Once again, there seems to be no objection in principle, but some danger of
abuse in practice: can the people who are really dangerous be identified, how likely
is it that some people who are no risk to others will be compulsorily detained, and,
apart from this risk of mistakes, might there be pressure to detain people who are
not dangerous but are a great nuisance? There is also a particular issue of
competence, discussed in an article by Giordano [2]. Normally, it is taken that if a
person is compulsorily admitted to hospital they may also be compulsorily treated
for their mental disorder #see part A of this chapter). But here either no treatment is
available, so that they will be given only care, or #perhaps this is more likely)
various treatments will be tried with only a low expectation of success. Moreover,
even if these people are mentally disturbed and dangerous, and therefore are
rightly detained, they may still be competent to evaluate the proposed care and
treatment, and might quite rationally decide to reject a form of treatment on the
ground that it was very unlikely to alleviate their condition. Ethically, do they have
the right to refuse treatment, and if they do should this right be legally protected? I
leave this question for the reader to consider.
9.15 Consequences for nurses
What difference will all this make to the nurse's duties and responsibilities, if it
passes into legislation? The obligation to give treatment sensitively and honestly
will apply equally to treatment under a CTO. There would also be the legal
requirement to report failure to receive treatment. And there would be an ethical
obligation, if not a legal one, to report if anyone, in the nurse's informal opinion,
was wrongly on a CTO, if either their condition was so improved that no
compulsory medication was necessary or so much worse that there was a need for
them to be returned to hospital before they harmed themselves or others.
Similarly with those suffering from a DSPD, the obligation to give care or
treatment #if any) would be the usual one. Again, there would be an obligation to
report the fact if the nurse became strongly convinced that someone was being
wrongly detained. There might also be the special feature that there would be a
group of compulsorily admitted mental patients entitled, like patients with a
physical illness or voluntary mental patients, to take their own decisions about
treatment. But overall the situation would be similar. Essentially, mental health
nursing, under current conditions, does not involve any fundamental conflicts
between law and ethics. The ethical obligations of the nurse are rather to admin-
ister care and treatment under the law with sensitivity, humanity and honesty, and
to check that the law is not mistakenly applied or, either deliberately or uncon-
sciously, abused. For it would seem that as long as compulsion is applied only
when justified legally, it will also be justified ethically. In this area of nursing, strict
adherence to law and to ethics seem to coincide.
9.16 Acknowledgements
Iamvery grateful to the Philosophy and Ethics of Mental Health unit at Warwick
University for the seminar onReformingtheMentalHealthActat SOAS on 5 April
192 NursingLawandEthics