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Sample Essay

Ethical and Legal Foundations of PMHNP Care

It is a requirement for psychiatric mental health practitioners (PMHNP) to maintain high legal and ethical considerations in patient care. Since psychiatry involves both children and adults, health professionals must be conversant with all the legal/ethical facets for better care.  One of the most binding ethical topics is informed consent. Understanding the requirements of the topic between children and adults can help narrow the legal requirement of the PMHNP for best practice in psychiatry.

Informed Consent

Informed consent is a process of communication that respects the fundamental right of an individual to dignity and autonomy. It entails providing a patient with all the information necessary to decide on their care. To achieve informed consent, a provider must provide all information about intended care to the patient and all surrogates, conduct a thorough assessment of their ability to understand the information and their ability to influence medical decisions (Neilson & Chaimowitz, 2015). By providing this information, the patient/ surrogates have the power to accept or reject any medical intervention without coercion.

Informed Consent for Children

Informed consent is a prerequisite to proper psychiatric practice for children and adult patients. However, issues arise in understanding the conceptual necessity for informed consent due to their cognitive ability to influence medical decisions. It requires venturing into literature search for evidence based conclusions to the topic.

Information from the Committee of Bioethics (2016) is a scholarly tool by the American Academy of pediatrics on child psychiatry. It clarifies on the necessity for informed consent from children/adolescents as a standard for proper psychiatric care. However, it requires the provider to engage in developmentally-appropriate communication for comprehensive care. The assertion is supported by Robertson & Kjervik (2012), a nursing research and practice journal. It emphasizes on the need for child collaboration in all aspects of care. It also recognizes that adolescence is a stage where most minors have the capability for abstract thinking. However, they often need the caregiver/parental support in psychiatric care.  It is a succinct revelation that while a minor's consent is necessary, it is not completely considered competent. Nonetheless, it does not give the parents/caregiver and the provider the right to eliminate them from care decisions.

Informed Consent for Adults

Informed consent is also a necessary component of psychiatric care for adults. A recent medical journal by Neilson & Chaimowitz (2015) seeks to specify the need for permission before any psychiatric evaluation or treatment. It passes the CRAAP tests as a credible journal for scientific evidence. The journal specifies that although these patients have an underlying mental health issue, the condition does not entirely diminish their cognitive function. However, there are some situations that hinder an adult from informed consent.

 The Pennsylvania General Assembly (2004), an act by the regions general assembly is a guidance tool for health providers for these situations. Provisions of the act are a credible scholarly material for health professionals practicing in the region. It makes exclusions from informed consent if an adults existing mental illness prevents them from understanding the need for medical intervention. It is also not necessary if a patient is in danger and there is a need for urgent medical intervention to avert the danger (Committee on Bioethics, 2016). However, the exception is only valid if there is no surrogate to provide consent. It signifies the extent to which psychiatric care goes to respect a patient’s right to make decisions about their care.

Pennsylvania

According to Pennsylvania’s Act 147, a minor that is older than 14 years can consent to outpatient psychiatric treatment without the need for parental involvement. A parent may also provide consent for a minor less than 18 years without the necessity for the minor's consent (Pennsylvania General Assembly, 2004). By law, a parent in Pennsylvania cannot abrogate consent provided by a minor nor can a minor abrogate consent provided by the parent for psychiatric services (Pennsylvania General Assembly, 2004). The same need for consent is abiding for adult patients. The state recognizes them as self-determining in psychiatric care. An adult will only be distanced from providing informed consent if they exhibit significant limitations on their mental ability to influence medical decisions (Pennsylvania General Assembly, 2004). As a health professional in the state, I must succinctly follow these guidelines for best psychiatric practice.

Conclusion

It is evident of the importance of legal/ethical considerations in psychiatric practice. Informed consent is part of this obligation by health providers to promote voluntary choice in treatment modalities. While children/adolescents share the same legal right, they can only provide consent if they meet the required decisional ability and legal requirements. In such cases, parents/caregivers may provide informed consent and involve the child/adolescent only when it is appropriate. The same legal requirement is evident in Pennsylvania. Adults and children over 14 years are entitled to informed consent without coercion. It ensures that health professionals abide by the law for better patient care.

 

 

References

Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2). https://pediatrics.aappublications.org/content/138/2/e20161484

McNary, A. (2016). Consent to treatment of minors revisited. Innovations in clinical neuroscience, 13(9-10), 53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5141597/

Neilson, G., & Chaimowitz, G. (2015). Informed consent to treatment in psychiatry. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 60(4), 1.

Pennsylvania General Assembly. (2004). 2004 act 147. The official website for the Pennsylvania General Assembly. https://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2004&sessInd=0&act=147

Roberson, A. J., & Kjervik, D. K. (2012). Adolescents' perceptions of their consent to psychiatric mental health treatment. Nursing research and practice, 2012.

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