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Legal and Ethical Aspects of Psychiatric Care - Coggle Diagram
Legal and Ethical Aspects of Psychiatric Care
Introduction:
Ethics: The study of philosophical beliefs about right and wrong; concerned with standards of values, behaviors, and beliefs.
Legal Context: Focuses on clients' rights, quality of care, and laws governing admission and discharge.
Ethical Concepts:
Autonomy: Respecting the patient's personal liberty and right to make their own decisions.
Beneficence: The duty to promote good and act in the patient's best interest.
Nonmaleficence: The duty to "do no harm." This involves weighing the benefits of an action (like restraint) against potential harm.
Veracity: The duty to tell the truth. The patient has the right to know their diagnosis, treatment, and prognosis, unless the truth would cause significant harm.
Confidentiality: Safeguarding all patient information. This includes not discussing cases in public areas or with family/friends. It demonstrates respect.
Justice: Treating equals equally and unequals differently according to their needs (fair distribution of resources).
Fidelity: The obligation to be faithful to commitments, which includes keeping promises and being truthful.
Types of Admission:
Voluntary Hospitalization: The patient or their guardian submits a written application. The patient has the right to demand discharge.
Involuntary Hospitalization: Occurs when a person is a danger to self or others and needs immediate psychiatric treatment. The patient does not have the right to demand discharge.
Types of Involuntary Admission:
Emergency: For a short period (e.g., 3-15 days) to control dangerous behavior. Initiated by police or psychiatrists.
Observational/Temporary: For observation, diagnosis, or treatment. Requires a medical certificate from two physicians.
Indeterminate/Extended: For extended care, lasting months or indefinitely. Requires judicial/administrative action or medical certification.
Discharging Mentally Ill Patients:
Voluntary Patients: Can demand their own discharge.
Status of hospitalization must be reviewed periodically.
Involuntary Patients: Can only be discharged by a court order or medical certificate confirming improvement.
If a patient escapes, the staff must notify the police.
Types of Discharge:
Conditional: Requires outpatient follow-up for a specific period.
Absolute: A final discharge. The patient is either functioning well or is unlikely to do so.
Judicial: The law mandates discharge if hospitalization is no longer appropriate.
Psychiatric Patients' Rights
The right to communicate with people outside the hospital (private phone calls, unopened letters).
The right to treatment.
The right to informed consent (must be given sufficient information about treatment to make a decision). For involuntary patients, the hospital has the right to treat.
The right to keep personal belongings (considering storage space).
The right to religious freedom.
The right to be employed and compensated if possible.
The right to confidentiality (safeguarding information about therapy/hospitalization). Breaking confidentiality is sometimes both ethical and legal (e.g., duty to warn).
The right to education.
The right to an independent psychiatric examination by a doctor of their choice.
The right to privacy (to keep information secret, respect dignity).
The right to treatment in the least restrictive setting (greatest amount of freedom, autonomy, and dignity).
Note: Seclusion and restraints require adequate rationale and documentation of the precipitating event.
Medication used to prevent violence can be seen as a "chemical restraint" and is justified as "public protection."