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Covert use of medication in Long Term Care Facilities
The practice of covert use in medication administration is by no means limited to specialty of psychiatry. It is not an uncommon situation in geriatric medicine. In this situation, an example would be the use of anti-hypertensive or anti-diabetic medications given to uncooperative and forgetful patients. However, when used in this manner, the practice raises some fundamental ethical and legal questions.
The covert use of medication presents both a legal and ethical challenge for nursing staff as there requires balance to be sought between respecting a patients’ rights, freedoms and choices against what is the most beneficial and health maximizing approach that would improve the patients’ healthcare status.
What is of paramount importance for the nursing team is to be familiar with the legal frameworks relating to mental capacity as this is what sets the course for how care is delivered and how clinical decisions are made. The capacity of the patient should be assessed and defined before any interventions planned and implemented with the ethical reasoning process working in parallel to ensure the care and treatment of the patient is not only ethical but legal.
Case Study
An elderly gentleman currently living in the long term care facility where you are working refused to take his medications this morning and has refused to adhere to his pharmacological treatment plan. This decision placed his health and wellbeing at significant risk and presented a considerable legal and ethical debate to the team providing his care. The staff on shift this morning has given the gentleman his medication hidden in applesauce. In light of this decision what ethical and legal frameworks could be utilized to support the clinical decision to covertly administer medication; as the gentleman in question has severe dementia. Identify and discuss principles of medical ethics as they apply to the topic of covert use of medication administration in Long Term Care.
Formulate an argument that supports your position on this controversial issue by answering the following questions related to the case study.
1. What is the issue?
2. What personal values/beliefs are you feeling with this issue? Describe.
3. What Ethical Principle best fits for you in this situation? Describe.
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