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1. Legal and ethical aspects of
psychiatric patient
Prepared by
Dr. Eman Elsayed Bauomey
Lecturer of Psychiatric/ Mental Health Nursing

2. O B J E C T I V E S
At the end of this lecture, each student will be
able to:
• Differentiate between ethics, morals.
• Describe ethical issues relevant to
psychiatric/mental health nursing.
• List Bill of Rights for Psychiatric Patients.
• Differentiate between Restraints and Seclusion

3. Definition of ethics, morals
• Ethics is a set of moral principles and a
code for behavior that govern an
individual’s actions with other individuals
and within society.
• Morality is what people believe to be right
and good, while ethics is a critical
reflection about morality.

4. Ethical Principles
Ethical principles are fundamental guidelines
that influence decision-making. The ethical
principles of autonomy ‫الحكم‬
‫الذاتي‬ , beneficence
‫اإلحسان‬, veracity ‫الصدق‬, and justice ‫العدالة‬are
helpful and used frequently by health care
workers to assist with ethical decision-making.

5. Bill of Rights for Psychiatric Patients
1. The right to appropriate treatment and related
services
in the setting that is most supportive and least restrictive
to personal freedom.
2. The right to an individualized, written treatment or
service plan; the right to treatment based on such a
plan; and the right to periodic review and revision of
the plan based on treatment needs.
3. The right, consistent with one’s capabilities, to
participate in and receive a reasonable explanation of
the care and treatment process.

6. Bill of Rights for Psychiatric Patients
4.The right to refuse treatment except in an emergency
situation or as permitted by law.
5. The right not to participate in experimentation in the
absence of informed, voluntary, written consent.
6. The right to freedom from restraint or seclusion except in
an emergency situation.
7. The right to a humane treatment environment that
protect from harm and appropriate privacy.

7. Bill of Rights for Psychiatric Patients
8.The right to confidentiality of medical records
9. The right of access to medical records .
10. The right of access to use of the telephone,
personal mail, and visitors, unless deemed
inappropriate for treatment purposes.

8. Bill of Rights for Psychiatric Patients
11.The right to be informed of these rights in
comprehensible language.
12. The right to assert grievances ‫َكاوي‬‫ش‬‫ال‬ if rights
are infringed ‫ف‬َ‫ل‬‫َا‬‫خ‬ُ‫م‬.
13. The right to referral as appropriate to other
providers of mental health services upon
discharge.

9. Legal Issues in Psychiatric/ Mental Health
Nursing Confidentiality and Right to
Privacy
Most statutes ‫القوانين‬protecting the
confidentiality of client records and
communications. The only individuals who
have a right to observe a client or have access
to medical information are those involved in
his or her medical care.

10. Protected Health Information
(PHI): Individually Identifiable Indicators
• Names
• Postal address information (except state),
including street address, city, county.
• All elements of dates (except year) for dates
directly related to an individual, including
birth date, admission date, discharge date,
date of death

11. Protected Health Information
(PHI): Individually Identifiable Indicators
• Telephone numbers
• Fax numbers
• Electronic mail addresses
• Medical record numbers
• Health plan beneficiary numbers
• Account numbers
• Certificate/license numbers

12. Informed Consent ‫لعة‬ّ‫ط‬‫الم‬ ‫الموافقة‬
According to law, all individuals have the right to
decide whether to accept or reject treatment.
The rationale for the doctrine of informed
consent is the preservation and protection of
individual autonomy in determining what will
and will not happen to the person’s body .

13. Informed consent
Informed consent is a client’s permission
granted to a physician to perform a
therapeutic procedure, before which
information about the procedure has been
presented to the client with adequate time
given for consideration about risk.

14. There are some conditions under which treatment
may be performed without obtaining informed
consent
When a client is mentally incompetent to make a
decision and treatment is necessary to preserve
life .
When refusing treatment endangers ‫للخطر‬ ُ‫ض‬ّ‫عر‬
the life
 During an emergency, in which a client is in no
condition to judgment.

15. There are some conditions under which treatment
may be performed without obtaining informed
consent
When the client is a child (consent is obtained
from parent).
In the case of therapeutic privilege. In
therapeutic privilege, information about a
treatment may be withheld َ‫جب‬َ‫ح‬if the
physician can show that full disclosure would
hinder ْ‫أعق‬or complicate necessary treatment,
cause severe psychological harm.

16. Restraints ‫يود‬َ‫ق‬‫ال‬ and Seclusion ‫العزل‬
In psychiatry, the term restraints generally refers to
a set of leather straps ‫الجلدية‬ ‫األشرطة‬that are used
to restrain the extremities of an individual whose
behavior is out of control and who poses an
inherent risk to the physical safety and
psychological well-being of the individual and
staff

17. Restraints
Restraints are never to be used as punishment
or for the convenience ‫الراحة‬ of staff. Other
measures to decrease agitation, such as
“talking down” (verbal intervention) and
chemical restraints (tranquilizing medication)
are usually tried first.
If these interventions are ineffective,
mechanical restraints may be instituted.

18. Seclusion
Seclusion is another type of physical restraint
in which the client is confined alone in a
room from which he or she is unable to
leave. The room is usually minimally
furnished with items to promote the client’s
comfort and safety.

19. Use of Restraints
Restraint chair – diagram

20. Use of Restraints

21. Use of Restraints
Restraint Jacket

22. Use of Restraints

23. Use of Restraints`1``
Restraint Jacket

24. Guidelines for Restraints
• Preferably five or a minimum of four persons
should be used to restrain the patient.
• Explain to the patient why he or she is going
into restraints.
• A staff member should always be visible and
reassuring the patient who is being restrained.

25. Guidelines for Restraints
• After the patient is under control, restraint at
a time should be removed at 5-minute
intervals.
• Always thoroughly document the reason for
the restraints, the course of treatment, and
the patient's response to treatment while in
restraints.