N 520 Legal and Ethical Issues in Health Care Module 1 Assignment
Legal and Ethical Issues Related to Psychiatric Emergencies
The United States contains several states with their own set of laws that guide the hospitalization of all mental health patients with a capacity to harm those in their surroundings in both temporal and involuntary manners (Canady, 2018). The legitimacy and value of the choice of treatment intervention however relyon several factors like statutory criteria, and how they are applied; accessibility to care concerning the selected intervention; and accuracy to the emergency hold procedure. The purpose of this paper is to conduct a comprehensive assessment of the psychiatric emergency laws of the state of Maryland for both children and adults.
State Laws for Involuntary Psychiatric Holds
The Maryland state, the laws allow healthcare workers such as physician, a psychologist, a county health officer among others to “file an emergency evaluation petition for involuntary hospitalization even without getting the approval of the judge” (Durns et al., 2021, p. 4). The petitioner must have substantial reason to believe that the person is mentally ill and display potential danger to themselves or others. Morris (2018) posits that amongst the provision of this law is the clause that permits authorities to issues involuntary commitment order within 72 hours whilst hearing should occur within 20 days after the former as regards adults. For children below the age of 18 years, the civil commitment hearing must be scheduled within 14 days, from the date of admission of the individual. The patient will be held for this period, however, when the psychiatrist fails to meet the hold criteria, the judge immediately releases the patient. A family member or emergency contact can come and pick the patient once the release order has been approved.
Evaluation/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment
The state of Maryland also allows civil holds as regards involuntary hospitlaizations to occur distinctively between both inpatient and outpatient commitments (Becker & Forman, 2020). According to the inpatient commitment laws in this state, the judge has the prerogative to make an order for a forceful patient hospitalization even when a patient has not contravened any of the civil commitment criteria and the elapsing of the emergency evaluation period. On the contrary, the outpatient civil commitment permits the same judge to order for the forceful hospitalization of mentally ill patients whose symptomatology is in tandem with the civil criteria whilst they are within the bounds of the community setup. Commonalities exist in the detainment time, the hearing and release orders in the two instances.
Difference Between Capacity and Competency
In mental health sphere, capacity is associated with the ability of a patient to undertake decisions that are regarded as sound as well as offer informed consent upon request. Therefore, the patient has the correct information such as the mental status, treatment interventions as well as their relevance and precise diagnosis of their condition (Perlin et al., 2018). On the other hand, competency is associated with the ability that a person has with regards to independent acting and participation in decision-making on matters associated with their health.
Legal and Ethical Issues
The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed into law in the year 1986 by the United States Congress (Terp et al., 2019). It was considered part of the Consolidated Omnibus Reconciliation Act (COBRA) mainly handling Medicare issues. The main legal and ethical issue associated with EMTALA is the inability to uphold and respect the patients’ autonomy and confidentiality, especially when it comes to payment issues.
Evidence-Based Suicide Risk Assessment and Violence Risk Assessment
Psychiatric emergencies see the adoption of various diagnostic tools for purposes of determining the levels of severity of the mental health illness in a patient. Tools such as Evidence-based Screening tools like Patient Health Questionnaire 2 (PHQ2) play important roles in the diagnosis of the severity of suicidal ideation. On the other hand, the risk for violence can be diagnosed using Brøset Violence Checklist and Violence Risk Screening-10 can be used to assess for risks of violence among others (Chunduri et al., 2019).
Psychiatric emergencies call for involuntary hospitalization of mentally ill individuals for evaluation and treatment. The laws governing psychiatric emergencies however vary from state to state. However, the entire process is mainly aimed at protecting community members from harm that can be caused by the mentally ill individual.
Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in psychiatry, 11, 127. https://doi.org/10.3389/fpsyt.2020.00127
Canady, V. A. (2018). TAC says many states fail to make the grade on involuntary treatment laws. Mental Health Weekly, 28(37), 1-3. https://doi.org/10.1016/j.ijlp.2021.101695
Chunduri, S., Browne, S., Pollio, D. E., Hong, B. A., Roy, W., Roaten, K., … & North, C. S. (2019). Suicide risk assessment and management in the psychiatry emergency service: psychiatric provider experience and perceptions. Archives of suicide research, 23(1), 1-14. https://doi.org/10.1080/13811118.2017.1414648
Durns, T. A., O’Connell, P. H., Shvartsur, A., Grey, J. S., & Kious, B. M. (2021). Effects of temporary psychiatric holds on length of stay and readmission risk among persons admitted for psychotic disorders. International Journal of Law and Psychiatry, 76, 101695. https://doi.org/10.1016/j.ijlp.2021.101695
Morris, N. P. (2018). Legal hearings during psychiatry residency. J Am Acad Psychiatry Law, 46, 351-358. https://doi.org/10.29158/JAAPL.003770-18.
Perlin, M., Dorfman, D., & Weinstein, N. (2018). On Desolation Row: The Blurring of the Borders between Civil and Criminal Mental Disability Law, and What It Means to All of Us. Articles & Chapters. https://digitalcommons.nyls.edu/fac_articles_chapters/1356
Terp, S., Wang, B., Burner, E., Connor, D., Seabury, S. A., & Menchine, M. (2019). Civil monetary penalties resulting from violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies, 2002 to 2018. Academic Emergency Medicine, 26(5), 470-478. https://doi.org/10.1111/acem.13710.
Complete both case studies:
1. Apply Guido’s MORAL model to resolve the dilemma presented in the case study described in EXERCISE 4–3 (Guido textbook). How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
2. Read the case study entitled You be the Ethicist, presented at the end of Chapter 3 (Guido textbook). What are the compelling rights that this case addresses? Whose rights should take precedence? Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? How would you have decided the outcome if his disease state had not intervened? Now, examine the scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy? Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
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