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Figure 11.1 Understanding all of the legal and ethical issues surrounding client care is critical to ensure the nurse can support a client who is unable to make their own choices and carry out their own actions. (credit: “Legal Gavel & Open Law Book” by “”/Wikimedia Commons, CC BY 2.0)

Nurses have a responsibility to uphold ethical and legal practices, and, when complex issues arise and cause dispute, courts of law can intervene. The need for psychiatric care itself may become one of these complex issues. Federal and state laws provide for involuntary mental health services when a person’s mental health status presents a danger to themselves or other people or if they are gravely disabled. These laws vary by state (Legal Information Institute, 2023) and there is an expectation that nurses will understand their state requirements and nursing practice expectations.

States have an interest in protecting the public and the individual. At the same time, individuals have the right to refuse treatment. Involuntary care poses the fundamental right to refuse treatment against the rights of public safety and the safety of the individual. While striving to preserve autonomy, the law must balance rights with risks. If a person’s health state includes symptoms that alter their ability to make rational decisions—that is, resulting in harm to self or others—it may justify involuntary treatment. Nevertheless, in order to impose involuntary treatment on a person without their expressed consent, they must first be adjudicated incompetent.


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