Informed consent (IC) is an ethical and legal obligation to healthcare practitioners to manage patients. In psychiatry, IC is a consensus developed between a psychiatrist and a patient based on acquired information in healthcare decisions (Neilson & Chaimowitz, 2015). In this regard, the IC process involves a friendly dialogue that facilitates the disclosure of appropriate information and gives insights into the proposed treatments. IC can be written and documented, especially for invasive treatments such as psychosurgery and electroconvulsive therapy (ECT). Patients can participate voluntarily and free from external influencers during the IC process. The type of information shared in IC may include the purpose, nature, probable risks, and benefits of the proposed treatment (Schachter et al., 2005). Moreover, the psychiatrist will discuss economic considerations regarding the treatment option with the patient, including possible consequences of ignoring treatment. The psychiatrist will essentially provide other alternative treatments for the client to choose from. Therefore, this paper provides a literature review of the most striking ethical and legal aspects of PMHNP practices and how they differ in adult and child care.

Informed consent is a prerequisite in PMHNP practices that protect the autonomy and welfare of patients. Self-determination or autonomy is one of the ethical principles in PMHNP practices that uphold individual capacity to make decisions, provided that they possess adequate mental capabilities (Seedsman, 2019). Autonomy is grounded on the belief that people have innate dignity and worth, which gives them the freedom to make their own choices. Notably, autonomy is an ethical value that creates a foundation for informed consent (Schachter et al., 2005). Overreliance on personal autonomy in healthcare decisions may result in an ethical dilemma that demeans other ethical values such as nonmaleficence, beneficence, and fairness. For example, the patient may refuse to take the best interests and overall welfare offered by psychiatrists and opt to seek irrelevant ones(Schachter et al., 2005). In this context, psychiatrists are likely to break the principle of beneficence by giving the client personal autonomy to pick a less effective treatment approach.

Mental competence or capacity is an essential element for informed consent. The law mandates that healthcare providers obtain IC from mentally competent patients in Maryland. In this regard, the patients must be able to acquire, process, and understand information (Seedsman, 2019). Most adults are perceived to possess the adequate mental capacity to make informed decisions regarding the proposed medical treatments. Most essentially, competent adults can justify their decisions or choice of treatment. Also, they can foresee the consequences and risks of making certain decisions (Seedsman, 2019). Elderly persons aged 80 and above are more likely to have low competence to give their consent for treatment, especially those with dementia. Children are not granted the autonomy to consent since they are presumed incompetent. Moreover, they cannot understand a psychiatrist’s information presented to them. Similarly, adolescents possess risk-taking behaviors that differentiate them from adults (Sori & Hecker, 2015). Therefore, they are more susceptible to choosing the wrong treatment. Under Maryland law, parents must consent for minors under 18 years.

In the context of mental illnesses, psychiatrists may face difficulties determining whether the client has the cognitive abilities to choose wisely. For example, adult patients that are administered with antipsychotic medication are likely to relapse or decline treatment if informed about its possible side effects (Schachter et al., 2005). According to Maryland law, incompetent patients would appoint a decision-maker or surrogate to make decisions that suit the patient’s best interests. In this regard, the patient must adhere to the patient’s wishes. The ultimate goal of the surrogate will be to promote the patient’s welfare and autonomy (Schachter et al., 2005). When adults make poor choices, their selection reflects a personal view. However, when children make poor decisions, it raises concerns about their maturity and mental capacity. In most cases, nurses are more likely than adults to struggle to balance patient autonomy and paternalism when handling children or adolescents.

Voluntariness is another ethical aspect of obtaining informed consent in PMHNP practices that only allows patients to share information out of their willingness (Neilson & Chaimowitz, 2015). In this case, the client should not be inflicted with circumstances or conditions such as coercion, threats, or pressures. However, some pressures may stem from experiences of condition (e.g., fear, pain, and discomfort), including family dynamics and proposed treatments (Seedsman, 2019). These situations may intensify in patients with mental health issues, causing a negative impact on decision-making and voluntariness. Maryland laws on informed consent assert that competent adults can choose to withdraw or withhold from any IC process. Also, the patient has the right to choose a treatment course. Psychiatric practices of involuntary commitment tend to demean the idea of obtaining informed consent from patients. The legal justification for this type of practice aims to protect an individual’s well-being and the possibility of causing harm to third parties. In other words, individuals display behaviors that can harm others or themselves (Neilson & Chaimowitz, 2015).

Both adolescents and adults may lose their nature to voluntarily consent based on how the psychiatrists treat them (Neilson & Chaimowitz, 2015). Health professionals should avoid threatening patients for failing to accept their recommendations. However, adults are likely to make independent decisions to consent voluntarily. On the other hand, adolescents depend on their parents to decide whether to participate in consenting (Schachter et al., 2005). Similarly, younger children rely on their parents to make the right decisions regarding their treatment.   

In conclusion, informed consent is a legal requirement for treating patients. Healthcare practitioners must secure the right consent before performing any patient treatment. Failure to acquire informed consent would result in multiple liabilities, such as criminal liability, negligence, malpractice, and professional indiscipline. Patients acquire consent to protect their well-being and autonomy in making healthcare decisions. However, IC is only obtained from mentally competent patients. In this regard, adults are perceived as more mentally competent than children and adolescents aged below 18 years. Therefore, children and adolescents may be limited in exercising autonomy in decision-making. Instead, parents are involved in obtaining consent from their children. Regarding voluntarism, adults usually make independent decisions to participate in the consenting process. On the other hand, most children and adolescents depend on their parents to decide whether to consent.

References

Neilson, G., & Chaimowitz, G. (2015). Informed Consent to Treatment in Psychiatry. Canadian Journal of Psychiatry, 60(4), 1–11.

Schachter, D., Kleinman, I., & Harvey, W. (2005). Informed consent and adolescents. Canadian Journal of Psychiatry, 50(9), 534–540. https://doi.org/10.1177/070674370505000906

Seedsman, T. (2019). Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care. OBM Geriatrics, 3(2), 1–1. https://doi.org/10.21926/obm.geriatr.1902055

Sori, C. F., & Hecker, L. L. (2015). Ethical and legal considerations when counseling children and families. Australian and New Zealand Journal of Family Therapy, 36(4), 450–464. https://doi.org/10.1002/anzf.1126

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