Ethical and legal issues in psychiatry Flashcards
Define competency.
The cognitive ability to understand and balance issues relevant to a decision. Competency can be overruled by court.
Why might mental illness affect competency?
It can affect the process of decision and alter values.
Under what conditions can a pt with a mental illness be overruled in regards to refusal of treatment?
Argue the illness has altered their normal values and so to respect pt autonomy, must respect the views of the pt when free from illness.
Argue that it is in the pt’s best interests or to protect society.
What are the ethical issues with treating a pt under the MHA, for their mental disorder despite without considering their capacity to consent or refuse?
It overrides a competent personals refusal by considering the presence of a mental illness as automatic incompetence. It discriminates between physically and mentally ill. May claim that it is for the protection of others as well as the pt, but this doesn’t apply in the situation of physical illnesses.
Why might a pt with a mental illness not be detained under the criminal law?
Although the aim is to protect society, it may not be appropriate to put the responsibility of the pt’s actions on them, but purely down to the illness itself. The difference between a dangerous patient under the criminal law and a pt under the MHA is RESPONSIBILITY.
What does the MHA allow HCP to do?
Allow overruling of competent pt’s refusal.
Gives power to forcibly detain, restrain and receive treatment for the protection of others.
Allows the prediction of risk in a mentally ill pt to be used to detain them before a dangerous act occurs.
When can a person with no mental illness be detained?
Only once a crime has been committed despite how dangerous they are considered to be.
Under what sections of MHA can a pt be admitted?
Section 2 - Admission for assessment
Section 3 - Admission for treatment
Section 4 - Emergency assessment
On what grounds can a pt be admitted under section 2 and who by?
A pt can be detained if their illness is of a nature and degree that warrant detention and it makes the individual dangerous to self or others.
Can be requested by a social worker or nearest relative (oldest blood). The application must be supported by 2 Drs (GP, psychiatrist). It lasts for 28 days.
On what grounds can a pt be admitted under section 3 and who by?
On the grounds that the nature of the illness requires treatment within a hospital and without it, the illness will continue to be a danger, but only if there is a treatment available to alleviate or prevent deterioration.
The admission lasts 6 months and can be renewed.
Social worker and nearest relative must be consulted or make the request.
Cannot be used to force treatment of an outpatient.
Under what situation can a pt be admitted under section 4 and who by? How long does it last?
On the grounds that the disorder is of a nature and degree that warrants detainment for assessment and is a danger. It is an emergency if there is not 2 Drs present. As only 1 Dr makes the detainment, it lasts 72hrs.
Describe the amendment made to the MHA in 2007 regarding the ‘removal of mental disorder categories’.
A mental disorder was previously described as ‘mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability to mind. Now ‘any disorder or disability of mind’. It provides a broader definition and more power to detain.
Describe the amendment made to the MHA in 2007 regarding the ‘replacement of treatibility and care test with appropriate treatment’.
Detainment under section 3 cannot be met unless medical treatment is available fir the pt, which is appropriate when considering the nature and degree of the disorder. It introduced the ‘appropriate medical treatment test’ to close the loop hole to prevent untreatable pts from not being detained e.g. detainment can be the most appropriate treatment in dangerous pts.
Describe the changes to the professional roles in the 2007 amendments.
Allowed the MHA to be carried out by a wider range of professionals = responsible clinician. It created the approved socail worker and approved mental health professional. Other professionals than psychiatrists can enact MHA and can detain pts on wards that are not ran by Drs.
Who can apply for an assessment of a pt under the MHA?
Pts nearest relative or social worker can apply.
But patient has the right to displace the responsibility from the nearest relative to someone willing to take on the role, if the current person is unsuitable e.g. abusive relationship.
Was introduced to increase pt safety.
