N 520 Legal and Ethical Issues in Health Care Module 1 Assignment

N 520 Legal and Ethical Issues in Health Care Module 1 Assignment

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 psychiatry11, 127.

Canady, V. A. (2018). TAC says many states fail to make the grade on involuntary treatment laws. Mental Health Weekly28(37), 1-3.

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 research23(1), 1-14.

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 Psychiatry76, 101695.

Morris, N. P. (2018). Legal hearings during psychiatry residency. J Am Acad Psychiatry Law46, 351-358.

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.

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 Medicine26(5), 470-478. 

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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Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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