Peer Responses

Responding to Beatrice N.

Hello,

Your discussion effectively highlights the ethical and legal complexities of involuntary hospitalization, particularly the balance between patient autonomy and public safety. One cultural consideration that may impact these issues is the role of collectivist versus individualist cultural values in decision-making. In collectivistic cultures, decisions, including those related to choosing a healthcare provider, might be made in the presence of the family, and the care of the patient might involve the support of the family (Laureano et al., 2024). This is in contradiction with the collectivist cultures of the West, where personal independence is valued, which may cause ethical dilemmas in situations requiring compulsory admissions: Peer Responses.

Additionally, marginalized populations often experience disproportionate rates of involuntary commitment due to systemic biases in mental healthcare (Freitas et al., 2022). Also, language barriers and ethnical apprehension of the medical institutions are some of the barriers that put ethnical and racial groups at a disadvantage since they experience delays in accessing their treatment, often resulting in hospitalization in case of a crisis.

References

Freitas, D. F., Walker, S., Nyikavaranda, P., Downs, J., Patel, R., Khondoker, M., Bhui, K., & Hayes, R. D. (2022). Ethnic inequalities in involuntary admission under the Mental Health Act: An exploration of mediation effects of clinical care prior to the first admission. The British Journal of Psychiatry, 222(1), 27–36. https://doi.org/10.1192/bjp.2022.141

Laureano, C. D., Laranjeira, C., Querido, A., Dixe, M. A., & Rego, F. (2024). Ethical issues in clinical decision-making about involuntary psychiatric treatment: A scoping review. Healthcare, 12(4), 1–22. https://doi.org/10.3390/healthcare12040445

Responding to Suzan

Hello,

Great work. Your discussion highlights the challenges of balancing autonomy and ethical care, especially in cases where patients lack decision-making capacity. A cultural factor that impacts this issue is differing beliefs about mental illness and psychiatric care across communities. For instance, in some cultures, people with psychiatric disorders are perceived to be rebelling spiritually or morally and not medically; this creates a conflict that hinders them from accepting forced treatment (Olejarczyk & Young, 2024).

This poses an ethical dilemma when a decision of whether the patient needs to be hospitalized has to be made, but culture is also an issue of consideration. In addition, the perception of confidentiality varies by culture. Some families expect full disclosure of a patient’s condition, even when the patient wishes to keep their information private (Flaubert, 2021). This is especially relevant for adolescents, who may struggle with both cultural expectations and their legal rights regarding privacy in psychiatric care.

References

Flaubert, J. (2021). The role of nurses in improving health care access and quality. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573910/

Olejarczyk, J., & Young, M. (2024). Patient rights and ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/

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Read a selection of your colleagues’ responses.

By Day 6 of Week 2

• Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

Student 1 – Beatrice N

Ethical and Legal Considerations in Involuntary Hospitalization and Due Process of Civil Commitment

Selected Topic: Involuntary Hospitalization and Due Process of Civil Commitment

Summary of Selected Articles:

Ethical Considerations for Adults

The first article explores the ethical tensions surrounding involuntary hospitalization, emphasizing the conflict between patient autonomy and beneficence (Laureano et al., 2024). It highlights that psychiatric-mental health nurse practitioners (PMHNPs) must navigate situations where patients refuse treatment but pose a risk to themselves or others. The ethical principle of justice is also examined, ensuring that involuntary hospitalization is applied fairly and not disproportionately to marginalized populations.

Ethical Considerations for Children/Adolescents

The second article discusses the ethical dilemmas specific to minors undergoing involuntary hospitalization (Pais & Wightman, 2022). It focuses on the role of parental authority versus the adolescent’s developing capacity for autonomy. The principle of beneficence is examined in cases where minors refuse treatment, while the concept of informed assent is discussed as a middle ground to involve minors in their care decisions. Ethical challenges also arise regarding potential overuse of hospitalization due to lack of outpatient resources.

Legal Considerations for Adults

The third article outlines the legal framework governing involuntary hospitalization for adults, including the criteria for civil commitment, legal protections, and due process rights (Walker et al., 2021). The importance of judicial oversight is emphasized to prevent unnecessary detainment and uphold civil liberties. The article also discusses variations in state laws and the evolving legal landscape regarding psychiatric treatment mandates.

Legal Considerations for Children/Adolescents

The fourth article examines the legal standards for involuntary hospitalization of minors, including the role of parental consent, court involvement, and emergency commitment procedures (Conrad & Brumbaugh, 2021). It discusses the challenges of balancing parental rights with the minor’s best interests and the legal thresholds for proving imminent danger or severe impairment. Additionally, the article highlights differences across states in terms of commitment criteria and due process protections.

Implications for Clinical Practice:

Understanding the ethical and legal aspects of involuntary hospitalization is crucial for PMHNPs to provide appropriate, patient-centered care while ensuring compliance with legal mandates. In my clinical practice, I must be vigilant about due process protections, ensuring that hospitalization is justified based on clear criteria and that patients’ rights are respected. Specifically, in my state, PMHNPs play a key role in evaluating risk factors and initiating the commitment process, often in collaboration with psychiatrists and legal professionals. Awareness of state-specific laws will guide my decision-making to balance safety, autonomy, and ethical care.

References

Conrad, R., & Brumbaugh, B. (2021). Respect for persons in the psychiatric treatment of children and adolescents. Psychiatric Clinics, 44(4), 613-625.

Laureano, C. D., Laranjeira, C., Querido, A., Dixe, M. A., & Rego, F. (2024, February). Ethical issues in clinical decision-making about involuntary psychiatric treatment: A scoping review. In Healthcare (Vol. 12, No. 4, p. 445). MDPI.

Pais, P., & Wightman, A. (2022). Addressing the ethical challenges of providing kidney failure care for children: a global stance. Frontiers in Pediatrics, 10, 842783.

Walker, S., Barnett, P., Srinivasan, R., Abrol, E., & Johnson, S. (2021). Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. The lancet child & adolescent health, 5(7), 501-512.

Student 2 – Suzan

The ethical principle of autonomy refers to the individual’s right to make an informed decision based on their values and beliefs, and act independently without harming others (Varkey, 2020). While most healthcare providers are familiar with autonomy and have used some aspects of this ethical principle during their careers, such as informed consent and confidentiality, it remains a source of conflict for many (Varkey, 2020). This is due to the complexity of individuals with mental health disorders, especially those deemed incapacitated and unable to make decisions for themselves.

This principle is often difficult for healthcare providers with a moral obligation to do no harm, who are also ethically bound by the principle of beneficence and nonmaleficence (Varkey, 2020). In Michigan, patients have the right to make informed decisions regarding their treatment. They are presumed competent unless a court has appointed a guardian, and are protected from abuse, neglect and discrimination (Office of Recipient Rights, 2020).

Having a strong knowledge in the legal and ethical aspects of treating patients with mental health disorders in the state a healthcare provider practices is crucial for the safety of both the patient and the provider. It can reduce the risk of violating the patient’s rights, and the risk of worsening patient outcomes.

Summary of Articles

Adults’ Ethical Consideration

A qualitative study by Manderius et al. (2023) interviewed 12 psychiatric mental health nurses from an inpatient adult unit and investigated their ethical consideration regarding the use of coercive measures. The study found a division between ethical considerations regarding coercive measures and obstacles to those ethical considerations. In the study, nurses showed a high level of ethical awareness, by respecting patient autonomy, avoiding coercive measures, and promoting health.

However, they did voice the need to increase knowledge of ethical awareness throughout the organization, which will minimize the use of coercive measures. The nurses in the study reported respecting and maintaining the patient’s autonomy by involving the patient in the decision-making and using persuasion to receive voluntary help (Manderius et al., 2023).

Children/Adolescents Ethical Consideration

A systematic review by García-Carrión et al. (2019) investigated school—and community-based interventions for children and adolescents with mental health disorders. The study included children and adolescents aged 6 to 18 and proposed that environmental, social, cultural factors, and family dynamics play a role in psychological development. It found that positive outcomes were linked with early interventions but were limited by autonomy and consent. The study emphasized the importance of children and adolescents’ interaction and involvement in their treatment plans.

Adults’ Legal Consideration

A systemic review by Saya et al. (2019) investigated the worldwide criteria and procedures for involuntary treatment. It included gaps between legislation and practice, use of coercion and its effect on patient perception, the therapeutic relationship, treatment adherence, and suicide prevention. The study found most countries agree that self-harm is not an adequate reason to use coercive measures and may cause more harm. Advance directives may alleviate some risks by promoting self-determination and autonomous decisions, thus reducing involuntary treatment.

Children/Adolescents Legal Consideration

Kafka et al. (2024) investigated children and adolescents’ perception of confidentiality in psychological and medical treatment. The study interviewed pediatric patients ages 11 to 15 and identified four themes, uncertainty regarding information shared with providers and parents, consequences of breaching confidentiality, exceptions to confidentiality, and desire for autonomy. The study found that one educational session regarding confidentiality before treatment tends to be insufficient, especially for younger children. Continuing education is needed to reinforce understanding, develop self-determination and promote autonomy.

References

García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and Adolescents Mental Health: A Systematic Review of Interaction-Based Interventions in Schools and communities. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00918

Kafka, J. X., Kothgassner, O. D., & Felnhofer, A. (2024). A Matter of Trust: Confidentiality in Therapeutic Relationships during Psychological and Medical Treatment in Children and Adolescents with Mental Disorders. Journal of Clinical Medicine, 13(6), 1752. https://doi.org/10.3390/jcm13061752

Manderius, C., Clintståhl, K., Sjöström, K., & Örmon, K. (2023). The psychiatric mental health nurse’s ethical considerations regarding the use of coercive measures – a qualitative interview study. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01186-z

Office of Recipient Rights. (2020). When receiving mental health services in Michigan. Retrieved March 5, 2025, from https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder3/Folder79/Folder2/Folder179/Folder1/Folder279/RR_Book_English.pdf?rev=c7a4164bec73423a843f97183a08faa0

Saya, A., Brugnoli, C., Piazzi, G., Liberato, D., Di Ciaccia, G., Niolu, C., & Siracusano, A. (2019). Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative review. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00271

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119Links to an external site.

(García-Carrión et al., 2019).pdfDownload (García-Carrión et al., 2019).pdf

(Kafka et al., 2024).pdfDownload (Kafka et al., 2024).pdf

(Manderius et al., 2023)..pdfDownload (Manderius et al., 2023)..pdf

(Saya et al., 2019).pdfDownload (Saya et al., 2019).pdf

(Office of Recipient Rights, 2020).pdfDownload (Office of Recipient Rights, 2020).pdf