Describe patients' rights, the civil commitment laws and the clinician's duty to warn. Do you agree or disagree with any of the procedures for them?How do the five influences that must be considered of any psychological disorder effect these decisions?

What role do biological, psychological/cognitive and social/environmental factors play in these decisions?

Lastly, provide a brief case study demonstrating an ethical dilemma that a mental health professional might face, making sure to identify the specific ethical standard being discussed, as well as providing suggestions as to how the professional can manage the situation appropriately.

Civil Commitment in the United States

1. Ethical Issues in Involuntary Hospitalization

• The first and foremost principle of medical ethics is the principle of non-maleficence—the physician's duty to "do no harm" (back to the time of Hippocrates)
• Physicians can avoid harming patients is by showing respect for their autonomy
• The ethical principle of beneficence requires that doctors provide to patients services that will benefit them
• When an individual is suffering from a severe mental illness that grossly distorts his perception of reality, it is often clear that he or she has lost the usual capacity for making decisions in his or her best interest. In this case, the individual is not truly autonomous. The medical team upon evaluating the situation can make actions that will benefit the patient and thus, ethical obligations is a little easier.
• There are two main legal principles that underlie the state's interest in the process of civil commitment. 1

1. Parens patriae Parens patriae is a Latin term that means "parent of the country." It refers to a doctrine from English common law that assigns to the government a responsibility to intervene on behalf of citizens who cannot act in their own best interest.
2. Police power, requires a state to protect the interests of its citizens. While physicians have a duty to people other than our patients in only very narrow circumstances (those involving a clear and imminent threat to an identifiable person or persons), the state, on the basis of police powers, has a duty to consider the welfare of all people living within its boundaries. 

• During the era of institutionalization,  all admissions were involuntary. Sometimes, unwanted relatives were confined to limit their rights.
• Along with the civil rights movement and de-institutionalization came a shift in the legal standard for civil commitment away from a need-for-treatment model to a dangerousness model
• Each state's civil commitment criteria also still reflect standards set forth in an important Supreme Court case—O'Connor v. Donaldson—in 1975.
• The issue of burden of proof, or the degree to which the evidence presented convinces the trier of fact that his decision is correct.

Patient's rights

• In response to abuses of civil commitment, States changed civil commitment laws to put legal protections in place to protect the right to liberty of the person being considered for commitment.
• States continued to allow patients to be admitted directly to hospitals against their wishes; however, they determined that this could only be done for a short, pre-determined period of time that varied by state from two days to approximately two weeks. Eventually, patients were entitled to a hearing before the court to determine whether their involuntary commitment should continue.4 Patients were also guaranteed that they would have legal representation at their commitment hearings.
• Legal protections included the potential inpatient's right to a trial, with attorney representation, prior to psychiatric admission.

Step-by-step explanation

I do not agree as many of the previous ways of dealing with mental health conditions were unethical and inhumane. Some modifications done are also lacking in foresight and create an impression that mental health is not a priority. For an instance, although the shift toward strict dangerousness criteria for civil commitment was based on the honorable intentions of protecting the rights of individuals with mental illnesses and ensuring that they received an effective treatment, unintended but risky negative consequences have occurred. One consequence of the shift toward dangerousness criteria has been compromised access to psychiatric care for non-dangerous individuals with mental illness who need but are refusing treatment.  However, under standards based on dangerousness, the medical system will not intervene against a person's wishes until he or she becomes suicidal, physically violent, or grossly unable to perform activities of daily living. 

Case Study:

The case of Mrs. Elizabeth Packard

• Mrs. Packard was committed to a Jacksonville, Illinois, asylum in 1860 at the behest of her husband who was a clergyman. Mr. Packard initiated the hospitalization of his wife to punish her for having an unclean spirit, a decision that he based on her exploration of spiritual traditions outside the Presbyterian faith.
• Mrs. Packard was diagnosed with "moral insanity" and held involuntarily in the hospital for three years before ultimately being declared sane. Once released, Mrs. Packard learned that she had lost custody of her children and ownership of her property. She filed a lawsuit for wrongful confinement and won. She then devoted her life to promoting change in civil commitment laws.

with the injustice that Mrs. Packard experience, it could be gleaned that the admissions process was easy as there was no presence of any procedural barriers to stand between a prospective psychiatric inpatient and the doorway of the asylum. Patients were presumed incapable of making decisions and the State commitment standards during this time were based on the doctrine of parens patriae—the government's obligation to provide for the incapacitated. For these reasons, coercing patients to comply with prescribed therapies was considered to be acceptable.