Health Care and Nursing - The Ethical and Legal Obligation Surrounding the Issue of Covert Administration of Medication

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Safety Medication Management

Safe care management is the most important foundation of good patient care. Careful handling of patients to ensure quality care is being provided is the primary task of the health care provider which includes maintaining a correct way of administering medication.

However, there are some instances wherein the practice of covert medication becomes the only means to an end during situations where covert medication is significantly considered as the priority in terms of accomplishing a result rather than in terms of the value on the provision of proper care in terms of safety medication management.

Covert Medication is a method not openly practiced by some hospitals or health care facilities which involves concealing medication in the food and beverages of confused and mentally impaired elderly patients who regularly refuses their medication. 

Prescribed Medicines are an important part of health care, it is a remedy for treating illness. But while it is a common knowledge that medication is a form of treatment necessary for the patient’s physical or mental health recovery, yet administering it is an extremely complicated task due to refusal of the patient to take their medication. This is especially true with agitated stubborn patients or with confused elderly patients.

Hiding drugs in the food and drinks of patients refusing medications simplifies the task of the nurse but there are issues concerning the effectiveness of this practice due to the risk involved. The main concern involving the practice of covert medication is on the legality of administering medication without consent, which in most worst cases could lead to mishandling of medication.

Even if the individual is incapable of consenting for their best interest, still the procedure of covert medication can be regarded as a violation of the rights of the individual. If the patient is found incapable of consenting to treatment, the best alternative is to have a substitute who can make a sound judgment on behalf of the patient. The substitute decision maker should nonetheless be a member of the patient’s immediate family or someone known to be trusted and duly chosen by the patient before the patient was found incapable.

Right to refuse treatment

Nurses who have worked very closely with patients suffering from dementia have experienced the sad but true tendency of these types of patients to have episodes of aggression.

It is most likely for these type of patients to behave or react negatively to the care and treatment being provided as a result of their confusion or fear of their surrounding since they are mentally incapable of understanding their condition, or they may also be irritated or suffering from depression and feeling so alone and alienated from the rest of the world that medical intervention is most commonly refused, wherein concealing drugs in their meal would most often be the only last resort. 

But this covert method of administering medication has long been argued by patient rights advocates because the method itself which involves secrecy tends to adversely affect the accuracy of administering drugs.

Health care facilities have rules set forth to guide the health care staff in the treatment intervention of mentally incapacitated patients. The rules must be adhered to with strict compliance which stipulates that covert medications may not be administered without the permission of the patient, or by the patient's immediate family or representative, or by a doctor who can decide for the best interest of the patient.

Understanding why a patient is refusing medication is important in care intervention. But while it is more convenient to just attribute this behavior to mental disorder, it is ideally important not to take for granted the other reason behind the refusal.

However incapable the person can be, yet still they are legally entitled to their moral judgment of refusing treatment if they are the subject of covert medication. Health care workers are required to abide by the medication administration policy implemented in every health care institution and facilities.

The legislation aims to ensure the provision of safety medication which entails the direct responsibility of health care providers in following the guidelines of safe medication management with due consideration on the patient's right to refuse treatment where appropriate.

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