Ethical Dilemmas in Mental Health

An ethical dilemma is a situation in which ethical principles conflict or when there is no one clear course of action in a gven sinuation.The nurse will confront some of these dilemmas di- rectly, and he or she will have to make decisions about a course of action.gto self-determination and independence (autonomy)

and concern for the "public good" (utilitarianism). Exam- ples include the following:

Once a client is stabilized on psychotropic medication, should the client be forced to remain on medication through the use of enforced depot injections or through outpatient commitment? Are psychotic clients necessarily incompetent, or do they still have the right to refuse hospitalization and medication? Can consumers of mental health care truly be empow- ered if health care professionals "step in" to make deci- sions for them "for their own good?"Additional dilemmas are in the larger social arena; the nurse's decision is whether to support current practice or to advocate for change on behalf of clients, such as laws permitting people to be detained after treatment is completed when there is a potential of fu- ture risk for violence.git dificult to arrive at fair or "right" decisions The legal aspect of an action is behavior that is allowed required by law there is almost always a clear "answer" to question about the legality of an action. The ethical pe of an action involves what is "right," or what a person o do. The answer is not always clear, and there is often Yean one possible course of action. Is it possible to maintain strict professional boundaries (i.e., no previous, current, or future personal relation-

ships with clients) in small communities and rural areas, where all people in the community know one another?For example, the client who refuses medica- ton or treatment is allowed to do so on the basis of the prin- iple of autonomy.