Legal Issues in Psychiatry Flashcards
All information regarding a doctor-patient shoud be held confidential except for in what situations?
- When sharing relevant information with other staff members who are also treating the patient
- If subpoenaed - physician must supply all requested information
- If child abuse is suspected
- If patient is an immediate danger to others
- If a patient is suicidal
What is the Tarasoff Duty?
The obligation of a physician to report patients who are potentially harmful to others
What is observed in an involuntary admission to a psychiatric hospital?
- Patient is found by two staff physicians to be potentially harmful to self or others
- Patients can be hospitalized against his/her will for a certain number of days (depending on laws of state)
- Patients must be provided with a copy or the commitment papers, have their rights explained to them, and have any questions answered pertaining to the commitment
What are the elements of informed consent?
- Name and purpose of treatment
- Potential risks and benefits
- Alternatives to treatment
- Consequences of refusing treatment
- Opportunity must be given for the patient to ask questions, and he/she must have the capacity to make an informed decision
What situations do not require informed consent?
- Lifesaving medical emergency
- Suicide or homicide prevention (hospitalization)
- Minors
When is parental consent not required in treating a minor?
- When giving obstetric care
- Treatment for sexually transmitted diseases
- Treatment for substance abuse (Laws vary by state)
When are minors considered emancipated?
- Self supporting
- In the military
- Married
- Have children
What is the difference between competence and capacity?
Competence is a legal term and can only be decided by a judge whereas capacity is a clinical term and may be assessed by physicians
What four criteria are required for a patient to have decisional capacity?
- Can communicate a choice or preference
- Understands the relevant information regarding treatment - purpose, risks, benefits, alternatives; patient must be able to explain this information to you
- Appreciates the situation and its potential impact or consequences according to his or her own value system and understands the ramifications of refusing treatment
- Can logically manipulate information regarding the situation and reach rational conclusions
What factors increase the likelihood of a patient becoming violent?
- History of violence
- Specific threat with a plan
- History of impulsivity
- Psychiatric diagnosis
- Substance abuse
What is required for a person to be deemed competent to stand trial?
- Understand the charges against him or her
- Have the ability to work with an attorney
- Understand possible consequences
- Be able to testify
To be deemed not guilty by reason of insanity, a patient must meet one of three statutory criteria…what are they?
- M’Naghten: Stringent test that assesses whether the person understands the nature, consequences, and wrongfulness of his or her actions
- American Law Institute Model Penal Code: Cognitive prong determines whether the person understands the wrongfulness of his or her actions; Volitional prong assesses whether the person is able to act in accordance with the law
- Durham: Most lenient test and rarely used; assesses whether the person’s criminal act has resulted from mental illnes
What three things must be proven to prove malpractice against a physician?
- There is an established standard of care
- The physician breached his or her responsibility to the plaintiff
- The physician’s breach of responsibility caused injury or damage to the plaintiff
What are the differences between compensatory damages and punitive damages?
- Compensatory damages: Awarded to the patient as reimbursement for medical expenses, lost salary, or physical suffering
- Punitive damages: Awarded to the patient only in order to “punish” the doctor for gross negligence or carelessness
