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CONCEALING MEDICATION IN PATIENTS' FOOD (p 62)
January 03, 2001A Viewpoint article in this week's issue of THE LANCET discusses the ethical issues of covertly giving medication to patients who may not be able to provide consent.
The practice of administering medication within the food or drink of patients has rarely been described. However, a recent study by Adrian Treloar and colleagues showed that the practice is widespread, occurring in 79% of a sample of long-stay care settings for the elderly. Concern was expressed about the lack of openness and poor recording that surrounds the issue. In a companion study, 94% of carers of patients with dementia considered the practice to be justified. In 1996, disciplinary action was taken by a UK national health service (NHS) trust after a nurse had concealed haloperidol, prescribed by a consultant, in a patient's drink, to provide treatment in an urgent and complex clinical situation.
In the Viewpoint article, Treloar and colleagues outline the current UK legal framework for the provision of covert medication, and comment that proposed new legislation should not be implemented unless there is significant additional benefit to incapacitated patients.
The authors state that there are two conflicting views on this issue; the first holds that all deception is wrong and that patients should not be secretly given medication, as it is a breach of their trust. The second is that because patients are sometimes not able to comprehend the result of their refusal and are therefore not making a valid choice, duty of care implies that patients should be deceived as a means of relieving suffering in the least restrictive way.
Barbara Beats (one of the authors) comments: "Carers have been shown to support the principle that medication may be concealed in foodstuffs in extreme circumstances. Ethical analysis also supports this view. However, the secrecy currently surrounding this practice is not helpful. We believe that the secrecy results in professional-care staff failing to discuss the issue with others, and is a potential form of patient abuse. Covert administration of medication should be the subject of local, perhaps national, policy, and regulated".
Contact: Dr Barbara Beats, Consultant Psychiatrist, East Kent Community NHS Trust, The Flats, St Martins Hospital, Littlebourne Rd, Canterbury, CT1 1TD, UK; T) +44 (0)1227 812067; F) +44 (0)1227 812279; E) bcbeats@aol.com
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