Posted: July 7th, 2022

Week 5: Patient Rights and Legal Issues Paper

Week 5: Patient Rights and Legal Issues Paper
People with psychiatric problems are vulnerable to mistreatment and abuse, laws have been passed that guarantee them legal protection. These laws offer protection of self-determinism, protection against discrimination in employment, and protection against mistreatment in health care settings (Boyd, 2017, p. 17)

Write a 4-5 page discussing the following concepts using APA format. The discussion section of the paper should be no more than 4-5 pages in length not including the title page, conclusion paragraph, level of headings and reference page(s); Include a minimum of 5 peer reviewed scholarly nursing journals as references.

Concept 1: Consider the relationship of self-determination to competence by differentiating patients who are competent to give consent and those who are incompetent. Discuss the steps in determining whether a patient is competent to provide informed consent for a treatment.
Concept 2: Define competency to consent to or refuse treatment and relate the definition to the Self-Determination Act.
Concept 3: Discuss the purposes of living wills and health proxies. Discuss their use in psychiatric- mental health care.
Concept 4: Identify the legal and ethical issues underlying the Tarasoff case and mandates to inform.
Concept 5: Compare the authority and responsibilities of the internal rights protection system with those of the external advocacy system.
Concept 6: Describe the differences between UST (Unfit to stand trial), NGRI( Not guilty by reason of insanity), and GBMI (Guilty but Mentally Ill). Give an example of a famous trial outcome using each criminal judicial process (UST, GBMI, and GBMI).
Concept 7: Discuss the legal liability in psychiatric nursing practice
Concept 8: Discuss HIPAA and Protection of Health Information versus Mandates to Inform (Boyd, 2017, p. 25)

Patient Rights and Legal Issues

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Many psychiatric patients face victimization in society. Study shows that these people with mental illness are 11.8 times more likely to be victims of violent crimes as compared to the general population. Individuals with psychiatric problems face mistreatment in healthcare settings, discrimination in employments violence, and self-determinism. People with mental illness are entitled to fair treatment; thus some laws ensure that these people are protected.

Psychiatric patients have the right to provide informed consent for treatment. Self-determination states that every person can manage their own life by making their own choices. Therefore, Informed consent requires the patient to decide whether he or she wants to go through a particular treatment. Psychiatric patients must give permission for medical tests and procedures. The consent requires the patient to have the ability to make the decision. The doctor must provide the patient with the full information on the expected procedure (Bang,2017). The patient must comprehend the knowledge and voluntarily provide consent without duress or coercion. Self-determinant competency is determined by the capacity of the patient to accept or refuse surgery. Competency is determined by the ability of a person to make informed decisions’. The medical provider can opine capacity but cannot assess competency. An individual who is termed as incompetent competent must undergo competency hearing.
The Self-determination Act was mandated in 1991to allow individuals to participate in the medical decision-making process. Self-determination Act is based on the theory that people have the power to control their choices in life. The Act presents an autonomous concept that states that patients are competent to accept or refuse medical treatment (Bengtsson et al.2012). However, competency is questioned when the psychiatric patient refuses treatment that is deemed rational by the physician.
Living wills and health proxies are the legal outlines for an individual’s mental treatment in the event of severe terminal illness that prevents them from expressing their wishes. The living will for psychiatric patients is an advance directive that entails the treatment information in case of mental health problems that cause impaired communication (Herman,2000). Mental health proxies allow another person to make decisions for the sick patient if they cannot do so themselves.
Trasoff laws require a therapist who determines that his patient presents a danger to another should use reasonable care to protect the involved victim. The law establishes that in such a situation, the public should be protected at the account of client-therapist confidentiality. However, Trasoff law breaches client-therapist privacy. Research shows that breaking the secrecy may lead to termination of the sessions (Välimäki,2006). The law causes legal and ethical issues because the therapist may be called upon to break standards to protect a victim.
Advocacy and internal protection systems work to advocate for individuals with disabilities by protecting and empowering them (Quinsey,2005). These systems offer training to service providers such as policymakers and state legislators by raising awareness on the issues that affect people with disabilities. Both systems provide legal support that helps individuals with a disability to navigate the system. The protection and advocacy systems fight for the personal and civil rights of individuals with disabilities (Schwarz, 2002). The internal rights protection protects the rights of individuals with disabilities by offering encouragement and support systems. The external advocacy system ensures that the members can exercise their rights in society to achieve independent living. Unfit to stand trial occurs when the accused person is unable to stand test because they are unable to understand they are in a courtroom or the people in the courtroom. The accused person is UST when they are unable to communicate with the lawyer or to follow the charges and the procedure involved. Not guilty because of insanity is when the accused pleads guilty but claims to be mentally disturbed during the occurrence of the crime. In this case, the accused claims to have lacked the required mental capacity to commit the crime. Guilty but mentally ill is when the defendant is found guilty of committing a crime while formally acknowledging being mentally ill. GBMIS adds to the verdict option of the insanity defense standard (Givelber,2004).
An example of a famous UST criminal charge process involves a student named Alexander Kinyua, who was accused of a cannibalistic case. He was charged with killing a family friend and ingesting his brain and heart. The accused was declared incompetent to stand trial. Kinyua was found to be unfit to stand trial. He was taken to Perkins on June 20th, 2016, for treatment. An infamous case that involves Not Guilty because of Insanity is of Lisa Montgomery, who was charged for murdering Either month pregnant Bobbie Stinnet by strangling her to death and cutting the unborn child from the womb. Lisa pleaded not guilty because she suffered from pseudocyesis. However, the jury declined the plea because Lisa had used a methodical plan to lure Bobbie into her deadly trap (Olley and Ogloff, 2015). The judge declared that Lisa was guilty and sentenced her to death. One of the Guilty but Mentally Ill cases involves a case that occurred in 1989, where the U.S congressman Daniel Sickles shot and murdered the U.S District attorney who was having an affair with Sickle’s wife. His lawyer argued that his action was due t temporary insanity after he came to the fact that his wife was having an affair with the attorney. The jury accepted, thus getting Sickle acquitted.
Legal liability in psychiatry nursing practice includes the nurse’s responsibilities and patient rights. The liabilities depend on the act of a particular state. The law governing the practice depends on the policies and procedures. Nurses can be liable when they fail to offer safe and acceptable practice. For example, seclusion and restraint techniques are supposed to get applied when necessary to protect the patient from harm (High,2008). Restraint and seclusion can be done with essential documentation.However, the approach cannot be used to manage behavior in the unit policy. In such situations, the nurse involved will be held liable.
HIPAA is a privacy rule that protects health information in any form, including paper, electronic, or oral. The rule protects any identifiable health information, whether it’s from the past, present, or future. The law allows health information to flow while staying protected, thus ensuring high-quality healthcare (Herr, 2006). The rule enables the safe use of data while offering privacy and protection to the individuals seeking treatment.


Bang, Y. R., & Park, J. H. (2017). Psychiatric disorders and suicide attempts among adolescents victimized by school bullying. Australasian psychiatry, 25(4), 376-380.
Bengtsson‐tops, A., & Ehliasson, K. John, M., Keiser, R.(2012). Victimization in individuals suffering from psychosis: a Swedish cross‐sectional study. Journal of psychiatric and mental health nursing, 19(1), 23-30.
Hermann, D. H. (2000). Autonomy, self determination, the right of involuntarily committed persons to refuse treatment, and the use of substituted judgment in medication decisions involving incompetent persons. International journal of law and psychiatry, 13(4), 361-385.
Välimäki, M., Leino-Kilpi, H., & Helenius, H. (2006). Self-determination in clinical practice: the psychiatric patient’s point of view. Nursing ethics, 3(4), 329-344.
Schwarz, J. K. (2002). Living wills and health care proxies. Nurse practice implications. Nursing & health care: official publication of the National League for Nursing, 13(2), 92-96.
High, D. M. (2008). All in the family: Extended autonomy and expectations in surrogate health care decision-making. The Gerontologist, 28(Suppl), 46-51.
Olley, M. C., & Ogloff, J. R. (2015). Patients’ rights advocacy: Implications for program design and implementation. The journal of mental health administration, 22(4), 368-376.
Herr, S. S. (2006). The future of advocacy for persons with mental disabilities. Rutgers L. Rev., 39, 443.
Givelber, D. J., Bowers, W. J., & Blitch, C. L. (2004). Tarasoff, myth and reality: An empirical study of private law in action. Wis. L. Rev., 443.
Quinsey, V. L., Pruesse, M., & Fernley, R. Jared, K.(2015). A follow-up of patients found “unfit to stand trial” or “not guilty” because of insanity. Canadian Psychiatric Association Journal, 20(6), 461-467.

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