required in nursing, but also with the special obligation to be honest and non-
manipulative. In this case, the obligation is clear, though carrying it out is not
always easy.
More difficult is the problem of dealing with the, hopefully rare, situation in
which the nurse is convinced that the wrong treatment is being used. Sections 11
and 12 of the UKCC Code of Conduct impose a clear duty to report this, if the
nurse is convinced that standards of practice are being jeopardised, or safe and
appropriate care is not being provided. There are good reasons, both moral and
prudential, for the nurse to need to be very sure before taking action, but such
situations do arise. The final decision must rest with the individual; once again, the
problem is not unique to mental health nursing.
We may therefore conclude that in mental health nursing the law as it stands
presents no ethical problems; indeed in this area the main difficulty for the nurse is
perhaps the temptation, sometimes very much encouraged by the general hospital
ethos, to comply with the law superficially but actually to act on rather different
principles. On the other hand, although I have argued that the criticisms of the law
as it stands, and of the general way in which mental illness is handled, do not in
fact stand up, they do nevertheless point to certain dangers. There is a permanent
need to be on the alert, and to try to ensure that compulsion is not being used
inappropriately or excessively and that treatments are effective and non-
manipulative.
9.14 Proposed changes in the law
All this relates to the law as it is. But the law is probably going to change before too
long. The exact details are not settled but a White PaperReformingtheMental
HealthActhas been published. The proposals in this White Paper raise in parti-
cular three ethical issues. The first concerns the provisions for compulsory treat-
ment or detention. The intention is that compulsion should be a last resort, that the
patient's rights should be safeguarded and that the combination of the two criteria
of impairment or disturbance of mental functioning' and the risk of harm to the patient themselves or to others #the need for specialist care in the patient's best
interestsorasignificant risk of serious harm to others') should remain necessary
to justify any compulsion. But there is a question whether in practice the new
legislation will make it easier to justify compulsion, and the exact wording of the
Act may well be crucial. At the moment, this is only a possible issue.
More important are the two new developments that are proposed. The first is the
use of Community Treatment Orders #CTOs). These have been discussed as a
possibility for some years, and they have been used in parts of the USA and
Australia. The grounds for their introduction are as follows. There are people who
can cope with life in the community and are no danger to themselves or others,
provided they remain on medication. It is argued that it is unnecessary and
undesirable for them to remain in hospital, but it is still necessary to ensure that
they take their medication. This could be done in two ways: by an order which
authorises the forcible administration of the medication if they do not take it
voluntarily, or by an order for them to be compulsorily returned to hospital if they
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