It is known that in some residential homes the use of covert drugs has become common practice. In 2001 the regulatory body, the United Kingdom Central Council for Nursing, Midwifery, said drugs could be given covertly if it was in the patient’s best interests. This statement has created a lot of debate among some human right defenders as they might enter in direct conflict to the Code of Conduct of Nursing and Midwifery where clearly states nurses must “Ensure to gain consent before beginning any treatment or care. (Code of Practice, Mental Health Act 1983) This has generated some ethical issues around this topic. The term ‘covert medication’ means to give medication secretly hidden in food or beverages, without consent from patients. For some this practice seems far less intrusive than administering injectable medication by physically restraining a person who does not want to be medicated. It will be undetected by the person receiving the medication.
According to the Alzheimer’s Society there are approximately half a million people living with dementia in England. Dementia is not a specific disease. Dementia is a progressive, degenerative disease of the brain that affects multiple brain functions to the point that affect daily life activities (driving, shopping, balancing a checkbook, working, etc. ) and relationships. While dementia often includes memory loss, memory loss by itself does not mean that a person has dementia. http://memory. ucsf. edu/Education/general. html, 12-02-09) A number of different disorders can cause dementia. Alzheimer’s disease is the most common in older adults. Some people with the disease can develop aggression and have violent verbalisations, their behaviour can become more and more abnormal, making it difficult for the care professionals to deliver the quality of care as to follow the treatment they need.
Residential homes are full of cases of people living with different conditions: Hypertension, arthritis, osteoarthritis, diabetes, heart disease etc. Medication needs to be given in a daily basis. The problem strives when patients are unable to take a decision due to some form of mental illness like dementia. Establishing any racional conversation it is not possible and some of them would not know where they are or who they are. Their condition makes them feel frustrated very easily, specially if they are not taking the prescribed medication.
They can become dangerous for themselves as they might try to attempt self harm, attack the nurses or attack other residents. Even if the situation does not develop in physical agression, people with dementia could shout, scream unpleasant words to people around them, making the environment unbearable not only for them but also for others. These cases are very common in many institutions and it seems like a burden for the nurses whom in some cases are seen more like babysitters.
Alison Norman president of United Kingdom Central Consul has said publishing guidelines was important, as it would bring the “complex issue out” into the open and thus reassure both patients and medical staff. BBC news 05-09-2001. These guidelines has been made to assist the registered nurses to come into terms to a decision as to whether to administer the medicines under certain circumstances or not. They have been told to treat each patient as an individual case and to follow this practice as the last resource, it should not become part of a daily routine with all patients.
Professional carers of patients with dementia has found this a justified way to approach patients who are not capable of consenting to treatment and it is intended to ensure that individuals refusing treatment as a result of their illness will have access to effective medical treatment. This issue has provoked widespread concern. It involves the fundamental principles of patient and client autonomy and consent to treatment, which are set out in common law and statute and underpinned by the Human Rights Act 1998.
Human rights defenders like Aberdonian Hunter Watson have stated the practice of “covert medication contravenes patient’s human rights”. He began raising questions after his mother was sedated without her consent at a nursing home in the city, “It’s very, very convenient for staff at care homes to conceal drugs in the food and drink of residents, not for therapeutic problems but to make the residents easier to manage. ” (http://news. bbc. co. uk/1/hi/scotland/7023097. stm, 13-02-2009) Mr Watson is known for campaigning about “covert medication” in care homes.
In residential settings, tranquillising medication might be seen as a cheap means of managing inadequate staffing levels as well as to ensure a quiet shift, but for those who are in favour of this approach argue that it is an essential and least restrictive means of managing unpredictable, violent outbursts against staff and fellow patients. Some might question this practice, who has the right to force someone to take a drug without her or his knowledge? , Do we know whether a patient is refusing treatment or is mentally unable to make that decision for themselves?
And could the guidelines encourage busy or less scrupulous nurses to take the quick way out? Treatment administered in food or drink should never be given to patients who are clearly refusing to accept treatment and have capacity to consent according to Mental Health Act 1983 whereas treatment for those who lack capacity may be prescribed in their best interests under the common law doctrine of necessity, and thus necessary to save life or prevent deterioration or ensure an improvement in the patient’s physical or mental health (Department of Health & Welsh Office, 1999).
For some people these new guidelines enter in direct conflict to the Code of Conduct of Nursing and Midwifery 2008 where clearly states nurses must : “Ensure to gain consent before beginning any treatment or care. ” “Respect and support people’s rights to accept or decline treatment and care. ” There are not easy answers in a overburden healthcare system where work load and time pressure put staff on the constant strain. The new guidelines aim to protect patients and their families from unethical practices and a more realistic solution to help healthcare professionals to safely care for atients who refuse to take their medicines. Whether in hospital or in residential care homes vulnerable patient specially the elderly have been missing out on vital care because they are confused. All adults have the right to refuse treatment but when a patient is mentally ill and unable to understand, medical staff needs some way of legitimately helping them. When the patients condition deteriorates it is not only sedatives that are given this way.
A diabetic patient or a patient with a heart condition who also has dementia may refuse to take any medication and their conditions will deteriorate. A patient with severe major depression by taking camouflaged drugs could prevent him from undergoing to an electro convulsive therapy which could potentially put his life in danger. United Kingdom Psychiatric Pharmacy Group has stated that the pharmacy department should be consulted about what way the medication will be administered to the patients whether in food or drink. http://www. ukppg. org. k/tablets-in-food. html (accessed 20-02-2009) The decision to covert medication in food or drinks means that it will have to be in the patient best interest and it wont be an isolated decision, Other people views will also be taken into account; anyone previously named by the patient as someone to be consulted, anyone engaged in caring for the person, close relatives, friends or others who take an interest in the person’s welfare, as well for the multidisciplinary health care team, but where doubt exists a second medical opinion will be sought.
Whichever way they played it could be deemed as not acting in the best interest of the patient if they do give the covert medication in food could be seen as innappropiate and if they do not give the medication in disguise it could also be seem as innappropiate and not acting in their best interest of the patient, but medication is essential if a patient has been prescribed with some medicine and its unable to make a decision he stills needs to take it.
Camouflaging medicines is arguably a kind way of giving them to distressed elderly patients.