Ethical and Legal Foundations of PMHNP Care

Ethical and Legal Foundations of PMHNP Care

Patients seeking healthcare services have a right to be actively involved and provided with all the pertinent information about their care. The right to decide on psychiatry treatment is fundamental to a patient’s autonomy and dignity. Patients have a right to accept or refuse treatment, provided they have a decision-making capacity. Thus, psychiatry and mental health nurse practitioners (PMNHPs) must know the ethical underpinnings and legal requirements linked with informed consent. However, informed consent may change depending on different circumstances and conditions.

Summary of Articles

Legal Issues of Informed Consent

The benefits of informed consent in psychotherapy may be overlooked, especially when there are uncertainties about adverse events or the success of treatment (Darby & Weinstock, 2018). There are significant risks for psychotherapy treatment. Occasionally, PMNHPs must breach doctor-patient confidentiality due to mandated reporting in situations of possible harm to patients or other persons (Darby & Weinstock, 2018). Some psychotherapists argue that patients have a right to know the limits of confidentiality at the beginning of any treatment. For example, the information revealed could be utilized to infringe on the patient’s freedom, resulting in gun prohibition, occupation problems, involuntary hospitalization, and personal problems (Darby & Weinstock, 2018). Even though patient autonomy is critical in healthcare, PMNHP should be aware of situations where patient safety or others may be at risk. PMNHPs are legally mandated to report cases in which patients may be a risk to themselves or others. Accordingly, this will require them to breach the principle of informed consent by not providing complete information on the limits of patient-doctor confidentiality.

To avoid legal liabilities, healthcare professionals should seek informed consent before initiating treatment by disclosing all information related to treatment that may affect the patient’s decision. Minors are incompetent to make legal decisions compared to adults. Most states assume children cannot give informed consent and require parental approval before treatment (Chen, 2021). Parents are legally obligated to provide informed consent on behalf of their children. Even though many states require a child’s support for mental health treatment, some states only require parental consent (Chen, 2021). State laws also give children more decision-making authority for outpatient treatment due to the low risks compared to inpatient hospitalization. In California, children older than 12 can consent to psychiatric health treatment or counselling services (Chen, 2021). The minor’s ability to give informed consent must be based on an attending professional’s opinion. States have different laws guiding informed consent for children, so healthcare professionals should be aware of these laws in the states they practice.

Ethical Issues of Informed Consent

Capacity and comprehension of consent are part of the informed consent process. Healthcare professionals must assess the decision-making capacity to determine patients who can give informed consent (Deshpande et al., 2018). Accordingly, considering the patient’s competence is essential in the consent process. The primary role of the healthcare professional is to ensure the patient understands the information provided to them in research or treatment (Deshpande et al., 2018). However, individuals with mental conditions may have impairments that affect their understanding ability.

With few exceptions, minors under 18 years cannot consent to psychiatric care. Parents and legal guardians are given the authority to make decisions in their children’s best interest (Bieber et al., 2020). Even though parental autonomy is considered an ethical value when providing care for minors, parental decision-making capacity is a critical lens. Decisional capacity includes an accurate understanding of the proposed treatment, an understanding of the information provided, and rationale manipulation. Since parents have the legal and ethical obligation to make decisions on behalf of their parents, healthcare professionals should assess their decision-making capacity.

Application to Clinical Practice

I am practising as a PMNHP in the state of Virginia. I will apply the ethical and legal considerations of informed consent when implementing care for children and adults. After reviewing these articles, I am better placed to address legal issues and moral dilemmas that may arise in my practice. The Virginia law requires healthcare professionals to seek informed consent from patients or their medical proxies. I will abide by this law to ensure I do not present any legal liabilities to myself or the organization. Moreover, adult and child psychotherapy requires maximum patient involvement to ensure success.

Conclusion

In summary, informed consent is an essential issue in the healthcare industry. It is the ethical and legal obligation of PMNHPs to ensure they gain informed consent from patients before initiating treatment. They must also assess the decision-making capacity of the patients to ensure they can give informed consent. Many state laws do not give children under 18 the authority to provide informed consent. Subsequently, healthcare professionals should be aware of the state laws that govern informed consent to ensure they do not face legal liabilities. I, however, believe that children should be involved in the treatment process and allowed to give informed consent.

References

Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J. L., & McKean, A. J. (2020). The role of parental capacity for medical decision-making in medical ethics and treating Psychiatrically ill youth: A case report. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.559263

Chen, J. (2021). Capacity and a Minor’s Right to Consent to Mental Health Treatment [Doctoral dissertation]. https://scholarship.shu.edu/student_scholarship

Darby, W. C., & Weinstock, R. (2018). The limits of confidentiality: Informed consent and psychotherapy. FOCUS, 16(4), 395–401. https://doi.org/10.1176/appi.focus.20180020

Deshpande, S. N., Mishra, N. N., Bhatia, T., Jakhar, K., Goyal, S., Sharma, S., Sachdeva, A., Choudhary, M., Shah, G. D., Lewis-Fernandez, R., & Jadhav, S. (2020). Informed consent in psychiatry outpatients. The Indian journal of medical research, 151(1), 35–41. https://doi.org/10.4103/ijmr.IJMR_1036_18

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For this Discussion, select a topic with legal and ethical implications for PMHNP practice and perform a literature review. Your goal will be to identify the issue’s most salient legal and ethical facets for PMHNP practice and how these facets differ in caring for adult patients versus children. Keep in mind as you research your topic that laws vary by state, and your clinical practice will be dictated by the rules that govern your state.

To Prepare
Select one of the following ethical/legal topics:
Autonomy
Beneficence
Justice
Fidelity
Veracity
Involuntary hospitalization and due process of civil commitment
Informed assent/consent and capacity
Duty to warn
Restraints
HIPPA
Child and elder abuse reporting
Tort law
Negligence/malpractice
In the Walden Library, locate four scholarly, professional, or legal resources related to this topic. One should address ethical considerations associated with this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal concerns related to this topic for adults, and one should be on legal matters associated with this topic for children/adolescents.
By Day 3 of Week 2
Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues concerning psychiatric-mental health practice for children/adolescents and adults. Explain how this information could apply to your clinical practice, including specific implications for training within your state. Attach the PDFs of your articles.

Advanced practice nursing in all specialities is guided by codes of ethics that put the patient’s care, rights, duty, health, and safety first and foremost. PMHNP practice is also driven by ethical principles specifically for psychiatry. These moral codes are frameworks to guide clinical decision-making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. On the other hand, laws dictate the requirements that must be followed. In this way, legal codes may designate the minimum standards of care, and ethics represent the highest goals for care.