Legal and Ethical Issues in Mental Health


A 17 year old male client in an inpatient psychiatric unit is being uncooperative. The client is standing in front of the nursing station, where the nurse answers incoming phone calls and discusses patient care with the treatment team. The nurse kindly asks the client to return to the dayroom and join the rest of patients for group. However the client says, “No, I am perfectly fine where I am.” A staff member observes the situation and steps in and states, “you need to go to group now, or we will have to escort you to the quietroom.” The client looks at the staff member and says in a calm tone, “you can’t make me move, I am not doing anything wrong.” The nurse realizes this situation is escalating and is stuck between a rock and a hard place. Please consider all the details provided above and answer the following questions:
1. What does the principle of the least restrictive environment have to do with this situation?

2. What role does HIPAA play in this scenario and why does it make the situation more complicated?

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3. Which nurse would be more likely to initiate a restrictive intervention for this client, a nurse with a utilitarianism view of ethics or a deontological view of ethics? And why?

4. Finally, how would you resolve this situation?

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