PubMed · 12035563
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Barry G Beeman. 2002. Same standards for doctors.. https://pubmed.ncbi.nlm.nih.gov/12035563/
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The term 'security hospital' is used for a variety of facilities including forensic hospitals and prison hospitals, which, because of their mission, the nature of their work, and the populations they serve-or because of the authority under which they operate-place the staff at considerable risk of ethical violations related to either clinical care or to forensic activities. The problem of divided loyalties is of special concern in security hospitals. Ethics principles particularly at risk are confidentiality and informed consent. Where there are cultural disparities between the staff and the patients, differences in background, socioeconomic class, education, and other types of diversity, cultural awareness is required and must be reflected in appropriate treatment and evaluation. To counteract the risks of ethical violations, a security hospital should create an ethical climate and develop means to anticipate, prevent, and deal with ethical violations. These might include detailed and specific policies and procedures, programs of orientation, education, consultation, and liaison as well as its own ethics committee.
This article explores four legal issues relevant to the provision of care in secure hospitals. These include the current status of right to treatment litigation; the potential impact of the Americans with Disabilities Act; new developments in laws governing restraint and seclusion; and the need for uniform institutional policies on risk assessment. These issues illustrate the potential conflicts between individual autonomy and institutional control that have been at the heart of mental health law for three decades. The article suggests that because of the diminishing oversight provided by the federal judiciary, institutional custodians have a particular obligation to ensure that individual rights are not overwhelmed by concerns with security.
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