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Running head: ETHICAL REFLECTIVE JOURNAL

Ethics and Law in Healthcare: Reflective Journal Student Name: Dermot Connolly Stenberg College Surrey BC 0312 NURS 104-3 (A) Kyle Taylor Jan 10th 2013.

ETHICAL REFLECTIVE JOURNAL

Ethics and Law in Healthcare: Reflective Journal I have noticed a recurring theme during my acute psychiatric clinical. Many involuntary patients have expressed their frustration with the mental health Act and indeed with Fraser Health over what they feel is their unlawful diagnoses and admission into a psychiatric unit. I can recall several incidents where an involuntary patient has threatened to pursue legal action against Fraser Health over this very issue. The issue of diagnoses and involuntary admission has therefore sparked several ethical issues for me. For the first time, I began to see the issue of involuntary admission from the point of view of the patient. I began to question the validity of the Mental Health Act and the power it had over the general public. As I reflect back on this now, I realize that there are several ethical issues at play. First of all, is it ethically correct for the Mental Health Act to weld such power over its patients? Secondly, involuntary admissions are largely dependant on the patient being correctly diagnosed, so what if the patient is incorrectly diagnosed as so often happens? Do they not have a right to question their diagnoses? Thirdly, the Mental Health Act itself. How valid and appropriate is it to have our lives controlled by an act that infringes on our rights and freedoms on those it is designed to protect, particularly when they have not committed a crime? When I consider the ethical issue of power and control over a patient, I am reminded of our forum discussion from week 4 where we discussed this very issue. I can recall reading Schaler who described state sanctioned psychiatry as an infringement of an individuals personal freedoms. He maintains that the innocent are presumed guilty and forced to receive medical treatment against their will. (Schaler, p21). He also maintains that the guilty are treated as

ETHICAL REFLECTIVE JOURNAL innocent through their ability to enter an insanity plea. (Schaler, p21). Referring back to the involuntary patients in my example, I am left asking, what if even one of these patients was incorrectly admitted? How successful would they be in suing Fraser Health when there is little help afforded to them by means of the Mental Health Act? This question brings me to me next ethical dilemma surrounding the BC Mental Health Act itself. I cant help but wonder how the act was drawn up. There are several components to

the act which have left me a little concerned from an ethical standpoint. Using the example of an involuntary patient, they may be involuntarily admitted following the completion of a medical certificate from a physician who does not need to be a psychiatrist. (The Mental Health Act of British Columbia, 2007). This raises some serious ethic concerns for me where a patient can be diagnosed with a mental illness from a professional who does not have a background in mental illness. The second ethical issue I have with the Mental Health Act is the use of police intervention. I am not aware if any of the involuntary patients from my clinical were apprehended by the RCMP but their involvement can represent a contradiction of responsibility between the RCMP and that of the mental health sector. The RCMP for example, has an ethical duty to protect the general public whereas the mental health sector has an ethical duty to protect the individual. (Coleman & Cotton, 2010). This poses an ethical issue on behalf of the patient when the RCMP is asked to intervene under the mental Health Act but in doing so, infringes on the rights of the patient by entering their home to apprehend him without the need for a warrant. (Coleman & Cotton, 2010). The example given above demonstrates the ethical theory of Utilitarianism where both the RCMP and the Mental Health Act work together to protect the greatest good for the greatest number of people. (Butts & Rich, 2005).

ETHICAL REFLECTIVE JOURNAL The issue of involuntary admission also triggers for me the ethical discussion on the

correct diagnoses of a mental illness. This ethical issue of incorrect diagnoses resonated with me after week nine when we discussed this topic in the forum. Attempting to diagnose a patient with a mental illness can be challenging in the absence of physical symptoms. I have sat in several care conferences in my clinical where the conditions of the patients have been discussed. I have noted that the recommendations of the psychiatrics are all that is considered when evaluating the patients condition. It may be different in other facilities, but at my clinical, the psychiatric nurses who interact and care for each patient are not invited to the care conferences. Instead they are represented by the ward manager who does not interact with the patients on a regular basis. If I were a patient, particularly an involuntary one who felt I was incorrectly diagnosed, I would find this difficult to accept. From the intakes I have seen, the patients are diagnosed following an assessment from their psychiatrist who may also consult with their DSM IV to confirm the patients symptoms. While I appreciate it can be difficult to diagnose a mental illness, this is of little consolation to the patient affected by this diagnoses. Particularly, when they are being forced to take medication for an illness they do not have. The ethics of correct diagnoses reflects the ethical theories of prima facia duties where the psychiatrist has the moral duty to perform acts that are right and just. It also relates closely with the ethical theory of virtue where the questions we ask ourselves calls our character into question. This is particularly relevant if a mental health professional realizes that a patient has being incorrectly diagnosed. (Butts & Rich, 2005). Another interesting ethical dilemma I witnessed during my clinical was splitting. I had never heard of the term before until our instructor informed us that it is the term used to define when a patient takes a member of staff into their confidence by telling them information that she

ETHICAL REFLECTIVE JOURNAL

does not wish to be shared with the rest of the staff. While I was not directly exposed to splitting, it did happen to one of the other students I was working with. During her assessment of her patient, the student was informed that the patient still had the means to kill herself in the facility if she so desired. While she appeared to be joking, this still caused quite an ethical dilemma for my fellow student who was forced to break the confidence of her patient by reporting the issue to our instructor and other members of staff. Her dilemma was confounded when she also had to assist other members of staff in confiscating personal belongings deemed to be life threatening to the patient. While the patient probably didnt realize it, both the student and staff were advocating for on her behalf. Through demonstrating concern for her care and well being, they demonstrated that her care was important to them. As I reflect on this example even now, I admire my fellow students courage in breaking her patients confidence and in my opinion demonstrated her virtue, an important ethical theory where we are governed by behavior that demonstrates our excellence of character. (Butts & Rich, 2005).

References:

ETHICAL REFLECTIVE JOURNAL Butts, J.B, & Rich, K.L. (2005). Nursing ethics, across the curriculum and into practice (2nd ed.) Jones and Bartlett. Coleman, T., G. & Cotton, D. (2010). Police interactions with persons with a mental illness:

Police learning in the environment of contemporary policing. Mental Health and the Law Advisory Committee. Mental Health Commission of Canada. Schaler, J. Freedom, Psychiatry and Responsibility. Retrieved from Resource File. http://stenbergcollege.mrooms3.net/mod/resource/view.php?id=21470 The Mental Health Act of British Columbia (2007). Vancouver Island Health Authority. Retrieved from: http://www.viha.ca/NR/rdonlyres/5CACE7D4-86ED-4403-886D387DC6A4EBF2/0/mental_health_act_learning_module.pdf

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