psy

1. Informed consent
 Given when pt with mental illness needs
any surgery or ECT,
◦ Will obtain from
 Patient himself or herself
 Relative or guardian
 2 psychiatrists
 Include :
◦ Diagnosis
◦ Identification of procedures
◦ Risks expected
◦ Any alternative procedures
◦ Offer to answer any inquiries
◦ Can discontinue without prejudice
◦ Prognosis

2.  Duty to inform patient or relatives
◦ About which provision of the Mental Act
2001 to be detained
◦ The effect of the provision
◦ What rights to refuse treatment
 Exceptions to rules of informed consent
◦ Emergency
 Require immediate intervention
 to prevent death or serious harm to pt or other ppl
 to prevent deterioration of pt’s clinical state
◦ Therapeutic privilege
 Info from psychiatrist that may harm the pt or be
an antitherapeutic

3. Child custody
 The action of a court in a child-custody
dispute is predicated on the child’s
interests.
 However, the courts presume that the
welfare of a child of tender years generally
best served by maternal custody.
 Task of psychiatrist is to provide expert
opinion and supporting data
 Mental disability parent can cz transfer of
custody to another parent or agency
 Will terminate parent’s right if chronic

4. Testamentary and contractual
capacity and competence
 Mental competence
◦ Ability to perform certain function for particular
legal purpose
 Contracts
◦ Contractual capacity
 Wills
◦ Testator know
 Nature of act
 Nature and extent of property
 Heirs, relatives’ claims on patient
 Marriage

5. Testamentary and contractual
capacity and competence
 Guardianships
◦ Whether can manage affairs or not
 Durable power of attorney
◦ To permit patient
 Make provisions for their anticipated loss of
decision-making capacity
 Advance selection of substitute decision maker
 Competence to inform
◦ Risks and benefits of withholding information
about suicidal or homicidal intent

6. Worker’s compensation
 A psychiatrist is often called to do evaluation.
 The stresses of employment can cause/
accentuate mental illness.
 Pts are entitles to be compensated
◦ for their job-related disabilities
◦ to receive disability retirement benefits.

7. Criminal law
 Competence to stand trial
◦ a test of competence that seeks to
ascertain whether a criminal defendant
“has sufficient present ability to consult with
his lawyer with a reasonable degree of
rational understanding & whether he has a
rational as well as factual understanding of
the proceedings against him”.
◦ Criteria
 Whether understand charges against him or her
 Whether can assist in his or her defense

8. Criminal law
 Competence to be executed
◦ Requirements based on 3 general
principles
 Aware of what is happening is supposed to get
punished
 Competent person believed that peace is
appropriate for religious beliefs (including
confession and absolution)
 Competent person recall a forgotten detail of
event or crime proven exonerating

9. Criminal law
 Criminal responsibility
◦ Criteria whether at the time of act due to
mental disorder, defendant
 Did not know what is doing or the action is
wrong (cognitive test)
 Could not confirm the conduct to requirements
of law (volitional test)

10. Criminal law
 Criminal responsibility
◦ M’Naghten rule (right-wrong test)
 This rule holds that persons are not guilty by reason of
insanity if they labored under a mental disease such that
they were unaware of the nature, the quality, the
consequences of their acts.
◦ Irresistible impulse
 Person charged with an offense is not responsible for an
act, if the act was committed under an impulse that the
person was unable to resist because of mental disease.
◦ Model Penal Code
 Persons are not responsible for criminal conduct if, at the
time of such conduct, as a result of mental disease/defect,
they lacked substantial capacity either to appreciate the
criminality (wrongfulness) of their conduct/ to conform their
conduct to the requirement of the law.
◦ Durham Rule
 The accused is not criminally responsible if the unlawful act
was the product of mental illness or mental defect.

11. Guilty but mentally ill:
1. This verdict is available to the jury if the
defendant pleads not guilty by reason of
insanity.
2. 4 possible outcomes:
-not guilty
-not guilty by reason of insanity
-guilty but mentally ill*
-guilty
* The convicted person is still sentenced but
he should receive psychiatric tx at the same
time.

12. According to CPC
 Medical Director shall prepare a medical report and it
will be given to the courts as requested in the order
(without consent of the patient)(usually routinely)
 Admit patient if required
 Treatment given should be multimodal and may
include pharmacotherapy and psychosocial therapies.
 Management should comprise comprehensive
assessment and treated through a multidisciplinary
team approach wherever possible

13. •If there is significant evidence to establish that a
defendant or suspect has a significant mental
illness, a prosecution may not be appropriate
unless the offence is serious or there is a real
possibility that it may be repeated.
•The procedure has two stages:
- Whether the offender is under a disability i.e.
whether he is unfit to plead (section 4
Criminal
Procedure (Insanity( Act 1964);
- Whether he did the act or made the omission
charged against him (Section 4A of the
above
act)

14. Civil Liability
1. Psychiatrists who sexually exploit their pts are
subject to civil & criminal actions
2. Legal & ethical consequences of sexual
exploitation:
- Civil lawsuit ( negligence, loss of consortium)
- Breach-of-contract action
- Criminal sanctions (e.g statutory, adultery,
sexual assault)
- Civil action for intentional tort (e.g battery, fraud)
- License revocation
- Ethical sanctions
- Dismissal from professional organizations

15. references
 Kaplan & Sadock’s Synopsis of
psychiatry 10th edition
 Mental Health Commission,
2009. Code of practice on the use of
physical restraint in approved centres.
Mental Health Commission.