Psychiatric Mental Health Practices Ethics and Dilemmas

Psychiatric Mental Health Practices Ethics and Dilemmas

Review literature for moral/ethical issues encountered by a PMHNP.
Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment
Summarize the moral/ethical issue in the article (no more than 1 paragraph).
Describe the moral and ethical dilemmas surrounding the issue.
Analyze the ethical issue and compare them to the state health laws and regulations in your state.
Outline the process of ethical decision making you would use to address this ethical dilemma.


Psychiatric Mental Health Practices Ethics and Dilemmas

A summary of an ethical issue in the article

“Hem, M., Molewijk, B., Gjerberg, E., Lillemoen, L., & Pedersen, R. (2018). The significance of ethics reflection groups in mental health care: a focus group study among health care professionals. BMC Medical Ethics, 19 (1):54”.

Coercive treatment is a prominent ethical issue that professions in psychiatric mental health practices face. Over the past years, the utilization of coercion in psychiatric services has gained increasing attention and raised some of the utmost hard ethical issues. The usage of coercion threatens the autonomy of the patient. It can cause both physical and psychological harm and it as well threatens the perception of healthcare professionals of what entails good treatment and care. Generally, coercion is used to assist the patient. Nevertheless, it might also be utilized to safeguard others or be misapplied by healthcare professionals. Thus, the usage of coercion is an intricate ethical enterprise Psychiatric Mental Health Practices Ethics and Dilemmas.

Ethical and moral issues surrounding the use of coercion

There are several different ethical challenges connected to the usage of coercion.  As Norvoll et al (2018) indicate, coercion entails professionals overriding apparent autonomy of patients, with resultant ethical implications. The serious impacts of coercion on a patient’s liberty and autonomy make coercion an innately value-laden action.  The most significant justification for coercion is that it is aimed at promoting the well-being and best interest of the patient. As Hem et al (2018) allege, the usual argument is that coercive care and treatment might improve the health of the patient or that failure of not doing what is viewed as safe or good can cause impairment. Psychiatric Mental Health Practices Ethics and Dilemmas. This line of thinking presumes that a patient’s best inters is thoroughly evaluated and carefully considered when applying coercion.

How to balance between nonmaleficence and beneficence when using coercion is a major ethical dilemma because it entails balancing between inflicting harm(nonmaleficence) and promoting good. For instance, restraints lessen the risk of physical harm to the patient but they have an adverse effect resulting in humiliation, fear, anger, embarrassment, and powerlessness. Practitioners are also faced with the ethical dilemma of balancing between the patient’s best interest and the safety of hospital staff and other patients (Hem et al, 2018). According to Steinert (2017), if practices that restrict liberty, like involuntary detention and inpatient treatment or seclusion becomes essential due to dangerous behavior, there is a likelihood of severe deterioration of psychosocial health. Averting such an outcome may be regarded as acting in the best interest of the patient’s well-being. Therefore, treating a patient against her or his will is justifiable as being beneficent to the patient if the aim is to avert long-term constraint of his freedom and if this restriction isn’t merely a hypothetical possibility Psychiatric Mental Health Practices Ethics and Dilemmas.

An analysis of the ethical issue and its comparison to Indiana state laws and regulations

Legislation exists in the majority of states to allow for coercion and involuntary treatment of individuals who are considered to be ill and at danger. The civil commitment laws are a mechanism to coerce a person to undergo outpatient treatment of psychiatric hospitalization. AS Cautin and Lilienfeld (2015) assert, civil commitment might transpire only after a court determines that a person is suffering from a statutorily needed level of mental condition and probably associated conditions.  Typically, a court orders civil commitment when the involved person is unable to voluntarily consent to treatment. Psychiatric Mental Health Practices Ethics and Dilemmas. Like other states, Indiana has civil commitment laws that determine the criterion establishing when involuntary care or treatment is suitable severely mentally ill patients who cannot voluntarily seek care. Indiana state laws permit for inpatient treatment and assisted outpatient treatment.

Ethical decision process

As a PMHNP, I might address the ethical dilemma of the use of coercion by evaluating the patient’s decisional capacity and the best interest of the patient. If the capacity of the patient to make rational choices is hindered, I may respect the autonomy of the patient by involving his relatives to make decisions on behalf of the patient or offer any pertinent information that they possess about the possible preferences of the patient. As Baruth and Lapid (2017) allege, discussions with healthcare team and family are key in making a determination of patient values that apprise medical decision making. Information from other healthcare professionals and family are useful in supporting conclusions when establishing capacity, and can also be valuable to a proxy or surrogate decisionmaker when the patient is considered to not to have decisional capacity. Psychiatric Mental Health Practices Ethics and Dilemmas.



Baruth, J., & Lapid, N. (2017) Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal. AMA Journal of Ethics, 19(5): 416-425.

Cautin, R., & Lilienfeld, S.  (2015). The Encyclopedia of Clinical Psychology, 5Volume Set. New York:  John Wiley &  Sons

Hem, M., Gjerberg, E., Husum, T., & Pedersen, R. (2018). Ethical Challenges when using coercion in mental healthcare: a systematic literature review. Nursing Ethics, 25(1): 92-110.

Norvoll, R., & Hem, M., Pedersen, R. (2016). The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care. HEC Forum, 29(1): 59-74.

Steinert, T.  (2017). Ethics of Coercive Treatment and Misuse of Psychiatry. Psychiatric Services, 68(3): 291-294. Psychiatric Mental Health Practices Ethics and Dilemmas.

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