Legal and Ethical Principle of Mandatory Reporting Mandatory reporting of child and elder abuse falls on several professions and agencies. Some of these professions or
agencies include hospital employees, school employees, child care agencies, social workers, law enforcement, clergy, and
many more. Definitions of mandatory reporting vary by state and between children and elders but generally involve
reporting a reasonable belief that the individual has undergone physical, sexual, or in some cases, emotional abuse law
enforcement or designated agencies. The purpose of this discussion is to examine legal and ethical principles of both
child abuse and elder abuse.
Mandatory Reporting of Abuse Mandatory reporting of child abuse refers to the legal obligation of certain individuals to report suspected abuse to
appropriate agencies. In general, a mandatory reporter is obligated to report any reasonable belief that a child is being, or
has been abused or neglected. Child abuse and neglect, defined by the Washington State Department of Health and Social
Services is mental or physical injury, sexual abuse or exploitation, negligent treatment, or maltreatment that results in
Discussion Ethical and Legal Foundations of PMHNP Care harm to the child’s health, welfare, and safety (Department of Children, Youth & Families, n.d.). Mandatory reporting of
elder abuse includes many of the same individuals responsible for reporting child abuse and includes the same criteria,
but adds financial abuse. In Washington, elder abuse can be intentional or unintentional acts that cause harm incidences
of intimidation or punishment (Vulnerable Adult Abuse/Washington State, n.d.).
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Legal Considerations According to Liu and Vaughn (2019), legal implications of mandatory reporting of child abuse can be brought against
both the alleged abuser as well as the reporter. This article also informs the reader that in 2016, child abuse and
Discussion Ethical and Legal Foundations of PMHNP Care neglect
resulted in 1,750 fatalities, 70% of which involve children under 3 years of age (Liu & Vaughn, 2019). Unfounded reports of
child abuse have been reported, however, the potential benefits of reporting a false positive abuse case outweigh the risks
of not reporting a true abuse case, known as a false negative. This article also discusses several case reports of child abuse
reporting cases and explains that reporters can be held liable for false reporting, however, not when acting with
reasonable suspicion and with good intent (Liu & Vaughn, 2019). Elder abuse is considered by many to be a human rights
and civil rights issue in many contexts (Jackson, 2015). Conceptualizations of elder abuse have changed throughout the
years and definitions vary, but in any context, it is a social issue that goes beyond care providers (Jackson, 2015).
Ethical Issues There are certainly ethical issues that pertain to mandatory reporting of child and elder abuse. Brashler et al. (2016)
explain that this obligation of physicians will certainly cause false positives when reported and the hesitancy of not
reporting can result in false negatives. Ethical considerations of child abuse include uncertainty about the abuse, disbelief
that the individuals are capable of abuse, worry that the report may cause worsening problems within the family dynamics,
and concern that the report will ruin a trusting client-provider relationship (Brashler et al., 2016). Ethical considerations of
elder abuse include violations of human rights, loss of autonomy, beneficence, and non-maleficence; as well as issues of
competency of the individual in question (Saghafi et al., 2019). The protection of an individual’s health and welfare is
important and can be done when these ethical principles are taken into consideration without bias or personal beliefs of
different cultures (Saghafi et al., 2019).
Implications for Practice
Mandatory reporting of child and elder abuse presents challenges, but also promotes the well-being of at-risk
individuals. The protection of these individuals is of utmost importance and therefore, any reasonable suspicion that
abuse has or is taking place should be promptly reported. It is our duty as practitioners to do no harm and lack of action
in these cases causes harm. Making a report about suspected abuse does not necessarily imply that children will be taken
from their home or that parents will be charged with a crime, nor caregivers when elder abuse is suspected. A thorough
professional investigation will occur and all findings will be evaluated. Making a report is simple and can sometimes be
done online. In Washington State, mandatory reporters are obligated to report reasonable suspicion of child or elder
abuse of varying forms.
Conclusion Child or elder abuse can happen in different ways and by anyone close to the victim. Mandatory reporters, such as
health care providers, teachers, and social workers are obligated to report to the appropriate agency any reasonable belief
that the well-being of an individual is threatened. Legal and ethical issues exist within the context of mandatory reporting,
but mandatory reports are well accepted when made without malicious intent and on the basis of reasonable suspicion.
All health care practitioners are obligated to report such beliefs and should be done regardless of any negative
consequence that may occur, as the risk of not reporting a false negative is superseded by the potential benefits of
reporting actual abuse.
References
Brashler, R., Finestone, H. M., Nevison, C., Marshall, S. C., Deng, G., Bismark, M., & Mukherjee, D. (2016). Time to Make a Call? The Ethics of Mandatory Reporting. PM&R , 8 (1), 69–74. https://doi.org/10.1016/j.pmrj.2015.11.009
Jackson, S. L. (2015). The shifting conceptualization of elder abuse in the United States: from social services, to criminal justice, and beyond. International Psychogeriatrics , 28 (1), 1–8. https://doi.org/10.1017/s1041610215001271
Liu, B. C. C., & Vaughn, M. S. (2019). Legal and policy issues from the United States and internationally about mandatory reporting of child abuse. International Journal of Law and Psychiatry , 64 , 219–229. https://doi.org/10.1016/j.ijlp.2019.03.007
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of Medical Ethics and History of Medicine , 12 (12), 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642445/
JMEHM-12-7.pdf (317.492 KB)
Sample Answer 2 for NRNP 6665 Discussion: Ethical and Legal Foundations of PMHNP CareTort Law The topic chosen is tort law. Tort law addresses a wrong act done to an individual to ensure justice is given and relief from the wrong acts is provided to the affected individuals. It mainly involves monetary awards to the victims to compensate them for the wrong acts committed by other individuals. The person committing the act suffers the cost/ pain of inflicting wrong acts on others. The law ensures that the victim suffering the wrongful act is compensated to relieve them from the pain of experiencing the wrongful acts.
Tort law provides guidelines on the different approaches of individual victims of a committed wrong act (Mor & Pikkel, 2019). The law guides on the steps to undertake in cases where the individuals who have committed the offense, where a child (minor) or an adult face different punishments as guided by the law. The punishment aims at compensating the individuals suffering the offense. Therefore, the individuals who have committed a crime, depending on the type of crime/ offense, both the minor and adults face different punishments.
The law obeys various ethical and legal issues/ considerations while executing its laws on individuals. The most salient ethical and legal issue identified in and utilized by the law is justice. The law ensures justice prevails through compensation of the affected victims/ individuals. Justice is ensured by enforcing compensation from the offender; for instance, if the individual is an adult, he or she pays for the damages caused to the other individual.
Tort law protects adolescents and children, the minor, from facing the consequences out of the innocence of their actions. The law ensures that the child’s/ minor’s parent or guardian is responsible for the actions committed by the minor. The law states that if the minor commits a crime/ causes damages while under supervision, the supervisor carries the burden of the damages caused (Zdraveva, 2021). The supervisor is held responsible since the child committed the damage while under his/her care and supervision. However, the compensation depends on the type of damage caused and the minor’s ability to make abstract reasons and judgments of their actions and possible consequences.
Moreover, the law also obeys the ethical consideration of beneficence. It ensures that good is done to the affected victims by ensuring accountability of the offender. These ethical and legal considerations concern mental and psychiatric health for both adults and minors, that is, children and adolescents(Mor & Pikkel, 2019). The ethical considerations help protect and promote the mental well-being of an individual. Providing compensation ensures mental stability by relieving the individual from the ill actions of the offender.
Tort law is applicable in clinical practice because it ensures fairness and compensation for committed ill acts. Protection of children against abuse is key, and the law is applied in ensuring the children are covered and well taken care of. The child might be innocent and commit a task that he/she doesn’t know the consequences of. The la ensures their well-being by ensuring that their parents and guardians are responsible for their actions. The law promotes the mental well-being of adolescents, minors, and adults through enacting activities and laws that ensure justice and fairness.
The mental well-being of an individual is necessary and should be considered when passing laws and regulations. The consequences of some acts might affect an individual’s mental state; therefore, there is a need to ensure the wellness of an individual. Children’s mental state and experiences play an important role in their wellness in their adult stages. The consequences or compensatory measures should ensure that the mental status is not affected. Tort law favors all individuals of any age and promotes morality among populations.
Reference Mor, S., & Pikkel, R. B. (2019). Disability, Rights, and the Construction of Sexuality in Tort Claims. Law & Society Review , 53 (4), 1016-1050.
Zdraveva, N. (2021). The Children in the Macedonian Tort Law. Balkan Social Science Review , 17 (17), 143-161.
Sample Answer 3 for NRNP 6665 Discussion: Ethical and Legal Foundations of PMHNP CareEthical/Legal Discussion of Abuse Child and elder abuse are disturbing, unfathomable issues due to the helpless nature of the victims; however, many people are affected daily by maltreatment. Healthcare providers often discover this abuse by assessment rather than self-disclosure. It can also be an issue family members bring up to a healthcare provider. Abuse can occur in many forms such as neglect, emotional, stealing their belongings, or sexual abuse. It is vital for health professionals to recognize maltreatment and know how to handle the situation properly for the sake of the patient’s safety. This post will cover four resources covering ethical and legal aspects of child and adult abuse and how they concern psychiatric mental health practitioners in their field.
Elder Abuse Ethics Saghafi et al. (2019) studied the ethical dilemmas healthcare professionals face while trying to manage elder abuse. The ethical concerns they discuss cover the difficulties care team members face when the abused elder chooses to stay in an abusive situation, the legality of telling other team members secretive patient information for help with how to properly intervene, and the issue of how nurses should intervene for patients with neurocognitive disorders. They also discuss federal law mandating elder abuse reporting and the importance of protecting the autonomy of elders without forcing what another person believes is best for them. This can overlap when it comes to what the healthcare provider believes is best for a patient but it is not what the patient wants. Saghafi et al. (2019) pointed out the importance of clinical guidelines to help support care teams with making these ethical decisions.
Child Abuse Ethics Glover and Justis (2015) discussed how many people believe taking care of child abuse when discovered is easy and should be taken care of immediately without realizing how many ethical dilemmas can make child abuse issues difficult to resolve. When people think of sexual or physical abuse, it seems understandable to know and report such abuse. However, when the abuse comes in the form of obese children, underweight children, verbal, or end of life care decisions, the ethics of what is right and wrong can become more difficult (Glover & Justis, 2015). Decisions that are difficult for all parties involved, including the health care provider that would be mandated to report it. Glover and Justis (2015) stated health care providers sometimes might find themselves having to intervene with parents and discuss decisions if not found to be in the child’s best interest, with a threshold of not reporting as mandated as long as their decisions do not cause harm.
Legal Considerations for the Elderly Hess (2011) provided multiple types of elder abuse to assist health care providers to recognize what is legally mandated to be reported. Besides the more obvious physical or sexual abuse, she discusses psychological abuse that can present as being upset, withdrawn, agitated, or unusual behaviors such as biting, and also financial abuse, neglect, or abandonment. She provides the three R’s in detecting and reporting abuse of recognize, respond, and report. Health care teams should legally follow their reporting procedures for documentation, reporting abuse if needed, and following up to ensure patient safety. Hess (2011) points out a law in place to protect the elderly like the Older Americans Act of 1965. She also provides web sites like (http://www.apsnetwork.org/Abuse/index.htm that provide resources for reporting and http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx for numbers to call.
Legal Considerations for the Children Fishe and Moffat (2016) discussed the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 that causes the Department of Human Services (DHS) to collect data and monitor the effectiveness of each state’s practices. By law, there are certain people required to report any type of child abuse. Fishe and Moffat (2016) provided those who are mandated to report child abuse which includes any medical or mental health professional and should be done quickly in most states (Fishe & Moffat, 2016). If abuse is discovered after a patient turns 18 or a while after the abuse happens, then the occurrences should still be reported (Fishe & Moffat, 2016). Another action required of healthcare professionals is collecting evidence by documenting findings, taking photos of evidence, and presenting lab results if ordered (Fishe & Moffat, 2016).
Personal Practice Considering all medical or mental health professionals are mandated to report witnessed or suspected child or adult abuse, this directly affects my personal practice by providing an understanding of what, when, and who the information needs to be reported to. I was not aware that if patients report abuse from years ago, that I am mandated to report it so that changes my personal practice as well. According to Fishe and Moffat (2016), the state of Arkansas requires abuse to be reported immediately. Although it can be difficult to report suspected abuse, not knowing if more harm is being done than good, I would much rather live with that on my conscious than not reporting and having a terrible outcome for a patient.
References Fishe, J. N., & Moffat, I. F. L. (2016). Child Abuse and the Law. Clinical Pediatric Emergency Medicine, 17(4), 302–311. https://doi.org/10.1016/j.cpem.2016.09.003
Glover, J., & Justis, L. (2015) Ethics and the Identification and Response to Child Abuse and Neglect. General Law. https://lawexplores.com/ethics-and-the-identification-and-response-to-child-abuse-and-neglect/
Hess, S. (2011). The Role of Health Care Providers in Recognizing and Reporting Elder Abuse: [1]. Journal of Gerontological Nursing, 37(11), 28–37. http://dx.doi.org/10.3928/00989134-20111012-50
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and history of medicine, 12, 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642445/
Sample Answer 4 for NRNP 6665 Discussion: Ethical and Legal Foundations of PMHNP CareFidelity in Mental Health Nursing Fidelity describes the responsibility of the PMHNP to provide the best possible care to his or her clients according to evidence-based practice guidelines, the client’s choice, or desire for treatment interventions (honoring autonomy), and available resources. Conflict can arise when the PMHNP feels there are safer or more effective treatment options than what the facilities policy is, when financial constraints exist or there are differences in postop treatment according to the client’s ability to pay, or when the action taken by a PMHNP is the ethical one, but maybe not the legal one. The American Nurses Association has published the code of ethics for nurses with interpretative statements (2015). The provisions of this that I am opening for further review in this discussion include 4.2, 4.3, 5.1, and 5.5 as follows:
Code of Ethics for Nurses
Provision 4.2 Accountability for Nursing judgements, decisions, and actions: nurses are accountable for the care of the patient; if a medication error occurs because of an IV pump failure or electronic M.A.R. glitch- you as the providing nurse are still responsible for the care of the patient.
Provision 4.3 Responsibility for Nursing judgements, decisions, and actions: there is a shared responsibility with nursing administration who make the policies of care; issues include staffing ratios and safeguarding care of the patient and staff.
Provision 5.1 Duties to self and others: we need to take care of our own emotional and physical selves to be fit for providing care to others.
Provision 5.5 Maintenance of competence and continuation of professional growth: nurses owe it to themselves and to their patients to engage in continuing education, to stay up to date with controversies and issues effecting the population (American Nurses Association, 2015).
The American Psychological Association has their own code of ethics, or set of “aspirational” ideals. Principle B addresses the ethics of fidelity and responsibility. Within this set of values, it is proposed that you should be attentive to not only your own practice, but also your colleagues (American Psychological Association, 2017).
Legal and Ethical implications of Fidelity in the child and adolescent population I will share an anecdotal story. As a charge nurse of an adolescent unit, the intake office informs me that we have a patient coming in with an active history of being sexually assaultive to others. My professional judgment is that this patient requires his own room to protect the safety of others. Our unit is full and it is not possible to make this patient a no roommate order. I have a responsibility to the safety and wellbeing of my unit- including patients and staff. I examine my options and report to the psychiatrist on call to request admitting orders to include 1:1 supervision until we can accommodate a no roommate order. Now, to switch roles from an RN to an APRN and be the PMHNP providing admitting orders. In this scenario, I am focused on the safety, well-being, and treatment of this 1 singular patient. To not admit him, I would be refusing treatment. Could this be considered bias d/t diagnosis or personal values? Is my education, continued education, and experience relative to the situation? Do I have staff available that I can collaborate with?
Sample Answer 5 for NRNP 6665 Discussion: Ethical and Legal Foundations of PMHNP CareFor this discussion I chose to discuss the ideas of involuntary commitment related to psychiatric hospitalization, I have some experience in dealing with patients who are on involuntary holds while working on an inpatient adult and adolescent behavioral health unit. The four articles I found speak on the topic from different perspectives, one defines involuntary commitment and reviews some history related to it, the second goes over how giving these patients choices can increase compliance, the third how patient characteristics affect decision making, and lastly how involuntary hospitalization impacts youth and young adults level of trust when seeking help/care. All for the information gathered throughout the four articles found helped me to see how important and the impact the involuntary admission can have and how beneficial and detrimental it can be depending on overall inpatient admission. Legally involuntarily admitting someone and taking away their choice or their autonomy related to the admission is always a topic of conversation so implementing decisions and choices post that involuntary status is important to promote as well.
Involuntary Commitment According to Fariba & Gupta, “The Unites States Health and Human Services, involuntary hospitalization of a patient- is the legal process by which a person is confined in a psychiatric hospital because of a treatable mental disorder, against his or her wishes.” (2022). When it comes to involuntary admissions or involuntary holds it is and has been a topic of discussion and debate since its beginning. The biggest issue of concern related to involuntary commitment is removing a patient/person’s autonomy towards themselves and their care (Fariba & Gupta, 2022). As a medical or psychiatric provider, ensuring you know the laws associated with an involuntary hold and knowing what assessments need to be completed, what information needs to be gathered and what is necessary to initiate the involuntary hold or commitment (Fariba & Gupta, 2022). The tool of the involuntary commitment for those patients who you feel may become a harm to themselves it can be a useful tool, though it requires you to be diligent with your assessment and your plan of care for the patient, so they gain the care you feel they need, and you meet all legal requirements of the involuntary commitment.
Giving Patients Choices During Involuntary Admission: A New Intervention Those patients who are involuntarily hospitalized are the group of individuals who have some of the poorest outcomes, due to having a lack of support post admission as well as them not having wanted to be admitted initially which can lead to a lack of cooperation or focus while involuntarily admitted (Burn, et al., 2019). In all hospital visits or hospital admissions the patient should be involved in their medical decision making whether involuntarily present or voluntarily present, in a wide majority of hospitalizations patient involvement is not as high as it should be (Burn, et al., 2019). The studies within this article showed that it is possible to increase patient outcomes by increasing their involvement in decision making (Burn, et al., 2019). In instances that a patient was admitted due to an involuntary hold, they may eventually accept that they are going to be here for a certain amount of time and if you begin to let them make small decisions and encourage them to participate in their care as a practitioner this will increase their long-term positive outcomes.
Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making S ome of the main characteristics that this study showed had an association with an eventually involuntary admission included, brought in by police, organized suicide plans, physical signs of harm, previous suicide attempt, psychosis, depression, hopelessness, lack of social support, a previous psychiatric diagnosis, and more as well (Bhalla, et al., 2022). The patients that were involuntarily admitted are patients who are struggling with their ongoing mental health or who do not have a strong support system to fall back on if they were to be sent home or not admitted. As a psychiatric provider deciding when a patient should be placed on an involuntary hold, this article shows the importance of considering all the contributing factors that can influence the safety of the patient if they were to be discharged and not admitted.
Investigating The Impact of Involuntary Psychiatric Hospitalization on Youth and Young Adult Trust and Help-Seeking in Pathways to Care One topic that is a part of the discussion is how an involuntary admission can impact a patient of any age and their likelihood of then seeking care post and involuntary hospitalization. In the adult population the article found that when looking back some adult patients who had been involuntarily hospitalized later realized that the hospitalization was necessary for their care (Jones, et al., 2021). The study did show that a large portion of the sample of patients did have negative feelings towards people of authority post their involuntary admission, the study did not assess or find how this affected their admission and their discharge (Jones, et al., 2021). Some patients involved in the study reported that the care they received had enough positive impacts to counteract the negative feelings they had towards the initial involuntary admission (Jones, et al., 2021). This information is important to remember as a practitioner and as staff working on the inpatient settings, knowing that the care you provide when a patient is admitted can influence how they will trust and seek care in the future is extremely important.
Involuntary Psychiatric Hospitalization- How Patient Characteristics Affect Decision‑Making.pdf
Download Involuntary Psychiatric Hospitalization- How Patient Characteristics Affect Decision‑Making.pdf
Involuntary Commitment .pdf
Download Involuntary Commitment .pdf
Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help‑seeking in pathways to care.pdf
Download Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help‑seeking in pathways to care.pdf
Giving Patients Choices During Involuntary Admission_ A New Intervention – PMC.pdf
Download Giving Patients Choices During Involuntary Admission_ A New Intervention – PMC.pdf
Works Cited
Bhalla, I. P., Siegel, K., Chaudhry, M., Li, N., Torbati, S., Nuckols, T., & Danovitch, I. (2022). Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making. Psychiatric Quarterly , 93 (1), 297–310. https://doi.org/10.1007/s11126-021-09939-2
Links to an external site.
Burn, E., Conneely, M., Leverton, M., & Giacco, D. (2019). Giving Patients Choices During Involuntary Admission: A New Intervention. Frontiers in psychiatry , 10 , 433. https://doi.org/10.3389/fpsyt.2019.00433
Links to an external site.
Fariba KA, Gupta V. Involuntary Commitment. (2022). StatPearls Publishing; 2022 https://www.ncbi.nlm.nih.gov/books/NBK557377/
Jones, N., Gius, B. K., Shields, M., Collings, S., Rosen, C., & Munson, M. (2021). Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Social Psychiatry & Psychiatric Epidemiology , 56 (11). https://doi.org/10.1007/s00127-021-02048-2
Links to an external site.
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.
peer2-1609.pdf
