Patient Autonomy

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Discussion 1

Patient Autonomy Comprehensive Essay Example

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Patient autonomy is essential in mental health because it recognizes that the clients have the right to make personal health choices, including their mental health decisions.  Respect for autonomy means that clients have the right to make informed decisions about their treatment options based on their beliefs and values (Bergamin et al., 2022).  Upholding patient autonomy is important because it promotes patient-centered care where the client’s preferences and needs are at the forefront of decision-making.  The clinicians support patient autonomy in the clinical practice by providing the client information regarding their psychiatric condition, treatment options, and the risks and benefits of each one.  It is essential for clinicians to respect the client’s preferences, even if they disagree with them.  In doing so, the clinician will recognize that clients come from various cultural and individual backgrounds and consider them when discussing treatment options.  Once the clinician provides the client with all the necessary information pertaining to the treatment, the clinician will support and obtain voluntary informed consent from the client before starting any treatment. This discussion will cover information regarding ethical and legal considerations for children, adolescents, and adults.(Patient Autonomy Comprehensive Essay Example)

Patient Autonomy Comprehensive Essay Example

Ethical Considerations Related to Children and Adolescents

A research study by Farmer et al. (2020) explores the relationship between children’s motivation for physical activity (PA) and their emotional and behavioral difficulties.  Research data shows children who were more autonomously motivated to engage in PA had lower levels of emotional and behavioral problems than those who were less autonomously motivated.  When children and adolescents feel a sense of control (autonomy), competence, and connection to others (trust and rapport with clinicians), they are more likely to have the autonomous motivation to participate in the course of treatment, thus having a positive effect on the treatment outcome.  Therefore, when treating children and adolescents, I will respect patient autonomy by encouraging participation, using age-appropriate language, disclosing confidentiality, and respecting the client’s right to refuse.  If the young client refuses treatment, I will work with the parents or guardian to explore alternative treatment options to meet the client’s needs.(Patient Autonomy Comprehensive Essay Example)

Ethical Considerations Related to Adults

The article by Pons et al. (2020) contains a systematic search of observational studies that examine the ability of adults with schizophrenia, psychosis, or bipolar disorder to make autonomous decisions about their pharmacological treatment.  The literature review provides evidence that while some clients may experience difficulties in decision-making due to their psychiatric conditions, many can still make autonomous decisions with the appropriate support and information from the clinicians.  The study also highlights the importance of respecting patients’ autonomy and involving them in decision-making to ensure that their treatment aligns with their goals and values.  In doing so, the clinician must consider the specific phase of the mental disorder, the capacity of clients over time, and the severity of symptoms when treating clients with altered cognition.  The article emphasizes the need for patient-centered care in treating clients with schizophrenia, psychosis, or bipolar disorder. (Patient Autonomy Comprehensive Essay Example)

Legal Considerations for Children and Adolescents

A systematic review of cases by Bieber et al. (2020) examines the role of parental capacity for medical decision-making for young clients with psychiatric illnesses and how their refusal of recommended treatment can delay treatment and raise the concern for medical neglect. Parents and legal guardians can make health decisions for children and adolescents.  However, medical negligence may occur when parents have different views about their child’s treatment and do not follow through with the child’s best interest.   The information in this article is significant to my clinical practice as it reminds clinicians to properly evaluate parental capacity for decision-making and ensure the treatment process is patient-centered.  Some legal actions the clinician can take include documenting, consulting with the administrator, and involving child protective services if the child’s health or welfare is endangered.  Clinicians must be familiar with their state laws and regulations governing psychiatric treatment for minors and know what legal steps to take when dealing with this type of situation. (Patient Autonomy Comprehensive Essay Example)

Legal Considerations for Adults

The article by Darby and Weinstock (2018) discusses the limits of privacy in certain situations, such as when the client poses a danger to themselves or others or when there is evidence of child abuse or neglect.  In this situation, the clinician must disregard patient autonomy and legally breach confidentiality to protect the client or others.  Informed consent is a legal requirement and is essential for respecting the client’s right to make decisions for their healthcare.  Informed consent should contain clear communication regarding limitations on confidentiality before the start of any treatment.  This article is relevant to my clinical practice because it emphasizes the importance of disclosure of confidentiality and staying up-to-date on state laws and regulations surrounding mental healthcare.(Patient Autonomy Comprehensive Essay Example)

In summary, clinicians can support patient autonomy by providing clear and accurate information, encouraging client participation, considering client preferences based on cultural and individual differences, and obtaining appropriate informed consent.  Research shows upholding patient autonomy in clinical practice will provide patient-centered care, promote positive treatment outcomes, and enhance trust in the relationship between the clinician and client.(Patient Autonomy Comprehensive Essay Example)

The scholarly research journals that I have attached are considered reliable sources because they were written by experts in their field, published within five years, and are peer-reviewed.(Patient Autonomy Comprehensive Essay Example)


Bergamin, J., Luigjes, J., Kiverstein, J., Bockting, C. L., & Denys, D. (2022). Defining Autonomy in Psychiatry. Frontiers in psychiatry13, 801415. Autonomy Comprehensive Essay Example)

Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J. L., & McKean, A. J. S. (2020). The Role of Parental Capacity for Medical Decision-Making in Medical Ethics and the Care of Psychiatrically Ill Youth: Case Report.  Frontiers in psychiatry11, 559263. Autonomy Comprehensive Essay Example)

Darby, W. C., & Weinstock, R. (2018).  The Limits of Confidentiality: Informed Consent and Psychotherapy.  Focus (American Psychiatric Publishing)16(4), 395–401. Autonomy Comprehensive Essay Example)

Farmer, E., Papadopoulos, N., Emonson, C., Fuelscher, I., Pesce, C., McGillivray, J., Hyde, C., Olive, L., & Rinehart, N. (2020).  A Preliminary Investigation of the Relationship between Motivation for Physical Activity and Emotional and Behavioural Difficulties in Children Aged 8-12 Years: The Role of Autonomous Motivation.  International journal of environmental research and public health17(15), 5584. Autonomy Comprehensive Essay Example)

Pons, E. V., Salvador-Carulla, L., Calcedo-Barba, A., Paz, S., Messer, T., Paccardi, B., & Zeller, S. L. (2020). The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review.  Health science reports3(3), e179. Autonomy Comprehensive Essay Example)

Discusssion 2

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                            Involuntary Hospitalization and due Process of civil commitment

            According to Hotzy et al. (2019), involuntary admission for psychiatric treatment is an execution regulated by the law where human rights are restricted to support the patient’s recovery and keep society safe. Treatment and other interventions are provided to persons who may pose a danger to themselves or others or those who are so debilitated that they cannot adequately care for themselves (Zhong et al., 2022). During this process, a mental health professional intervenes against the patient’s will for their supposed benefit and that of society (Hotzy et al., 2019).(Patient Autonomy Comprehensive Essay Example)

            Civil commitment includes legal processes and procedures that protect persons committed from abuse of their liberties, and these laws vary from state to state (Zhong et al., 2022). The laws concerning involuntary hospitalization include strict codes about the criteria that must be met for a person to be denied the right to leave a location physically and refuse treatment (Hotzy et al., 2019). Legal expectations emphasize the requirement of dangerousness as the foundation of civil commitment criteria (Zhong et al., 2022). After meeting this criterion, the admitting clinician must provide the court with a commitment petition. According to Zhong et al. (2022), a successful commitment petition obtains a judicial order authorizing clinicians to provide involuntary treatment in a psychiatric unit that may extend into an outpatient setting if outpatient commitment is also ordered. There is a scheduled civil commitment hearing during which the state must provide clear and convincing evidence that the person in question, due to mental illness, poses a danger to self or others or cannot offer essential self-care (Zhong et al., 2022).(Patient Autonomy Comprehensive Essay Example)

            Ethical and legal considerations also relate to the involuntary hospitalization of children and adolescents. Mental Health Act permits involuntary hospitalization of adolescents deemed a risk to themselves or others due to substance abuse or other drug-induced psychosis (Goodyear et al., 2023). Involuntary hospitalization is considered necessary when it is clear that the young person cannot make healthcare-related decisions (Goodyear et al., 2023).(Patient Autonomy Comprehensive Essay Example)

            The ethical argument in favor of involuntary hospitalization often concerns the balance between the principle of beneficence and non-maleficence (Goodyear et al., 2023). Involuntary hospitalization is used as stabilization of care which provides time for the adolescent’s mental status to improve and allows providers time to formulate a care plan in collaboration with parents, caregivers, and guardians (Goodyear et al., 2023). When the effects of drug intoxication and psychosis have subsided, the adolescent is given back the right to contribute and participate in their care. Clinicians endeavor to recognize the adolescent’s decision-making capacity to foster autonomy and offer choice even during moments of crisis when they may appear incapable of participating in their care (Goodyear et al., 2023).(Patient Autonomy Comprehensive Essay Example)

            Forcing patients to receive psychiatric treatment against their wishes shapes not only the lives of individual patients but also their families, friends, first responders, clinicians, judicial authorities, and others in the community (Morris, 2020). Even though civil commitment is used in every U.S. state, its statistics and data are sporadic, limited in scope, or inaccessible to the public (Morris, 2020). Concerns regarding patient privacy cause this if these records are availed to the public. Information on involuntary commitment due process is essential in the PMHNP practice to enable clinicians to balance this process’s ethical and legal aspects. Even though the statistics on the prevalence of involuntary hospitalization due to mental illness in the USA are limited, overall, in the world, the rates are high, and clinicians need to pay attention. It is also important to note that patients can contest, and commitment petitions can be overturned in the courts of law. According to Morris (2020), research indicates that clinicians involved in civil commitment often lack knowledge about these laws. The PMHNP can also advocate for the availability of civil commitment data to enhance public understanding of these laws and reform interventions used (Morris, 2020). All articles used are peer-reviewed, educational journals and written within the past five years.(Patient Autonomy Comprehensive Essay Example)

Patient Autonomy Comprehensive Essay Example


Goodyear, T., Jenkins, E., Knight, R., Sedgemore, K., White, M., Culham, T., & Fast, D. (2023).             Autonomy and (in)capacity to consent in adolescent substance use treatment and         care. Journal of Adolescent Health72(2), 179–181.    to an external site.

Links to an external site. Hotzy, F., Marty, S., Moetteli, S., Theodoridou, A., Hoff, P., & Jaeger, M. (2019). Involuntary     admission for psychiatric treatment: Compliance with the law and legal considerations in        referring physicians with different professional backgrounds. International Journal of      Law and Psychiatry64, 142–149. to an external site.(Patient Autonomy Comprehensive Essay Example)

Morris, N. P. (2020). Detention Without Data: Public Tracking of Civil      Commitment. Psychiatric Services71(7), 741–744.    to an external site.(Patient Autonomy Comprehensive Essay Example)

Zhong, R., Moreno, A., & Wasser, T. (2023). A Proposal for the Capacity to Stipulate to Civil     Commitment and a 50-State Review of Statutes. The Journal of the American Academy o     f Psychiatry and the Law51(1), 93–102. to an external site.

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