9 LEGAL ANDETHICALISSUES 187
involved in the plan of care, to be treated in
the least restrictive environment, to refuse
to participate in research, and to have
unrestricted visitors, mail, and phone calls.- The use of seclusion (confinement in a locked
room) and restraint (direct application of
physical force) falls under the domain of the
patient’s right to the least restrictive envi-
ronment. Short-term use is permitted only
if the client is imminently aggressive and
dangerous to himself or herself or others.- Mental health clinicians have a legal obliga-
tion to breach client confidentiality to warn a
third party of direct threats made by the
client. - Nurses have the responsibility to provide safe,
competent, legal, and ethical care as outlined
in nurse practice acts, the Scope and Stan-
dards of Psychiatric-Mental Health Nursing
Practice, and the Code of Ethics for Nurses. - A tort is a wrongful act that results in
injury, loss, or damage. Negligence is an
unintentional tort causing harm through
failure to act. - Malpractice is negligence by health profes-
sionals in cases in which they have a duty to
the client that is breached, thereby, causing
injury or damage to the client. - Intentional torts include assault, battery,
and false imprisonment. - Ethical theories are sets of principles used to
decide what is morally right or wrong, such
as utilitarianism (the greatest good for the
greatest number) and deontology (using
principles such as autonomy, beneficence,
nonmaleficence, justice, veracity, and
fidelity), to make ethical decisions. - Ethical dilemmas are situations that arise
when principles conflict or when there is
no single clear course of action in a given
situation. - Many ethical dilemmas in mental health
involve a conflict between the client’s
autonomy and concerns for the public good
(utilitarianism).
For further learning, visit http://connection.lww.com.
I NTERNET R ESOURCES
Resource Internet Address
◗Mental Health Patient’s Bill of Rights http://www.apa.org/pubinfo/rights
◗ADA Information Center http://www.adainfo.org
◗Psychiatry & the Law http://www.reidpsychiatry.com
◗Institute of Law, Psychiatry, and Public Policy www://pp.virginia.eduCritical Thinking Questions
1.Some clients with psychiatric disorders make
headlines when they commit crimes against
others that involve serious injury or death.
With treatment and medication, these clients
are rational and represent no threat to others,
but they have a history of stopping their
medications when released from treatment
facilities. Where and how should these clients
be treated? What measures can protect their
individual rights as well as the public right
to safety?
2.Some critics of deinstitutionalization argue
that taking people who are severely and
persistently mentally ill out of institutions
and closing some or all those institutions have
worsened the mental health crisis. These
closings have made it difficult for this minor-
ity of mentally ill clients to receive necessary
inpatient treatment. Opponents counter that
institutions are harmful because they
segregate the mentally ill from the commu-
nity, limit autonomy, and contribute to the
loss of social skills. With which viewpoint do
you agree? Why?