Ethics and Law

  • Ana Hategan
  • James A. Bourgeois
  • Tracy Cheng
  • Julie Young


The focus of this section is on the practical application of basic ethical and legal principles to the practice of medicine. After a brief overview, several case studies will illustrate the practical application of pertinent ethical and legal principles in the management of psychiatric illness in the geriatric population.


Ethics Respect for autonomy Narrative-based ethics Informed consent Decisional capacity Advanced directives Involuntary commitment 


  1. 1.
    United Nations Department of Economic and Social Affairs, Population Division. World Population Ageing. New York. Contract No.: ST/ESA/SER.A/390; 2015.Google Scholar
  2. 2.
    Ambrosini DL, Hirsch CH, Hategan A. Ethics, mental health law, and aging. In: Hategan A, Bourgeois JA, Hirsch CH, Giroux C, editors. Geriatric psychiatry: a case-based textbook. Springer International Publishing; 2018. p. 201–16.Google Scholar
  3. 3.
    Welsh S, Deahl MP. Modern psychiatric ethics. Lancet. 2002;359(9302):253–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Walaszek A. Clinical ethics issues in geriatric psychiatry. Psychiatr Clin North Am. 2009;32(2):343–59.CrossRefPubMedGoogle Scholar
  5. 5.
    Beauchamp T. The principle of beneficence in applied ethics. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy (Winter 2016 Edition). 2016.
  6. 6.
    Baldwin C. Narrative, ethics and people with severe mental illness. Aust NZ J Psychiatry. 2005;39(11–12):1022–109.CrossRefGoogle Scholar
  7. 7.
    Parikh R, Montgomery A, Lynn J. The Older Americans Act at 50—community-based care in a value-driven era. N Engl J Med. 2015;373(5):399–401.CrossRefPubMedGoogle Scholar
  8. 8.
    Older Americans Act. 1965. (Pub. L. 89-73, 79 Stat. 218).Google Scholar
  9. 9.
    Birke MG. Elder law, Medicare, and legal issues in older patients. Semin Oncol. 2004;31(2):282–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Alford D. The Elder Justice Act. J Gerontol Nurs. 2011;37(8):14–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Criminal Code of Canada. 1985. (R.S.C. c. C-46).Google Scholar
  12. 12.
    Shah K, Shah N. The ethical intersection of elder law and elder care practices. J Am Geriat Soc. 2013;61(12):2265–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Roberts LW. Informed consent and the capacity for voluntarism. Am J Psychiatry. 2002;159(5):705–12.CrossRefPubMedGoogle Scholar
  14. 14.
    Moye J, Marson D, Edelstein B. Assessment of capacity in an aging society. Am Psychol. 2013;68(3):158–71.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Appelbaum P. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007;357(18):1834–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Leo RJ. Competency and the capacity to make treatment decisions: a primer for primary care physicians. Prim Care Companion J Clin Psychiatry. 1999;1:131–41.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bourgeois JA, Cohen MA, Erickson JM, Weintraub Brendel R. Decisional and dispositional capacity determinations: the role of neuropsychiatric illness and an integrated clinical paradigm. Psychosomatics. 2017; 58(6):565–73. pii: S0033-3182(17)30126-3. Scholar
  18. 18.
    Moye J, Marson D. Assessment of decision-making capacity in older adults: an emerging area of practice and research. J Gerontol B Psychol Sci Soc Sci. 2007;62(1):P3–11.CrossRefPubMedGoogle Scholar
  19. 19.
    Cole M. Clinical assessment of the mental capacity of the older adult. McGill J Law Health. 2011;5(2):273–7.Google Scholar
  20. 20.
    Glezer A, Stern TA, Mort EA, Atamian S, Abrams JL, Brendel RW. Documentation of decision-making capacity, informed consent, and health care proxies: a study of surrogate consent. Psychosomatics. 2011;52(6):521–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Derse AR. What part of “no” don’t you understand? Patient refusal of recommended treatment in the emergency department. Mt Sinai J Med. 2005;724:221–7.Google Scholar
  22. 22.
    Ganzini L, Volicer L, Nelson W, Derse A. Pitfalls in assessment of decision-making capacity. Psychosomatics. 2003;44(3):237–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Fitzgerald MJ. Assessing capacity in the medically ill: I don’t want to! In: Amos JJ, Robinson RG, editors. Psychosomatic medicine: an introduction to consultation-liaison psychiatry. New York: Cambridge University Press; 2010. p. 15–21.CrossRefGoogle Scholar
  24. 24.
    Rabins P, Black B. Ethical issues in geriatric psychiatry. Int Rev Psychiatry. 2010;22(3):267–73.CrossRefPubMedGoogle Scholar
  25. 25.
    Weiss B, Berman E, Howe C, Fleming R. Medical decision-making for older adults without family. J Am Geriat Soc. 2012;60(11):2144–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Weinstock R, Bonnici D, Seroussi A, Leong GB. No duty to warn in California: now unambiguously solely a duty to protect. J Am Acad Psychiatry Law. 2014;42(1):101–8.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ana Hategan
    • 1
  • James A. Bourgeois
    • 2
    • 3
  • Tracy Cheng
    • 4
  • Julie Young
    • 5
  1. 1.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of PsychiatryBaylor Scott and White Health Central Texas DivisionDallasUSA
  3. 3.Department of PsychiatryTexas A&M University Health Science Center, College of MedicineTempleCanada
  4. 4.St. Joseph’s Healthcare Hamilton, McMaster UniversityHamiltonUSA
  5. 5.Mercy San Juan Medical CenterFarmingtonUSA

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