Contemporary Ethical Issues in Clinical Medicine - Psychiatry
L3 Clerkships 2011-2012

6 weeks

1. Law rules governing treatment of psychiatric patients in LA
2. Case for discussion- Confidentiality and informed consent
3. Case for discussion- Conflicts of Care for Mental and Physical illnesses

Louisiana Laws

Revised Statutes

RS 9:2800.2 - Limitation of liability for warning intended victims and law enforcement
RS 28:52 Part A - Voluntary Admission
               Part H -. Administration medication & Consent for Surgery
RS 28:53  Parts A 1 & B 1 - Physician’s Admission by Emergency certificate (PEC) 
                Part D. Right to judicial hearing
                Parts G 1, G 2, G 3 & G 5 - Coroner’s Emergency Certificate
                Part K 1 a - consent for major surgery
                Part K 1 b -administration of medication without patient’s consent or against patient’s will
RS 28:221 Parts A 1 & A 2 - Advance directive for mental health treatment

Take Louisiana Laws Quiz

Confidentiality and Informed Consent:

A 30-year-old woman underwent lobectomy surgery to cure intractable seizures.  Following the surgery she developed bipolar disorder.  The surgery has diminished her ability to perceive social cues, permanently affecting self-awareness of her behavior.   She is working as a teacher, and has made serious accusations of workplace mistreatment that seem delusional.  Her psychiatrist is providing supportive psychotherapy, as well as medications to reduce psychosis and stabilize her mood. However, the psychiatrist’s ability to treat her is limited by her refusal to provide surgical records.  The surgery was performed in another state, and the psychiatrist does not have even casual knowledge of her surgeon’s practice.  Does patient have capacity to refuse access?  Should psychiatrist refuse to treat?  Patient is not suicidal or at risk of harming others but confidentiality is not in best interest of patient treatment.  How should psychiatrist proceed?  Should psychiatrist refuse to treat patient? 

Outline one issue and suggest how to proceed in 50 words.  Discuss case.

Conflicts of Care for Physical and Mental Illness

A 40-year-old man with schizoaffective disorder is vastly improved on a medication associated with the onset of diabetes mellitus. He has a family history of diabetes. He has been hospitalized many times in the past, and prescribed numerous other medications that have rarely helped. He has taken his current medication for 15 years and not only has not been hospitalized, but also has obtained a graduate degree. He has now developed diabetes, and is being treated with two oral anti glucosic agents.  He refuses consider changing his antipsychotic, even though he continues to have paranoid delusions that affect his judgment and prevent employment in his chosen field. He also says, “I will be lost without you.” Knowing the well-publicized relation between diabetes onset and this antipsychotic, should the physician continue to offer the medication? 

Assume that the patient does not have complete capacity to make health care decisions. Outline one issue and suggest how to proceed in 50 words.  Discuss case.

Rev 9, Revised 5/13/09