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Ethical and Legal Foundations of PMHNP Care Discussion
Respond to at least two of your colleagues on 2 different days
Vida
Week 2 Discussion – Ethical and Legal Foundations of PMHNP Care
Informed assent/consent and capacity are essential components of healthcare practice, regardless of the target patient population. In pediatric psychiatry, informed consent is related to respect for childrenâ€s developing capacity by assisting them in understanding their conditions and treatments at a developmentally appropriate level. However, clinicians often disregard the procedure and allow only the parents or legal guardians to make decisions on behalf of their children (Cotrim et al., 2021). Among older adults, obtaining valid informed consent requires clinicians to assess the patientâ€s mental capacity (Dalal, 2020). Seeking and obtaining informed assent or consent can significantly affect the implementation of the intervention and may have legal implications for practitioners. The discussion summarizes ethical and legal issues associated with informed assent/consent and capacity pertinent to psychiatric care for pediatric and adult patients. Ethical and Legal Foundations of PMHNP Care Discussion
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The literature revealed autonomous decision-making as a crucial ethical issue surrounding informed consent. Minors usually can understand and act upon the information provided when seeking assent. However, research shows that the involvement of parents in the process may hinder its success when children are not allowed autonomy. Specifically, the barrier emerges from the lack of awareness and understanding of mental health issues or the benefits of interventions (Cavazos-Rehg et al., 2020). Among older adults, the issue of informed consent and capacity may bring ethical challenges in managing the refusal of medical care (Oâ€Cionnaith et al., 2021). Conventionally, clinicians should assume that older adults have the mental capacity to make autonomous decisions. However, Oâ€Cionnaith et al. (2021) argued that clinicians working with older adults with mental illness should understand the complex issues impairing capacity and advocate for the patients to avoid the potential effect of stigma and ageism in managing their care. In practice, clinicians should consider autonomy in the light of respecting patients†autonomy. Nevertheless, they should examine and consider the decisional capacity of parents when providing treatments to children or addressing issues such as refusal of medication.
Informed assent/consent and capacity come along with some legal issues. Parental decisional power is among the legal issues associated with informed assent among psychiatrically ill pediatric patients (Bieber et al., 2020). Parents have the role to consent to treatments for their children. While clinicians should postpone interventions when parental refusal does not put a child at significant risk of harm, the standard does not address the needs of children with severe and persistent mental health problems. This raises legal issues of medical negligence if clinicians accept seriously inadequate parental decisions. Therefore, the clinical rationale for medical decision-making and course of action may not always align with the legal frameworks advocating for childrenâ€s best interests. In adult psychiatry, informed consent and capacity may bring legal issues of implementing interventions without patients†consent (Becker & Forman, 2020). In managing psychiatric emergencies such as agitation and aggression, clinicians can use restraints, commit patients, and use appropriate treatments without patients†consent if delays can increase the risk to life. While the failure to do so risks charges of negligence against clinicians, it could also raise concerns regarding violating the false imprisonment tort. The evidence illustrates the legal limits of informed consent and treating patients without consent (Becker & Forman, 2020; Bieber et al., 2020). In practice, this implies the importance of commencing involuntary commitment proceedings when handling psychiatric emergencies and understanding the adequacy of parental decisional capacity when seeking informed consent from children to avoid negligence charges. Ethical and Legal Foundations of PMHNP Care Discussion
References
Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00127Links to an external site.
Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J. L., & McKean, A. J. (2020). The Role of Parental Capacity for Medical Decision-Making in Medical Ethics and the Care of Psychiatrically Ill Youth: Case Report. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.559263Links to an external site.
Cavazos-Rehg, P., Min, C., Fitzsimmons-Craft, E. E., Savoy, B., Kaiser, N., Riordan, R., Krauss, M., Costello, S., & Wilfley, D. (2020). Parental consent: A potential barrier for underage teens’ participation in an mHealth mental health intervention. Internet Interventions, 21. https://doi.org/10.1016/j.invent.2020.100328Links to an external site.
Cotrim, H., Granja, C., Carvalho, A. S., Cotrim, C., & Martins, R. (2021). Childrenâ€s Understanding of Informed Assents in Research Studies. Healthcare, 9(7). https://doi.org/10.3390/healthcare9070871Links to an external site.
Dalal, P. K. (2020). Consent in psychiatry – concept, application & implications. The Indian Journal of Medical Research, 151(1), 6-9. https://doi.org/10.4103/ijmr.IJMR_1518_19Links to an external site.
Oâ€Cionnaith, C., Wand, A. P., & Peisah, C. (2021). Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness. Clinical Interventions in Aging, 16, 1315-1325. Ethical and Legal Foundations of PMHNP Care Discussion
