¶ … Ethical and Legal Issues in Acting as a Client Advocate" focuses on issues facing the psychiatric nurse in his or her dealing not only with patients, but also with family members of patients as well as wider social and political issues. The article emphasizes the complexity of the ethical issues surrounding the psychiatric profession, not only because of the nature of the afflictions of patients, but also because of the integrated factors and variety of beliefs surrounding these afflictions. In general, the article provides and excellent overview of the issues that nurses might expect to encounter, although it might have done better by providing a more inclusive introduction.
The article provides only a brief introduction that sets the stage for a discussion of the issues facing psychiatric nurses. The introduction does make a good point in terms of focusing on the importance of ethics in terms of the psychiatric nurse's dealings with clients.
One element about the article that surprised me is the many definitions that takes up about half of the full volume of the article. This somewhat detracted from the central point of the paper. On the other hand, as one works through the definitions, their central theme does become clear: the ethics surrounding a psychiatric nurse's work with clients are an integrated and complex topic.
What particularly brought this home ot me was the distinction of ethics from other elements in the daily work with these clients, including legal law, the code of conduct and ethics, hospital etiquette, hospital policy, public opinion, superior orders, and the "gut response" to what appears to be the best course of action at any given time.
The complexity of the issues surrounding psychiatric nursing can be compared to opinions such as those of Schaler (p. 23), who compares the current premise of the psychiatric profession to burning heretics in the past. The basis of this opinion is that involuntary psychiatric treatment is based upon the general public conception, or indeed belief, in what constitutes insanity. If a "heretic" is identified in terms of the sanity paradigm,...
The publication of such literature indicates that this is an opinion held by a significant sector of the public.
On the other hand, the article under review also indicates that psychiatric treatment should be voluntary in most cases. Problems arise, however, when the client in question poses a danger to him- or herself or to other members of the family or public. In such a case, the professional is under legal obligation to protect the public from preventable harm by either incarcerating or medicating the individual who suffers from mental illness.
This issue in itself indicates the complexity of issues facing the psychiatric nurse. In this way, the article's many definitions also serve to bring home to the reader the necessity of definition in order to provide a clear paradigm for navigating the ethical, legal and other issues facing the profession.
In this light, the most significant part of the article is the length of the section dealing with clients. After the definitions, the article moves to more specific considerations, such as the psychiatric nurse's work in the context of the client, the family context, the social context, and the context of workplace issues. What is significant here, is the fact that the section that focuses on the client is the longest of all the sections in the article, even the one concerning the psychiatric nurse.
The implication here is that the client is the most important component in psychiatric nursing, which almost directly opposes the opinion raised by Schaler, as mentioned above. Indeed, whereas Schaler's claim is that the psychiatric client is treated as little better than a woman to be burned as a witch in the times of heresy, the article focuses on the fact that the client's autonomy should be retained as far as possible without causing needless harm. In this, Raines (p. 11) seems to more closely resemble the current practice of psychiatric nursing. This author focuses on the accountability of the psychiatric nurse not only in…
