This is a written summary of a case study that will encompass the legal and ethical theory along with the professional codes, standards and guidelines that are relevant to the case study. The case study is of a patient, named Victoria who is a 67 year old woman that belongs to the Polish descent. The patient has been reported with some unusual psychological behaviors because of which she was assessed by the team of community mental health services and later on admitted to the hospital settings. The ethical and legal implications and all the other aspects in this assessment would be based on the care interventions received by the patient and the decision of the healthcare professionals in the case scenario.
Mental health legislation has been implemented in order to ensure a regulatory framework for the mental health services along with the healthcare providers of the treatment and care so that the individuals with a mental illness are assured of the afforded protection from the mental illness and its consequences (Ayano, 2020). There are specifically two pieces of the legislation that administer how the individuals with the mental health conditions will receive their care and treatment. Similarly, these two key legislations in case of Victoria would be there and they are The Mental Health Act 1983 and the Mental Capacity Act 2005 (Szelepet, 2018).
The Mental Health Act helps in setting out how an individual with mental health illness can be admitted, detained and treated in the hospital settings against his choice. But, it should ensure the patients' rights to be upheld. The treatment must follow the Mental Health Act along with the standards and safeguards that place out in code of practice. For Victoria the acquiescence with all the needs of the Act along with the safeguards should be monitored carefully by the care quality commission. While, The Mental Capacity Act will allow someone else to take the legal authority of making a decision on the behalf of an individual who lacks the capacity in making the decision for themselves (NHS, n.d.).
The ethical issues or theories that are relevant to Victoria’s case scenario are autonomy, beneficence, and nonmaleficence. According to Valero, (2019) autonomy of the patient is their right of being acknowledged and respected in terms of decision making as it is the right of the patient to be treated the way he/she wants to get treated. However, in case of patients such as Victoria with mental health illness they do not have the right to take their decisions and their consent is not even considered (Levinsson, Kjellin & Ostman, 2016). The other ethical consideration here would be the beneficence and nonmaleficence. Beneficence could be understood as the implicating such measures that will benefit the patients. The patients with mental health illness often pose certain life-threatening danger to themselves as well as to others also as they do not have the ability make appropriate decisions individually. However, in general cases consent is taken from the patient but, in case of an individual with mental health illness beneficence is by implicating the interventions that is conducted without the consent of the patient but, it is for their benefit only (Ye et al., 2018). Similarly, happened in Victoria’s case where the sedation was given to her without her consent only for her own benefit so that she could not cause any harm to herself. Nonmaleficence. Non-maleficence means causing no harm to the patient. In this the health-care providers balances the therapeutic goals and the possible side effects (Ye et al., 2018). Ethical decision making is considered as ethical dilemma when it comes to the patient with some mental disorder. Such patients lacks in the capacity to take decisions for them. There are actually two type of patients with mental disorders, one are those for which the shared decision making could be done and the other are those for whom it seems risky and challenging as they are unable to make decisions on their own. In such case patient’s family is involved and if they are also not present then the clinicians or the health care professionals can take the decision.
In case of Victoria, it has been mentioned that she is a widow and her husband died 10 years ago. She is now living alone though she has four children and all of them are settled up with their wives and they meet sometimes. So, for decision making process regarding Victoria the healthcare professionals could take consent from her children. But, the situation was such that things were going out of control and there was a need to take spontaneous decision and waiting for their children’s approval would have taken a long time. If the professionals would have waited then, might have harmed either herself or someone else. In order to avoid this taking decision as per the ordered phone call and taking the decision to give her an intramuscular sedation was an ethical decision.
From the whole scenario, it could be concluded that for the patients with mental illness the actions should be taken as per the legislations. The key legislations involved in this are The Mental Health Act and the Mental Capacity Act. It also has to be understood that it is very important to take an account on ethical considerations. Though, all the ethical principles such as autonomy, beneficence, nonmaleficence, and justice should be considered but, in this specific case scenario; autonomy, beneficence, and nonmaleficence are being focused. From the case scenario it has also been understood that the health professionals play a major role in decision making when it comes to the patient with mental health disorder. Ethical decision making is a very crucial aspect in healthcare and it is very important to take the decision in the benefit of the patient as in such cases healthcare professionals have all the accountability and is answerable for everything. This is so because, the patient is not in state of taking decision of her neither she has the ability and at times when there is a delay from family’s end then, everything is up to the healthcare professionals. However, they do so by focusing on the legislations.
Ayano G. (2018). Significance of mental health legislation for successful primary care for mental health and community mental health services: A review. African Journal of Primary Health Care & Family Medicine, 10(1), e1–e4. https://doi.org/10.4102/phcfm.v10i1.1429
Levinsson H, Kjellin L, Östman M (2016) Autonomy and severe mental illness: The relationship between social network and functioning. SOJ Nursing and Health Care 2(2): 1-5. http://dx.doi.org/10.15226/2471-6529/2/2/00118
NHS. (n.d.). Mental health legislation. Retrieved from http://www.awp.nhs.uk/advice-support/legislation/#:~:text=There%20are%20two%20specific%20pieces,the%20Deprivation%20of%20Liberty%20Safeguards.
Szelepet, E. M. (2018). The Mental Capacity Act 2005 best interests test as applied to the elderly – is it fit for purpose? Medico-Legal Journal, 86(3), 142–146. https://doi.org/10.1177/0025817217749521
Valero, A. I. (2019). Autonomies in interaction: Dimensions of patient autonomy and non-adherence to treatment. Frontiers in Psychology, 10, 1857. https://doi.org/10.3389/fpsyg.2019.01857
Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2017). Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 5(1), 68–71. https://doi.org/10.1016/j.ijnss.2017.12.001
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