Clinical Criteria for Determining Danger to Self

Clinical Criteria for Determining Danger to Self
A 45-year-old wife of one of the staff physicians was admitted to the emergency room. She
is intoxicated and loud. Her husband wants her admitted to the psychiatric unit. He has
asked to have two other physicians that are his friends to sign the paper work to admit her.
In New York State where the hospital is located two physicians can admit a patient against
their will if they are a danger to themselves or others. You happen to be a neighbor and
know that the couple is going through a divorce and the husband wants custody of the two
children. You also know he is dating a nurse on another unit.
Differentiate between the ethical and legal implications of her admission. What actions will
you take? Support your decisions with legal reasoning and case law.

Clinical Criteria for Determining Danger to Self

A divorce is defined as a court’s ruling to end a marital contractual agreement between
marriage partners which exempts them from performing their marital obligations. In the United
States, divorces are categorized in two forms: absolute divorce, which is also referred to as
divorce a vinculo matrimonii, while the other is a limited divorce also known as divorce a menso
et thoro (Kjervik & Brous, 2010). These forms of divorces are determined by various
circumstances, for example, absolute divorce occurs when there is evidence showing misconduct
or wrongdoing of either marriage partners. In this case, the facts show that the wife of the
physician had taken some toxic substances harmful to her personal health and in addition, she
was loud. Westrick and Dempski, (2008) argues that stressful situations such as divorces could
make people depressed or suicidal. The woman in question must have developed depression and

this is an equivalent of a psychiatric case. This means that the patient is dangerous and is at risk
of harming herself as a result, she could have posed a serious danger to the other patients in the
emergency room. Based on this argument, it becomes legal for the staff physician to convince
two other physicians to sign the medical papers. The action is justifiable and of utmost good
faith, hence ethical and legal ‘per se’.
Patients suffering from depression after a painful divorce are bound to abuse drugs in a
suicidal attempt thus making them violent and at times loud but this again does not justify the
reason for taking the patient to a psychiatric unit (Johnston & Roseby, 2007). Apparently, the
husband to the patient wants to use the documents as prove that the wife has mental retardations
so that he gains a leverage during the court proceeding. This will definitely be in his favor as he
will be given the custody of their two children on the ground of the other party being mentally
unfit. Such a case is reported in Laznosky v Lasnosky, where the Maryland Court of Appeal ruled
in favor of the husband since the wife had been declared mentally unfit to retain the custody of
their children (Kjervik & Brous, 2010). Even though the intentions of the husband might be
malicious and heavily inclined towards his position as a staff physician, the wife can still put up
a strong case protesting against her medical condition and she can still be considered to take
custody of their two children. But again, assuming that the actions of the husband were in good
faith, then it is legal, moral and ethical to take precautions when handling a patient who is
intoxicated and loud.
Ackerman, (2006) elaborates that the directives for handling such patients require
medical practitioner to take a clinical assessment of the patient after which the physicians can
sign a form stating which unit to put the patient, either in accordance or as opposed to their will.
Such an action is completely legal. On the other hand, it is unethical to infringe the rights of the

patient as they have the privilege of deciding what is suitable for them. In fact the law states that
it is unlawful to forcefully admit or detain a patient. The same case scenarios apply to contracts
formed without the consent of the contractual parties. According to the rule of law, mental illness
is not proof enough to be denied custody of the children during divorce because the children too
have the legal obligation and a right to select a custodian parent (Schoenly & Knox, 2012). As a
good neighbor, I second the physicians’ decision to take his wife to a hospital facility to get
medical attention. However, the decision to confine her in the psychiatric unit is malicious.
Based on this arguments balancing between ethics and legality of the admission process, I would
advise that the patient be taken to an emergency unit so that the husband does not get a chance to
use the medical documents to his advantage in the court proceedings.



Ackerman, M. (2006). Clinician’s Guide to Child Custody Evaluations. New York: John Wiley
& Sons.
Johnston, J.R., & Roseby, V. (2007). In the name of the child. A developmental approach to
understanding and helping children of conflict and violent divorce. New York: Free
Kjervik, D. & Brous, A. (2010). Law and Ethics in Advanced Practice Nursing. London:
Springer Publishing Company.
Schoenly, L. & Knox, C. (2012). Essentials of Correctional Nursing. Springer Series. London:
Springer Publishing Company.
Westrick, S. & Dempski, K. (2008). Essentials of Nursing Law and Ethics. New York: Jones &
Bartlett Learning.

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