NRNP 6665 ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

NRNP 6665 ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

Week 2 Main discussion post

Ethical and Legal Foundations of PMHNP Care

PMHNP are often confronted with situations that require sound ethical decision-making ability. As PMHNPs, we are guided by a code of ethics that puts the care, rights, duty, health, and safety of the patient first and foremost. These codes are the framework to guide clinical decision-making; they are generally not oppressive. They also represent ambitious ideas for the profession. On the other hand, laws dictate the one requirement for the domain. In this way, legal codes represent the minimum standards of care, and ethics represent the highest goals for care (Walden, 2022). Informed consent remains among the most critical issues in mental health settings. Informed consent emphasizes respect for persons, which relates to the ethical principle of autonomy (Bester et al., 2016). Bester et al. (2016) say that consent should be used with other bioethical principles, like beneficence and nonmaleficence, in mind. The consideration of informed consent may differ between adults and children. Specifically, children do not have the legal capacity to give informed consent. Therefore, their legal guardians or parents have to make the decisions on their behalf. However, children and adolescents may give informed consent if they are emancipated (Davis & Fang, 2020). The discussion summarizes four articles related to informed consent in adult and pediatric psychiatry.

In their report, Katz et al. (2016) provide crucial insights regarding informed consent, parental permission, and childhood assent in pediatric psychiatry. According to the article, it is standard practice in both the medical and legal worlds to get informed consent from legal guardians or parents. The article observes that decision-making depends on legal empowerment and decisional capacity. As such, the reliance on autonomy and individual liberties may be challenging, legally unacceptable, and unrealistic for pediatric patients. Clinicians should assess the capacity of the patient or their surrogate to make informed decisions about the provision of medical interventions. In this regard, parents and legal guardians are positioned appropriately to make the decisions because they understand the unique needs of their children.

In adult psychiatry, different considerations are made regarding informed consent. From an ethical perspective, Bester et al. (2016) address the issue of informed consent when patients are overwhelmed. In such circumstances, the article argues that the clinician should focus on preventing harm and identifying ways of discharging his or her obligations without paternalism. Respecting a patient’s autonomy is important, but there may be times when a clinician needs to override this autonomy. For example, patients may not provide informed consent when their understanding and capacity are overwhelmed. Clinicians should think about information-related factors, patient-related factors, and communication-related factors when it’s hard to get informed consent. In sum, the article argues that the capacity to offer informed consent should be made in relation to patient factors, communication factors, and information factors.

Davis & Fang (2020) provide insights about the legal aspects of informed consent in pediatric settings. Most importantly, the article talks about the legal limits of children and teens giving informed consent. While minors lack the legal capacity to provide informed consent, emancipation offers an opportunity for adolescents to give informed consent. In this case, a minor who is a legally grown adult would be able to give informed consent. Although the legal doctrine of a “mature minor” exists, few states recognize the doctrine. Minors over the age of 12 are thought to have the mental maturity to agree to treatment, but if the child is not emancipated, the clinicians have to limit the child’s power.

Zhang et al. (2021) discuss the issue of informed consent in adult psychiatry. The study observed that informed consent is part of respect for patients’ autonomy. However, the study observes that cultural factors influence the application of bioethics. The study points out that the slow development and adoption of bioethics in China causes ethical problems for clinicians. Comparing China to the US, the study finds that Chinese doctors often ignore the principle of informed consent because of their cultural beliefs. Still, clinicians are required by law to respect the autonomy of their patients, unless they can’t think for themselves.

Overall, the studies show that informed consent may differ in psychiatric and adult mental health settings. Clinicians should understand the legal limits regarding the provision of legal consent. Notably, clinicians should consider the mental capacity of patients before considering their informed consent. As psychiatric nurses, we should  have a wide breadth of knowledge to practice responsibly and legally. That means understanding the impacts that laws have on us. We are accountable for our practice according to current laws, regulations, and standards.

 

References

Bester, J., Cole, C. M., & Kodish, E. (2016). The limits of informed consent for an overwhelmed patient: clinicians’ role in protecting patients and preventing overwhelm. AMA journal of ethics, 18(9),869–886.https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/peer2-1609.pdf

Davis, M., & Fang, A. (2020). Emancipated Minor.  StatPearls [Internet]. Treasure Island,

FL: StatPearls Publishing.

Katz, A. L., Webb, S. A., and the Committee on Bioethics (2016) used informed consent in decision-making in pediatric practice.  Pediatrics, 138(2). http://dx.doi.org/10.1542/peds.2016-Links to an external site.

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Zhang, H., Zhang, H., Zhang, Z., & Wang, Y. (2021). Privacy and autonomy of patients: a comparison of ethical problems in China and the US BMC Medical Ethic, 22(1), 1–8. https://doi.org/10.1186/s12910-021-00579-6Links to an external site.

Walden University (2022). Minneapolis Minnesota.

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