Overview
This lecture covers ethical responsibilities and legal obligations in psychiatric mental health nursing, focusing on ethical theories, decision-making frameworks, Canadian legislation, and client rights.
Ethical Principles in Psychiatric Nursing
- Autonomy means respecting clients' right to choose, but mental illness may impair capacity.
- Beneficence is acting in the client's best interest.
- Non-maleficence is avoiding harm to clients.
- Justice means fair and equal access to care and resources.
- Fidelity is maintaining loyalty and trust with clients.
- Principle of impossibility states duties can't be met if circumstances make them impossible.
Major Ethical Theories
- Deontology judges actions by rules and duties, emphasizing autonomy, fidelity, and non-maleficence.
- Consequentialism (utilitarianism) bases decisions on outcomes, seeking the greatest good and least harm.
- Virtue ethics emphasizes nurses’ character traits like compassion, honesty, and courage.
- Relational ethics focuses on trust, mutual respect, engagement, and the nurse-client relationship.
Ethical Dilemmas and Moral Concepts
- Ethical dilemmas arise when duties or principles conflict without a clear right answer.
- Moral distress occurs when you know the right action but can't do it due to barriers.
- Moral uncertainty is not knowing what the right action is.
- Moral residue are lingering feelings after difficult ethical situations.
- Moral resilience is adapting and maintaining integrity after challenges.
Legal Frameworks in Psychiatric Nursing (Ontario Focus)
- The Mental Health Act allows voluntary, informal, and involuntary admissions.
- Form 1: Physician-initiated application for assessment (risk to self/others, inability to care for self).
- Form 2: Justice of the peace-initiated order for assessment.
- Police can apprehend individuals without a warrant in emergencies.
- After 72-hour assessment, clients are discharged, admitted voluntarily, or held involuntarily.
- The Healthcare Consent Act governs treatment consent, capacity, and substitute decision-makers (SDM).
Client Rights and Protections
- Clients have the right to informed consent if capable.
- Substitute decision-makers or the Public Guardian and Trustee act when clients lack capacity.
- Consent and Capacity Board reviews client decision-making ability.
- Clients retain rights unless deemed incapable by legal process.
- Community Treatment Orders (CTOs) allow mandated treatment in the community for some clients.
Research Ethics
- Canadian Nurses Association Code of Ethics outlines professional standards.
- Tri-Council Policy Statement defines three core research principles: respect for persons (informed consent), concern for welfare (protecting well-being), and justice (fairness in participation).
Key Terms & Definitions
- Autonomy — the right of clients to make their own decisions.
- Beneficence — the duty to act in a client's best interest.
- Non-maleficence — the obligation to avoid causing harm.
- Justice — fairness in distributing care and resources.
- Fidelity — loyalty and maintaining trust.
- Deontology — ethical theory judging actions by adherence to rules and duties.
- Consequentialism — ethical theory guided by the outcomes of actions.
- Virtue Ethics — ethical theory based on character traits.
- Relational Ethics — ethical theory prioritizing relationships and context.
- Form 1/2 — legal forms authorizing psychiatric assessment/admission in Ontario.
- Substitute Decision-Maker (SDM) — appointed person making decisions for incapable clients.
- Moral Distress — knowing the right action but barred from taking it.
- Moral Uncertainty — unsure what the right action is.
- Community Treatment Order (CTO) — mandated outpatient treatment for certain clients.
Action Items / Next Steps
- Reflect on the case study: apply each ethical theory to the scenario provided.
- Review the Canadian Nurses Association Code of Ethics.
- Read the assigned textbook table comparing mental health legislation by province.