Is It Ethically Correct to Hide Medication in Food and Drinks of Patients with Dementia?

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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. (, 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...
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