One of the challenges I have experienced as a forensic nurse, is determining whether a client in the midst of a behavioral health episode, can provide consent for a forensic exam. Is it ethically reasonable for FNEs to expect an individual, involuntarily hospitalized for behavioral health evaluation, to be able to give consent for a forensic exam? If so, what is the instrument do we use to assist to determine capability to consent? Does this instrument exists? Would an standardized instrument be helpful in obtaining consent in these circumstance? Any observations or comments would be appreciated and would form the basis of a research question.
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When I asked this question before another FNE sent me this document.
Same standard is applied if what is used in behavioral health as someone with dementia. There is just no research On our population.
barb
Continuing on this thread. I guess the common factor that is embedded in the question is "what is capacity?' I leaning toward trying to develop a common "understanding" of what capacity should look like in behavioral health. Or, does an existing standard, assuming one exists, apply to trauma victims particularly the population we work with? Secondly, would this same construct would apply to consentability? ( I think I just made up a new word.) More importantly, how do we develop and apply a standard that would be applicable to our circumstance.
Barb,
Many thanks for the observations. I did find a study by Dr. P Campbell from MSU ( I went there as an undergrad) that talks about capacity to consent and created a measurement vehicle to assess this. Not sure if she is still working on this and I will follow up with you.
Rod,
This questions comes up frequently. I was until about a year ago an active participant on our hospital ethics committee.
So I did bring this up to some of our more seasoned ethics clinician. Basically even schizophrenic patient can give consent to treat, right...we as nurses deal with all the time. Really what you need to determine if that patient has the capacity to consent.
If the patient is given the risks, benefits, alternatives, and interventions of the exam, and they can give reasonable explanation for their reason for choosing a MFE or declining and they understand the risks, benefits, etc then they probably have the ability to consent. If they are actively delusional and hallucinating they probably cannot consent to an exam but this is a clinicians assessment of the current situation. We experienced this not infrequently but it does happen. Normally if it is questionable and they are admitted to our secure holding we go see them 24-48 hours later and reassess. I get it evidence is lost but if they can't give you someone of a coherent history of event it may not be feasible for you to do the exam at that time.
I have an article I believe that discusses capacity I will try and find it to post. Also a past AFN webinar there was a psychologist ( I think she is anyway) that gave a great presentation on capacity.
Diana she is a friend of yours can you direct Rod to that webinar if it is still available??
Rod if further questions email me at barbra.bachmeier@gmail.com.
Regards,
Barb
Even if they are on a hold in a behavioarl healht unit patinets still have rights. We would not tie or restrain and patinet down just to do the forensic examine. We have to loo at what th ecourt has ordered as well. this is a difficult quetion and I hope some of our psych. people will start this dicussion. I do not know all the answers to this.