychiatric Ethics, 2015

Some features that collectively serve to distinguish psychiatry as a unique social and medical practice impose distinctive ethical challenges for practitioners. Challenges discussed are: (1) those associated with data protection and obligations around confidentiality; (2) those resulting from the practitioner's expertize over core societal values; (3) those engendered by the controversy surrounding psychiatric practice; (4) dilemmas arising from dual roles, particularly when they are imposed by judicial and public safety institutions; and finally (5) those associated with visions of a post-psychiatry world put forward by critics of present day practices. In each of these ways, the ethical demands borne by the practitioner in psychiatry are distinctive and beyond the ordinary, in part as the result of a multiplier effect among the factors involved. Some challenges involve ethical dilemmas, others call for particular moral strengths (or character virtues), or extra obligations in practitioners; yet others place the practitioner in situations of ethical vulnerability.

The Bulletin of the American Academy of Psychiatry and the Law, 1996

The Bulletin of the American Academy of Psychiatry and the Law, 1976

The psychiatrist has traditionally viewed himself as the patient's advocate, friend, and confidant, as well as his physician. Therefore it is no surprise that mental health professionals should feel anger, disappointment, and resentment as a result of the recent flurry of patients' rights litigation and legislation which is so dramatically changing psychiatric practice. Psychiatrists, like other physicians, had grown to expect their clients to accept and follow clinical judgments without question, and were therefore unprepared for recent public requirements of increased accountability for effectiveness and appropriateness of treatment, and unprepared for patients' demands for participation in all treatment decisions. As an outgrowth of the patients' rights and consumer movement of the late '60s and early '70s, the doctor-patient relationship has been significantly altered and expanded. No longer is it acceptable for the physician unilaterally to decide upon treatment with the patient accepting the role of passive recipient of care. Other forces now impinge upon the interactions between doctor and patient, and have created a pentagonal relationship consisting of providers, consumers, third-party insurers, the judiciary, and public regulators and law makers, including Federal and State legislatures, professional licensing and accreditation boards, etc. The interaction among these forces generally affects the availability, quality, and nature of mental health services, and, more specifically, the role the mental health profes~ional has in delivering them. l Psychiatrists, like other health professionals, often have resented the intrusion of government, third-party insurers, and especially the judicial system into the mental health field. Many doctors complain about increased paperwork, limitations on flexibility in treatment decisions, the loss of necessary care for patients in need of help ("dying with their rights on"), etc. Although these complaints may be valid, it must not be forgotten that the conditions which have existed within the mental health system during much of the past one hundred years have warranted the public'S demand for increased accountability and judicial purview. That demand also signals the imperative need for psychiatry to set its own house in order, rather than have changes foisted upon it. Historically, American society has tended to ignore, to mistreat, or to exclude from view the mentally ill citizen. In colonial times, the mentally ill were frequently beaten and were driven from town to town or placed in "poor houses." During the 19th century, care improved somewhat with the establishment of small rural asylums and other institutions where "moral" treatment was provided. The goal was to restore the mentally ill person to normal functioning or, failing that, at least' to isolate him and his deviant behavior from the rest of society. To carry out this mission, government, through its commitment laws, gave a relatively free hand in treating the mentally ill to the only group willing to accept responsibility for their care-the earliest mental health professionals. 2 This period also marked the beginnings of organized psychiatry. Those early psychiatric physicians, charged by the public with caring for the mentally ill, created in 1844 the "This paper was presented at the annual meeting of the American Academy of Psychiatry and Law in