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Basics of Eating Disorders
Published in Wayne A. Bowers, Civil Commitment in the Treatment of Eating Disorders, 2018
When the behavior of these patients endangers their lives, they will usually be committable under grave disability standards (Goldner, McKenzie, & Kline, 1991, Goldner, 1989, Goldner, Birmingham, & Smye, 1997). There is a consensus that involuntary commitment should be used as an approach of last resort, when patients decline voluntary hospitalization and their physical safety is at risk. Civil commitment should probably also be limited to circumstances in which therapeutic gain is likely from hospitalization (APA, 2006). Safeguarding the individual can become paramount and coercion can be seen as legitimate instrument to restore health that is in the individual’s best interest (Tan et al., 2003). Goldner (1989) offers a view of treatment refusal that suggests that clinicians may need to refuse treatment in exceptional cases as an “ultimatum” to provide a confrontation regarding the lack of collaboration in the treatment.
Comparative analysis and future health care decision-making
Published in Roger Worthington, Robert Rohrbaugh, Health Policy and Ethics, 2017
Roger Worthington, Robert Rohrbaugh
In China, specific health policy and law may be either lacking or rarely enforced, and since so many changes have come about recently there is little precedent to guide health service providers and administrators. For example, there is no central and little provincial-level law or health policy directed towards care of the mentally ill. This means there is no consistent means for adjudicating difficult issues like involuntary commitment to a hospital for treatment, criminal responsibility while mentally ill, or the appointment of an individual to act in one’s stead for financial or personal decision-making when mentally ill.
Ethics: mental health–substance use
Published in David B Cooper, Introduction to Mental Health–Substance Use, 2017
Questions of confidentiality highlight the function of the law in mental health and substance use ethics. Much more than in other areas of medical care, professionals will frequently find that legal considerations impact clinical-ethics decisions. Specific areas of interface include: ➤ involuntary commitment for mental health–substance use treatment for danger to self, other or grave passive neglect➤ treatment refusal➤ the role of coercion in mandating treatment➤ treatment guardians, surrogates and conservators➤ criminal justice involvement, such as adjudication, parole, probation, mental health courts➤ workplace drug testing➤ legal obligation to report child and incompetent elder abuse➤ need to violate confidentiality to intervene in threats of suicide or homicide (Tarasoffprotections).7
Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?
Published in The American Journal of Bioethics, 2019
Brent M. Kious, Margaret (Peggy) Battin
The problem with this objection, though, is that psychiatry as it is currently practiced does not generally require an assessment of whether the suicidal person is acting impulsively or unreasonably to justify its interventions. Being suicidal in the context of a mental illness per se is enough. Again, most involuntary commitment laws in the United States ask only whether the person with mental illness is at risk of harming herself before allowing her civil commitment. We would also point out that, in practice, the more persistent a patient’s suicidal motives are, and the more considered or premeditated her plan for suicide, the more alarming her clinical condition tends to be, and the more likely she is to receive an involuntary commitment in order to prevent her suicide, if commitment has been sought. Thus it is also the desire to kill oneself because of one’s suffering, and not merely the matter of whether one’s actions are impulsive or poorly reasoned, that is held to justify involuntary commitment procedures.
Subjectivity as “evidence”: an exploration of medication adherence in the treatment of schizophrenia using in-depth interviews
Published in Journal of Progressive Human Services, 2019
In the ACT manual, these interventions (therapeutic limit setting) are “influencing tactics” which necessarily limit the consumer’s self-determination. In addition to “interpersonal pressures” and “leveraging access to money or housing against treatment participation,” ACT may include involuntary commitment to treatment. According to state law where this study took place, legal criteria for involuntary commitment require the individual to present a “clear and present danger” to self or others. Commitments were discussed casually in the clinical setting and occurred frequently to the ACT consumers I’ve met. Having no previous exposure to the system of treating schizophrenia, my impression based on the perfunctory attitude of staff was that the practice is just another “influencing tactic” to encourage compliance, albeit for more difficult situations.
Decision-Making Capacity Will Have a Limited Effect on Civil Commitment Practices
Published in The American Journal of Bioethics, 2019
Rocksheng Zhong, Dominic A. Sisti, Jason Karlawish
Civil commitment typically begins with an emergency hold. Although parameters vary by jurisdiction, all states enable some combination of mental health practitioners, law enforcement personnel, or concerned members of the community to request that a person be involuntarily detained for emergency psychiatric evaluation (Hedman et al. 2016). Evaluations usually occur in hospital emergency rooms, and if the evaluator determines that the person meets criteria for involuntary commitment, the person is admitted and placed in a psychiatric hospital or unit. This emergency hold usually lasts a few days (the most common duration is 3 days), at which point a formal court hearing must determine whether further hospitalization is appropriate (Hedman et al. 2016).