Jan 23, 2019

Is it ethical to covertly give medication to people living with dementia?

When we are caring for someone living with dementia, our first priority and commitment must always be to the person themselves. We must always have their best interests at heart and place their welfare at the centre of what we do.

When it comes to administering medication the same priority applies: medication must be given with sensitivity, with their wellbeing in mind, and it must do the person no harm.

However, sometimes healthcare workers or even carers looking after a loved one at home, will find themselves in the difficult situation where a person living with dementia refuses to take medication that is essential for their wellbeing.

What can be done in these situations?

First of all we must try to understand why the person is refusing to take the medication. Is the medication difficult to swallow? Does it taste awful? Is the person harbouring a deep-rooted desire to die? Are they experiencing delirium caused by an illness?

In these situations, people will sometimes ‘hide’ medication in the person’s food as a way to ensure the medication is taken.

Some studies show that as many as 71 per cent of long-stay care recipients had medication ‘covertly’ administered.

Hiding medication can be “kind”

Research by Anna M Lamnari from the Division of Geriatrics and Gerontology, Weill Medical College Cornell University, writes, “Yes, it is ethical [to give drugs covertly to people with dementia] if it is in their best interests”.

“Camouflaging medicines is arguably a kind way of giving them to distressed elderly patients,” she says.

One problem with giving medication covertly is that record keeping may be compromised. Of course, if medication is given without the care recipient knowing, it must be recorded as always.

Even if medication given covertly, consent is required

Consent is also still required. Ideally, when a new medication is introduced for someone with living with dementia, the person will have given informed consent themselves, but that will not always possible. Sometimes the person no longer has the capacity to provide consent, so a substitute decision maker must provide consent.

Dementia Australia told HelloCare, “To ensure the person living with dementia is treated with respect and dignity, and for legal purposes, informed consent for use of medications should be obtained from the person themselves where possible.

“Alternatively, if the person is unable to give informed consent, then consent should be obtained from a substitute decision-maker.

“Where the person is unable to give informed consent, that person should be treated with respect and have the medications, its application and any other relevant details, explained as appropriate for their level of understanding.”

“Medications for the ‘right’ reasons and in the ‘right’ circumstances may be crucial to well-being”

Leah Bisiani, dementia consultant Uplifting Dementia, provided HelloCare with the following statement.

“Chemical restraint is one of the most heinous manifestations of elder abuse.

“It has been indicated for years that management of stress related responses and behavioural expression displayed by people living with dementia, relies essentially on medications that sedate.

“It is commonly discussed that medications used as a form of restraint, create decline in health status, endorse disrespect, condone ruthless removal of choice from a person’s existence, and may likely place a person living with dementia in a position of life-threatening risk.

“Thus, by administering chemical restraint we are exacerbating and amplifying debility and deterioration, directly related to, and triggered by our evident and seemingly thoughtless neglect.

“The predominance of overuse and abuse of psychotropic medication, when caring for people living with dementia, must therefore be confronted and gravely reflected upon.

“We should instead consider that behaviour is a response to feeling devalued, unmet need essential to that person’s life being ignored, and/or frustration in the inability to verbalise this effectively.

“Accordingly, it seems it is we who are not delivering, and are the catalysts to creating the stigma related to behaviour and the consequent abusive practices that demean people living with dementia.

“Furthermore, there is little indication to demonstrate that when cognitively aware people display the very ‘same behaviours’ in day to day life, they receive the same inappropriate and horrific treatment.

“The common thread identified, in relation to chemical restraint, has sadly become one of acceptance.

“When medicating human beings for ‘being different’, becomes an acceptable and tolerable approach, and remains unquestioned, then we truly must look inside ourselves and challenge it for the disrespectful, degrading, inhumane process that it truly has become.

“We are the ones who instigated the use of chemical restraint, so we are conversely, the ones who can easily reverse it.

“Chemical restraint is a crucial area requiring urgent responsiveness and action, to ensure people who live with dementia no longer suffer at the hands of those who so callously debase their rights, when they are defenceless and exposed.

“Shame on us!”

Ms Bisiani added,

“We must be mindful that for many people, their specific and individual symptom relief or treatment requires medications that shall alleviate the suffering for that person. Medications for the ‘right’ reasons and in the ‘right’ circumstances may be crucial to well-being.

“Chemical restraint is considered abuse when:
– No medically identifiable condition is being treated
– Where the treatment is not necessary for the condition
– Used to over treat a condition
– Part of the intended pharmacological effect of the medicine is to intentionally sedate the person for convenience or for disciplinary purposes.”

 

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  1. In my view ethics is not something that a PSA with six weeks training really worries about. The goal is to sedate the patient and putting medication into jam or yoghurt does the job. When there is one Registered Nurse to four floors and two PSAs to the entire floor and residents spend long hours sitting by themselves with zero stimulation except a television for company medication is the question and the answer. Aged Care is not humane and medication is simply being given as a form of restraint because there are not enough staff of any description.

  2. gian, that is a grossly incorrect generalisation you have made. Only Registered Nurses are permitted to give these type of medications, and only then when directed by a GP. GPs are very interested in remaining GPs and they wont risk over medicating like you suggest. In my experience these sedations are given when a resident displays behaviours that could affect themselves or those around them in a negative manner. Everyone sprouts about residents “rights” but the same charter tells of “responsibilities” as well. If one resident showing agitation or aggression is sedated then this provides comfort and harmony .

    It annoys me endlessly when people like the above author , Caroline Egan, give the impression that there is a big pot full of dangerous drugs sitting on a bench and just any nurse or carer can make the decision to medicate at a whim. That is a blatant lie in the attempt to create some interest in this stupid rag of a newsletter. Clearly she is a disenchanted ex employee with a blunt axe to grind and thats OK but at least tell the truth. To give any such medication there is a serious protocol, endless recording and documentation so try telling the truth, you know, just for a change. People like this Caroline are still bringing up old news like Oakden, move on that was years ago and more a psychiatric facility than general aged care. Another popular mistruth by many.

    1. Anton. How many aged care facilities have you worked in and for how long? Note, these are rhetorical questions because I don’t wish to receive a trite response from you.

      Let me assure you, YOUR viewpoint is limited and also not factual in every workplace. If I were to agree with you then let me say we would both be wrong!!!
      Gian is 100% correct – I have seen it myself. Maybe you have been to busy to see or felt too self important to notice from your small pool of knowledge what is actually happening in aged care facilities in this country. Do you seriously think the Royal Commission was granted because they had nothing better to deal with at the time or how to spend govt. fund?

      May I also say that I thought Caroline Egan’s article , if anything, was TOO generous towards what actually does happen in aged care.

      Maybe you did your tasks by the book – well done and take a bow- but I can guarantee you, there are many thousands that don’t. And as for GPs, don’t start me on that. Either you are very naive, short sighted or simply incapable of grasping the fact that there are really bad people out there who do bad things. Yes, there are some wonderful people working in aged care, yes there are some reasonable aged care facilities and yes good care workers deserve respect and acknowledgement for the good work that they do. However, they are NOT IN THE MAJORITY.

      Finally, you would do everyone a great service to remove yourself from commenting on “….this stupid rag” as you call it so that contributors and commentators on this site are not subjected to your petulant rants.

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