Mental health issues are prevalent in many societies, and there is a need for sufficient care for patients with mental health problems and personality disorders as they are bound to affect their well being and that of others. Nonetheless, owing to ambiguities surrounding legislation on mental healthcare, many are the times that individuals with mental illnesses done harm to members of the society as a result of loopholes in legal and ethical frameworks. Worse off, the situation gets further complicated by the right to confidentiality of patients especially for those with psychiatric problems and health care providers are in a dilemma in trading off privacy with their duty to warn. The reason behind this is because it would amount to the breach of patient rights - concerns on duty to care come against a backdrop of the prevalence of mental health-related crimes with the landmark Tarasoff in CVS the Regents of the University of California case setting precedence on how mental health issues should be handled to mitigate crimes.
Nonetheless, the Tarasoff ruling created a dilemma of establishing the point at which the duty to warn takes precedence over the protective privileges accorded to the mentally ill. Consequently, many are the instances where mental health providers have failed to be decisive in knowing when to breach provider-patient confidentiality to protect the well being of others. The Daniel Gonzales case typifies a case of medical negligence that in part contributed to a spree of killings, self-injuries and bodily harm to others. According to Wright, (2009), on three days, Daniel Gonzales went on a Freddy Krueger inspired killing spree across Sussex land he knifed fours people to death; Fred Krueger was an evil figure in the Horror Film, Nightmare on Elm Street. During the rampage, the serial killers killed two men and women and stabbed others in what investigators claimed was a drug-crazed attack that could have easily been fatal. Gonzales, opted for the elderly as they offered the least resistance, nonetheless, after the murder of his last two victims, he was arrested after neighbors raised the alarm on seeing a naked man covered in blood.
Daniel Gonzales had a troubled childhood and a history of mental health problems; in fact, he was a paranoid schizophrenic who had attended over 60 appointments with doctors and other mental healthcare providers. Nonetheless, the professionals failed to engage him and solve his condition effectively successfully, and this was a predisposing factor to the murders he committed. Moreover, more than in one occasion, his mother wrote to local authorities seeking help and at one time rhetorically asked the Member of Parliament, does a severe incident have to occur before he could receive mental help. Besides that, even after his arrest, while awaiting trial, Gonzales bit himself very had with great ferocity in an attempt to take away his life. At this point, it was clear that he had not only been a threat to himself but others, as a result during criminal proceedings, he was escorted by armed police officers in riot gear.
What Were the Professional's Legal Obligations?
The death of the four victims, trauma to others and his ultimate demise through suicide by exsanguinations (slits his wrists) were as a result of medical negligence and deficiencies of the mental healthcare infrastructure, and its policies. The health care practitioners involved in Daniels therapeutic sessions and other forms of treatment owed him the duty of care. Nonetheless, that was not the case as the Gonzales case got marred by the failure to commit to fully appreciating Gonzalez's needs and the missed opportunities to shape his fate and that of his victims highlight medical negligence and human error. Furthermore, as in many occasions, Gonzales admitted to wanting to take life, the professionals had a legal obligation to warn as Unguru, (2018), reveals that when dispensing healthcare services, therapists must advise when they determine that the medical or mental condition of their patients is a threat. In so doing, healthcare providers provide warnings that are central to averting potential danger. Moreover, the duty to care obliges psychologists to use reasonable care to protect intended victims from the looming threat.
Was The Law Upheld?
Confidentiality between the doctor and patient has been a prerequisite to effective treatment as it not only provides reassurance that patient's details will remain confidential but also allows for the active exchange of ideas, feelings thoughts and emotions between the patient and healthcare provider. As a result, legislation on confidentiality seeks to ensure privacy which doctors swear to protect the Health Insurance Portability and Accountability Act (HIPAA) enforces the right to uphold privacy. In so doing it provides that there is ease in communication for treatment, nonetheless, after the landmark ruling by the Supreme Court in the Tarasoff decision, the confidentiality accorded to patients is not absolute. The privilege can thus get negated when a patient shows signs and intention to harm a third party. In the Gonzales scenario, it is clear that that the law was not upheld in that as the United Kingdom is bound by the jurisdiction of the English law system, there was a clear violation of the Idea of precedence. The stare decisis doctrine allows judges and court systems to use precedential decisions to evaluate their practicability in applications to current similar cases; in this scenario, the Tarasoff ruling was not applied amounting to a violation of the law.
Do you think the situation in the article got handled appropriately? Why or why not?
The situation in the article typifies medical negligence, a breach of duty to care, duty to warn and general complacency on the part of healthcare practitioners to help Daniel Gonzalesde, therefore it is clear that there was no proper handling of the case. To begin with, the history of the patient was well known, and it is difficult to understand why the psychologists failed to give him the attention he deserved. For instance, Daniel Gonzales spent a lot of time playing video games and watching Horror Films such as the Night on Elm Street which led him to launch a Fred Krueger inspired killing spree. According to Kumar, (2016) horror films have on many occasions' inspired real-life deaths especially those propagated by those with a history of drug abuse and mental illnesses. For instance, in 2011, the Hollywood horror film, Saw, inspired two Brits to cause deaths by replicating what they had watched in real life. The first culprit, a one, Benjamin Scott repeatedly stabbed his neighbor a hundred times while the other Mathew Tingling tortured and killed his friend by trying to sever his spinal cord.
Secondly, there is evidence of deliberate medical negligence as Gonzales' mother even claimed that despite seeking medical intervention, the service providers waited for crime to occur to act. In so doing they contravened the very foundation of the various law systems. For instance, the Common law system is concerned with the prevention and deterrence of behaviors that affect the well-being of others. More so, laws seek to facilitate the well being of all members of the society as any form of criminal or civil misconduct is not only a wrong against a private individual affected by the incident but is also an immoral and unlawful act against others. On matters, medical negligence, handling of Daniels mental health was a clear indication of the provision of substandard care that has been provided by medical professionals which directly worsened his conditions and indirectly led to the death of others. However, as the medical provider's reluctance to warn authorities of the impending danger posed by their patients would be justified by the risk to violate patients' rights through involuntary hospitalization, that would be impractical in this case as the intent to commit the crime was evident.
Incompetency of the doctors, the failure to conform to a specific regime and the absence of a carer also indicate that the situation got handled poorly. Mental health patients are a vulnerable group who require careful attention and even life-long therapy to help them cope with their situation and prevent harm to others. However, Gonzales was discontinued of his care and would often be taken to different doctors each with a different approach to his situation. Moreover, the contradicting recommendations from the tens of doctors that had at one time or another attended to him made it difficult to develop a closer relationship that would have helped him make his unconscious thoughts conscious and in so doing facilitate ease in coping with the day-to-day problems he was struggling.
How can this situation be used for training your counselors?
Many valuable lessons can get drawn from the Gonzales case, and this would facilitate a comprehensive training of counselors. To begin with, the case is suitable for ethical teachings, especially from a deontological Kantian perspective. According to Kant, (2017), an action is rendered right or wrong if the maxims behind such actions are good or bad; consequently, the only intrinsically good is the will to do activities that do not harm others. The action is rendered right only if one would wish it to be a universal law. About the scenario under scrutiny, counselors have to understand that providing care to the mentally ill is a moral and legal responsibility as they would also wish to be taken care of had they been in a similar situation.
Secondly, the situation is instrumental in familiarization of applicable laws and statutes regarding mental health, the duty to warn and the right to confidentiality. The legal knowledge supplements ethical considerations and would help in decision making on whether, when or not to trade-off the duty to warn for patient privacy. Moreover, it helps address ambiguity regarding when or not to deny a mental health patient his or her protective privilege. Borrowing from the Tarasoff ruling, and the Daniel Gonzales case, it is evident that a patients history should be thoroughly scrutinized to prevent harm to others, and the mentally ill given comprehensive care as well as frequent monitoring.
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