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Involuntary Commitment
Pages 285-291
16
Biology
05/12/2012

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Term
What is the historical relevance of Elizabeth Packard in debate over Involuntary Commitment
Definition
Involuntarily taken to state hospital based solely on her husband's testimony, which turned out to be motivated by religious beliefs and marital discourse. She fought for patients rights.

- Open hearings
- Access to written testimony
- 2nd opinion
- mandatory provision of defense representation
Term
What is the physicians role in civil commitment?
Definition
Social function rather then medical
Term
What is the basis of the 2 ethical principles which form the groundwork for involuntary commitment?

1) Parens patriae
2) Police power
Definition
1) Parent acts (or State in their place if they cannot) on the grounds that the patient is unable to care for themselves

1) Police acts as protector to preserve public safety on the basis that the patient is dangerous (society has shifted in this direction!)
Term
What is the concept of "least reactive" responses to patients with mental illness
Definition
Any infringement on a patient's autonomy should involve minimum restriction necessary to achieve societies' end.
Term
What are the legal grounds for Involuntary commitment?
Definition
Merely saying "I want to kill myself" is not enough!

1) Patient must be suffering from mental illness and be in need of treatment

2) They must be EITHER dangerous or unable to care for themselves

** In PA dangerousness consists of either a
- clear and present danger
- "acts of furtherance" within the past 30 days
Term
What are the basic procedures involved in involuntary commitment?
Definition
1) 302 is initial involuntary commitment that lasts 5 days (can be citizen filed, but must be physician approved)

2) Subsequent commitments have different durations and are determined by treatment team after 5 days (may be in different care settings)

303- 20 days
304- 90 days
305- 180 days
Term
What is the difference between patients under involuntary commitments (302, 303 ect.) and voluntary commitments (201)
Definition
- Can be "converted" in between the 2

- Voluntary commitments allow patient's to sign out of the hospital (72h notice) and get more privileges while in hospital.
Term
What are the major consequences post-commitment of having had a 302 filed?
Definition
No purchasing firearms!

This is civil, NOT criminal, so no difficulty with professional school
Term
What issues/Problems surround involuntary commitment?
Definition
1) Lawyers demand certainty, but dangerousness is a GRAY area.

2) Should physicians have such a sociopolitical responsibility?
Term
1. Who would a physician call to get an involuntary commitment authorized in Pennsylvania?

a. Hospital administrator
b. Police department
c. County mental health department
d. Social work department
Definition
C
Term
Who is allowed to request an involuntary commitment in Pennsylvania?

a. Only physicians
b. Only police/emergency workers
c. Only mental health professionals
d. Only fathers/husbands of patients
e. Anyone
Definition
E
Term
Which ethical principles underlie involuntary commitment laws?

a. Parens patriae
b. Locum parens
c. Police power
d. A+B
e. B+C
f. A+C
g. All of the above
Definition
F
Term
Which treatment setting would be considered “least restrictive"?

a. State hospital
b. Ambulatory clinic
c. Acute care hospital
d. Residential treatment facility
Definition
B
Term
All of the following elements are necessary for involuntary commitment in Pennsylvania, except:

a. Dangerousness or inability to care for self
b. Lack of improvement in outpatient care
c. Having a mental illness
d. In need of treatment
Definition
B
Term
A 302 involuntary commitment in Pennsylvania allows a treatment facility to hold a patient against their will for a maximum of:

a. 24 hours
b. 48 hours
c. 72 hours
d. 120 hours
Definition
D
Term
7. A 51-year old homeless male with schizophrenia is brought by police to the emergency room. His is disheveled and malnourished, refusing his psychotropic medications. He is experiencing significant auditory hallucinations and paranoia. You are the physician in the ER and you recommend hospitalization, but he refuses. What is the best course of action at this point?

a. Involuntary commitment: He is ill and in need of treatment, and malnourishment represents inability to care for self, which satisfies the dangerousness criterion.
b. Voluntary commitment: Having psychosis means that a person lacks adequate decision-making capacity; because the patient is not capable of deciding on hospitalization, he can be brought in on the basis of the ER physician’s substituted judgment.
c. Incarceration: Bring the police back and recommend he be jailed, which will allow his psychiatric illness to be treated within the forensic system.
d. No intervention: The patient cannot be hospitalized involuntarily because malnourishment does not in itself constitute dangerousness, unless it represents an imminent risk to his life.
Definition
D