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TitleEthical and legal issues for doctoral nursing students: a textbook for students and reference for nurse leaders
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Total Pages345
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CHAPTER 1 Ethics: What it is, What it is Not and What the Future May Bring
CHAPTER 2 Research Ethics
CHAPTER 3 Ethical Guidelines Particular to Practice
CHAPTER 4 Ethical Considerations in the Care of Vulnerable Adult Populations
CHAPTER 5 Ethical Considerations of Care and Research in Mental Health
CHAPTER 6 Ethical Considerations in the Care of Pediatric Patients
CHAPTER 7 Ethics and Women’s Health
CHAPTER 8 Ethical Business Practices Overview
CHAPTER 9 Legal Issues for Advanced Practice Registered Nurses
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Page 172

155Ethical Considerations of Care and Research in Mental Health

the notion that people with mental illness should have fair access to
opportunities to reap the benefits of research. As a social good, research
should extend in fair ways to those whose immense and costly suffer-
ing is of concern to society as a whole (National Commission for the
Protection of Human Subjects of Biomedical and Behavioral Research,
Weiss and Weiss (1999) reviewed the history of evolving ethics

guidelines for the conduct of psychiatric research, including the 1998
report of the National Bioethics Advisory Commission (NBAC), which
took an overall stance of protectiveness and placed emphasis on the
role of government regulation in safeguarding those with mental ill-
ness against exploitation in psychiatric research. The NBAC (1998)
report offered 21 specific recommendations across six categories, in-
cluding the following highlights: (a) With respect to informed consent
and decisional capacity in individuals diagnosed with mental disorders,
those who are capable of consent should be allowed to consent or re-
fuse research participation without the involvement of others and with-
out coercion. With or without decisional capacity, all conscious people
with mental illness have the right to refuse research participation, and
decisional capacity should be formally and independently assessed in
potential study participants when the research protocol presents greater
than minimal risk (Weiss and Weiss, 1999). (b) Psychiatric research
must be classified according to risk including “minimal risk,” “greater
than minimal risk with the prospect of direct medical benefit to sub-
jects,” and “greater than minimal risk that does not offer the prospect of
direct medical benefit to subjects.” Within each of these classifications,
there are stringent directives about IRB review and personal and surro-
gate informed consent (Weiss and Weiss, 1999). (c) Surrogate decision
makers have specific duties and must identify and act on the wishes of
the study participant; a ‘best interest’ standard is insufficient for con-
sent to participate in psychiatric research (Weiss and Weiss, 1999).
According to Weiss and Weiss (1999), the NBAC report, which rec-

ommended a moratorium on research with participants with impaired
decisional capacity, had significant drawbacks that derived from five
principal problems including: (a) insufficient awareness of the subtle,
widely varying, and fluctuating clinical features of psychiatric disor-
ders; (b) insufficient recognition of the immense societal impact of
mental illness and the pressing need for research to address it; (c) insuf-
ficient respect for the autonomy and personhood of people with mental
illness; (d) insufficient awareness of the practical dimensions of the sci-
entific context; and (e) insufficient integration of existing ethics data on
psychiatric research (Weiss and Weiss, 1999).

Page 173

Ethical and Legal Issues for Doctoral Nursing Students156

Overall, people with mental illness are capable of informed consent

cally ill and healthy populations because the symptoms of mental ill-
ness can adversely affect the information-based, cognitive aspects of

values, motivations, and context may affect research enrollment deci-

little is known about the effectiveness of ethical safeguards in protect-
ing human research participants. In mental health research, much more
education about ethics is needed in the areas of regulatory requirements,
the role of the IRB in psychiatric research, differences between clini-


and selection, symptom-provoking studies, medication-free research,
placebo-controlled clinical trials, genetics studies, better protection of
participants during research participation, relationships between patient

industry-sponsored research, and psychiatric research with children and

Much of the current controversy surrounding psychiatric research

medications for clinical trials, which provokes symptoms and can com-

lo, and Fegert, 2010; Rosenstein et al.

The latter is a particularly charged issue. Children and adolescents
with psychiatric disorders are doubly vulnerable by virtue of both their
mental disorder and the fact of being children with a developmental
status that entails normal dependency and limited decisional capacity.
Along with the historical reluctance of researchers to expose children
and adolescents to unnecessary risk during research trials, their pro-

ness, safety, and pharmacokinetics of psychotropic drugs in children

wanting to keep potentially helpful treatments away from children and
adolescents who suffer from severe psychiatric symptoms, clinicians
may treat pediatric patients by prescribing psychotropic medications

Page 344


LACE model, 282–283
Linares Case, 187–188
Litigation, 288–289
Logical reasoning, 19

Maimonides, 4
Malpractice, 288–289
Managed care, 258–262
Managed care, AMA statements,

Managed care and insurance, 181–184
Managed care in mental health, 149
Marketing, 262–265
Maternal-Fetal conflict, 191–192
Medicaid, 113
Medicare and Medicaid, 290
Medical futility, 95
Medical nutrition, 94
Mental health, 130
Mentorship, 48
Messenger case, 187–188
Methodological pluralism, 151
Military, 119
Mill, 6, 7
Model of Culturally Proficient and Ethi-

cal Practice, 108
Model of vulnerability, 107
Morality, 2
Moral absolutists, 223
Moral certainty, 85
Moral Imperative, 5
Morals, 2
Motherhood, safe, 226–227

National Bioethics Advisory Commis-
sion, 155

National Council of State Boards of
Nurses, 282–283

National Council of State Boards of
Nurses Consensus Model, 285

National Council of State Boards of
Nurses scope of practice, 285–286

National Council of State Boards of
Nurses state role in practice,

National Commission for the Protection
of Human Subjects of Biomedical
and Behavioral Research, 116

National Provider Identifier, 255

National Research Act, 36, 116
Neonates and withdrawal of treatment,

Neuroethics, 2, 16
Newborn screening, 192–195
NICU, 173
Nightingale Pledge, 13
NIH Revitalization Act, 47
Non-disclosure of diagnosis, pediatrics,

Nonmaleficence, 13, 81, 174
Normative ethics, 2
Nuremberg Code, 8, 34, 106, 116, 135,

Nuremberg Trials, 7, 23
Nursing ethics, 139
Nussbaum, 14

Office for Human Research Protections,

On Being A Scientist, 73
Opt-out of newborn testing, 194
Ordinary and extraordinary care distinc-

tion, 23, 93

Palliative care, 92, 190, 206–208
Parental authority, 176, 188
Paternalism, 12, 85, 121
Patient management conflicts, 184–188
Patient rights, 47
Patient Self-Determination Act, 120,

Pediatric patient decision making, 177
Pediatric patient outcome estimators,

Personal health information, 48, 50, 51
Personal Responsibility and Work Op-

portunity Reconciliation, Act, 112
Personal self, 146
Personhood, 222–223
Piaget stages, 177
PKU testing, 192
Preferential treatment and moral distress,

Pragmatic ethics, 2
Premature infants, 173
Prescription conflicts, 182–183
Preterm infant viability decisions,

Principle of Totality, 3, 4

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Ethical and Legal Issues for Doctoral Nursing Students328

Prisoners, 115
Privileged communication, 152
Professional authority, 185
Professional ethics, 131
Provisional nature of psychiatric expla-

nation, 151
Psychiatric-mental health ethics, 131
Public Health, 224–225

Quality improvement, 41
Qualitative methods, 64

Radden, 146
Rationing of care, 182, 258
Reducio ad absurdum, 21
Refusal of care, 178–180
Reimbursement, 259
Religion, 20
Reproductive health, 225–226
Research ethics, 33, 212–213
Research misconduct, 67
Resources, allocation of, 256–258
Risk management, 265–267

Romans, 3
Ross, 16
Royal College of Nursing, 64

Sadler, 147
Sarbanes-Oxley, 252–253

Scope of practice, 285–288
Self referral, 245–246
Shi and Stevens, 108
Singer, 11
Slippery slope, 22
Social determinants of health, 114
Social media, 210–211

Soon, 17
Speaker disclosure, 71
Special needs, 202
Stakeholder issues, 267–269
Stark laws, 245, 291–292
State regulations of advanced practice,

Sterilization, 210
Stigma, 146
Stinson case, 187
Surowiecki, 86
Surrogacy, 88, 90
Surrogate decision makers, 187

Termination of care, 197–199
Therapeutic misperception, 58
Therapeutic relationships, 142
Transparency, 269–272
Treatment pressures, 142
Trossman, 118
Tuskegee syphilis study, 35

Unauthorized residents, 110
Utilitarianism, 2, 6, 7

Vaccine refusal, 195–199
Vacco v. Quill, 25
Veracity, 15, 83
Virtue ethics, 2
Vulnerable populations, 56, 57, 103
Vulnerable populations conceptual

model, 108

Weiss, 155
Willowbrook State School, 35
Withholding and withdrawing, 23, 24,

91, 188
WHO, 56, 114

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