ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE POST 2 WEEK 2 DISCUSSIONS – Initial Post

 

JUSTICE

After reading Just Mercy, I understood the meaning of justice as not being limited to the judiciary system and all the attending laws but the hope that the system can and will work equally for everyone (Stevenson, 2014), age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status (“Ethical Principles of Psychologists and Code of Conduct,” n.d.) notwithstanding. This is the essence of the Ethical Principles of Psychologists and Code of Conduct (Principle D). The principle of Justice, as noted by the Code of Conduct, is geared towards ensuring fairness and equitable access to competent psychiatric care for all. The other principles (Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, and Respect for People’s Rights and Dignity) make sense in a paradigm where fairness and access is available to ensure that no harm is done, and patients are able to trust their providers (therapeutic alliance) to provide confidential and culturally sensitive evidence-supported care.

Ethical Considerations for Adults

While factors like income security, comorbid health conditions, the need for long-term care, nutrition, housing, abuse, neglect, and age discrimination are some of the ethical issues impacting care for the elderly, the issue of ethical considerations has loomed large in the area of consenting for genetic testing for this population. Lawrie et al. (2019) noted that early detection has not been linked to greater efficacy of treatment. However, they also note that the ethical considerations here are confidentiality, communicating, and sharing of research findings. On the issue of communication, they note that stigma associated with mental illness is a barrier to both delivering the result to the patient/family and disseminating pertinent significant research findings to the provider community. These considerations also apply to children and adolescents as parental consent are required – sometimes by adolescent patients deferring to parents and/or legal guardians, in most cases, to carry out research.

Ethical Considerations for children/adolescents

Adolescence is a period rife with gender issues and emerging gender identity. Kimberly et al. (2018) noted a disparity in the treatment outcomes of cisgender youths and youths with gender dysphoria. The authors urge for a more cautious approach to ensure access and equitable care for this population. Specifically, they advocate for ethical considerations for this population to be gender-affirming and tailored to achieve optimal treatment outcomes (beneficence), with minimal harm (nonmaleficence). The ethical considerations should have a focused treatment plan that supports autonomy for even children during times of rapid development with an emphasis on justice to provide that hope for the future with assured access to care.

Legal Considerations for Adults

As noted above, income security, health care decisions, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination are some of the factors that come with adulthood and become even more significant with age. Bipeta (2019) cautions that the mentally ill have the same right as everyone else and must be treated with respect to the principles enshrined in the Code of Ethics ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE. He warns of the need to treat each patient as a legal entity by understanding the unique aspects of each individual patient. He also recommends patience and learning over time for the practitioner to ensure that no harm comes to the patient in the process of care delivery to a mentally impaired patient.

Legal Considerations for Children/Adolescents

The issue of informed consent also looms large in caring for minors. Levin et al. (2022) note barriers to these include erroneous and biased professional assumptions, and inadequate initial assessments, which may lead to a paucity of information shared with the patients and their parents. They note that this is especially so with the gender dysphoric patient. At work, I noted that some children/adolescents have consented to treatment but have not shared their preferred gender identity with their parents/legal guardians. This limits the provider’s ability to share with the parents. According to Levin et al. (2019), this disagreement or disconnection from parents is a legal barrier to care. They also note that the presence of mental health problems may impair cognition and creates doubt about the minor’s ability to understand and be informed enough to consent to care.

Application to Clinical Practice in Co

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