Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-07-04T23:31:26.458Z Has data issue: false hasContentIssue false
  • English
  • Français

Covering It Up? Questions of Safety, Stigmatization, and Fairness in Covert Medication Administration

Published online by Cambridge University Press:  01 January 2021

Christy Simpson
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 45 , Issue 2: Symposium – Covert Medication: Legal, Professional, and Ethical Considerations , Summer 2017 , pp. 204 - 211
Copyright
Copyright © American Society of Law, Medicine and Ethics 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Haw, C. and Stubbs, J., “Covert Administration of Medication to Older Adults: A Review of the Literature and Published Studies,” Journal of Psychiatric and Mental Health Nursing 17, no. 9 (2010): 761-768.Google Scholar
See, for example, Lewin, M., Montauk, L., and Shalit, M. et 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 Medicine 47, 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.CrossRefGoogle Scholar
Farrar, H., Stewart, C., and Sturdevant, D., “Covert Medication Administration: The Practice of Hiding Medications in Long-Term Care Settings,” Journal of Gerontological Nursing 38, no. 8 (2012): 14-20, at 16.Google Scholar
Id.; see also Kirkevold, , supra 2; Hung, E., McNiel, D., and Binder, R., “Covert Medication in Psychiatric Emergencies: Is It Ever Ethically Permissible?” Journal of the American Academy of Psychiatry and Law 40, 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.Google Scholar
Wolpe, P., “From Bedside to Boardroom: Sociological Shifts in Bioethics,” HEC Forum 12, no. 3 (2000): 191-201, at 192.Google Scholar
Bishop, L., Cherry, M., and Darragh, M., “Organizational Ethics and Health Care: Extending Bioethics to the Institutional Arena,” Kennedy Institute for Ethics Journal 9, no. 2 (1999): 189-208; L. Emanuel, “Ethics and the Structures of Health-care,” Cambridge Quarterly of Healthcare Ethics 9, no. 2 (2000): 151-168; J. Gibson, R. Sibbald, and E. Connolly, et al., “Organizational Ethics,” in P. Singer and A. Viens, eds., The Cambridge Textbook of Bioethics (Cambridge: Cambridge University Press, 2008): 243-250; R. Pentz, “Beyond Case Consultation: An Expanded Model for Organizational Ethics,” Journal of Clinical Ethics 10, no. 1 (1999): 34-41; S. Reiser, “The Ethical Life of Health Care Organizations,” Hastings Center Report 24, no. 6 (1994): 28-35.Google Scholar
Okin, S., Justice, Gender, and the Family (New York: Basic Books, 1989): at 17; R. Phillips and J. Margolis, “Toward an Ethics of Organizations,” Business Ethics Quarterly 9, no. 4 (1999): 619-638, at 620.Google Scholar
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 Abdool, R., “Deception in Caregiving: Unpacking Ethical Considerations in Covert Medication”; L. Munden, “The Covert Administration of Medications: Legal and Ethical Complexities for Health Care Professionals”; Sheldon, T., “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).Google Scholar
See, for example, Haw, supra 1; Kirkevold, supra 2; Tweedle, F., “Covert Medication in Older Adults Who Lack Decision-Making Capacity,” British Journal of Nursing 18, no. 15 (2009): 936-939.Google Scholar
See, for example, Farrar, , supra 3; Haw, supra 1.Google Scholar
See Farrar, , supra 3; Munden, supra 8; Sheldon, supra 8.Google Scholar
See, for example, McCullough, L. and Wilson, N., 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).Google Scholar
See, for example, Lewin, , supra 2; Hung, supra 4.Google Scholar
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.Google Scholar
See Haw, , supra note 1 and 4; Treolar, , supra 2; Farrar, , supra 3.Google Scholar
In relation to workplace safety in the healthcare context, see, for example: Standards Council of Canada, “Psychological Health and Safety in the Workplace — Prevention, Promotion, and Guidance to Staged Implementation,” CAN/CSA-Z1003-13/BNQ 9700-803/2013, available at <http://carleton.ca/healthy-workplace/wp-content/uploads/National-Standard-CAS-Z1003.pdf> (last visited May 10, 2017); Department of Labour, Managing the Risk of Workplace Violence to Health-care and Community Service Providers: Good Practice Guide (New Zealand, 2009), available at <https://www.business.govt.nz/worksafe/information-guidance/all-guidance-items/managing-the-risk-of-workplace-violence-to-healthcare-and-community-service-providers/preventing-violence.pdf> (last visited May 10, 2017); Youngberg, B., Managing the Disruptive Patients: A Challenge to Patient and provider safety. (Healthcare Newsletter: Beecher Carlson, 2012), available at <http://www.beechercarlson.com/whitepapers/managing-the-disruptive-patient-a-challenge-to-patient-and-provider-safety> (last visited May 10, 2017).Google Scholar
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 Martin, T. and Daffern, M., “Clinician Perceptions of Personal Safety and Confidence to Manage Inpatient Aggression in a Forensic Psychiatric Setting,” Journal of Psychiatric and Mental Health Nursing 13, 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.CrossRefGoogle Scholar
See Farrar, , supra 3.Google Scholar
See, for example, McDonald, J., Jayasuriya, R., and Harris, M., “The Influence of Power Dynamics and Trust on Multidisciplinary Collaboration: A Qualitative Case Study of Type 2 Diabetes Mellitus,” BMC Health Services Research 12 (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.CrossRefGoogle Scholar
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.Google Scholar