This paper examines the practice of covert medication administration from an organizational ethics perspective. This includes consideration of vulnerability and stigmatization, safety, and fairness (justice) in terms of the culture of health care organizations and the relevance of policies and processes in relation to covert medication administration. As much of the discussion about covert medication administration focuses on patients and health care providers, this analysis aims to help expand the analysis of this practice.
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References
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C.Haw and J.Stubbs, “Covert Administration of Medication to Older Adults: A Review of the Literature and Published Studies,”Journal of Psychiatric and Mental Health Nursing17, no. 9 (2010): 761-768.
2.
See, for example, M.Lewin, L.Montauk, and M.Shalitet al., “An Unusual Case of Subterfuge in the Emergency Department: Covert Administration of Antipsychotic and Anxiolytic Medications to Control an Agitated Patient,”Annals of Emergency Medicine47, no. 1 (2005): 75-78; A. Treolar, B. Beats, and M. Philpot, “A Pill in the Sandwich: Covert Medications in Food and Drink,” Journal of the Royal Society of Medicine 93, no. 8 (2000): 408-411; C. Haw and J. Stubbs, “Administration of Medicines in Food and Drink: A Study of Older Inpatients with Severe Mental Illness,” International Psychogeriatrics 22, no. 3 (2010): 409-416; Ø. Kirkevold and K. Engedal, “Concealment of Drugs in Food and Beverages in Nursing Homes: Cross Sectional Study,” British Medical Journal 330, no. 7481 (2005): 20-22.
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H.Farrar, C.Stewart, and D.Sturdevant, “Covert Medication Administration: The Practice of Hiding Medications in Long-Term Care Settings,”Journal of Gerontological Nursing38, no. 8 (2012): 14-20, at 16.
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Id.; see also Kirkevold, supra 2; E.Hung, D.McNiel, and R.Binder, “Covert Medication in Psychiatric Emergencies: Is It Ever Ethically Permissible?”Journal of the American Academy of Psychiatry and Law40, no. 2 (2012): 239-245; E. Lynn and K. Rios, “Covert Administration of Psychotropic Medications in the Emergency Department: An Opposing View,” Annals of Emergency Medicine 48, no. 4 (2006): 478; see Haw, supra 1.
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Both the nature of fiduciary relationships and trust in the patient-health care provider relationship are addressed by the three other papers in this special issue. See R.Abdool, “Deception in Caregiving: Unpacking Ethical Considerations in Covert Medication”; L. Munden, “The Covert Administration of Medications: Legal and Ethical Complexities for Health Care Professionals”; T. Sheldon, “Proof in the Pudding: The Value of a Rights-Based Approach to Understanding the Covert Administration of Psychotropic Medication to Adult Inpatients Determined to Be Decisionally-Incapable in Ontario's Psychiatric Settings,” Journal of Law, Medicine & Ethics 45, no. 2 (2017).
9.
See, for example, Haw, supra 1; Kirkevold, supra 2; F.Tweedle, “Covert Medication in Older Adults Who Lack Decision-Making Capacity,”British Journal of Nursing18, no. 15 (2009): 936-939.
10.
See, for example, Farrar, supra 3; Haw, supra 1.
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See Farrar, supra 3; Munden, supra 8; Sheldon, supra 8.
12.
See, for example, L.McCullough and N.Wilson, eds., Long-Term Care Decisions: Ethical and Conceptual Dimensions (Baltimore: Johns Hopkins Press, 1995); M. Riedl, F. Mantovan, and C. Them, “Being a Nursing Home Resident: A Challenge to One's Identity,” Nursing Research and Practice (2013), available at <http://dx.doi.org/10.1155/2013/932381> (last visited May 8, 2017).
13.
See, for example, Lewin, supra 2; Hung, supra 4.
14.
It is also the case that there is a need to consider the future possible benefits and harms (e.g., the possibility of restoring autonomy) against the more immediate or imminent possible benefits and harms as well. See Abdool, supra note 8 for further discussion.
15.
See Haw, supra note 1 and 4; Treolar, supra 2; Farrar, supra 3.
While this article does not address the use of covert medication administration, its organizational focus and discussion of factors that impact managing care situations safely is informative and relevant. See T.Martin and M.Daffern, “Clinician Perceptions of Personal Safety and Confidence to Manage Inpatient Aggression in a Forensic Psychiatric Setting,”Journal of Psychiatric and Mental Health Nursing13, no. 1 (2006): 90-99. As well, if some health professional colleges argue that covert administration of medications ought not to be done, (see Munden, supra note 4), the obligation and onus on these colleges and healthcare organizations to provide other alternatives via policies, procedures, and training is further heightened.
18.
See Farrar, supra 3.
19.
See, for example, J.McDonald, R.Jayasuriya, and M.Harris, “The Influence of Power Dynamics and Trust on Multidisciplinary Collaboration: A Qualitative Case Study of Type 2 Diabetes Mellitus,”BMC Health Services Research12 (2012): 63; M. Stocker, S. Pilgrim, and M. Burmester, et al., “Interprofessional Team Management in Pediatric Critical Care: Some Challenges and Possible Solutions,” Journal of Multidisciplinary Healthcare 9 (2016): 47-58; E. Paradis and C. Whitehead, “Louder Than Words: Power and Conflict in Interprofessional Education Articles, 1954-2013,” Medical Education 49, no. 4 (2015): 399-407.
20.
See also Sheldon, supra note 4 for further discussion about fairness in terms of patients being able to contest or appeal being given medications covertly.
