Legal/Ethical Delima

Legal/Ethical Delima

Introduction

There are many ethical dilemmas that exist in the world we live in today, yet we live and function around these dilemmas. We learn to coexist with them, or we develop some system to solve them. It would be comforting if those ethical dilemmas were excluded from the healthcare systems that we trust our lives with, yet unfortunately they are not exempt. One of the ethical dilemmas that affect the healthcare system not only in America but on an international level is the issue of “covert medications.”

A covert medication is simply a medication that is hidden in a patient's food or drink so that the patient is unaware that he or she is taking that medication (Smith, 2002). A dilemma arises when the healthcare provider deems the patient unfit to make their own decision about consuming the medication and gives it to them unknowingly so they cannot refuse it in their altered state.

Discussion

Any patient in any population is susceptible to receiving covert medications, yet the population that seems to be the most vulnerable is the geriatric population, especially those with dementia (Nazarko, 2008). These elders with dementia are seen as lacking the capacity to decide what is healthful and what is harmful to them in their demented state (Nazarko, 2008). Along with cognitive changes, physiologic changes that occur with dementia, such as dysphagia, facilitate the administration of covert medications. Dysphagia is difficulty swallowing and commonly occurs in people with severe dementia. Since the nerves and muscles involved in the mechanism do not function together properly it is difficult for patients to swallow whole pills, tablets, or capsules (Nazarko, 2008). Because of this difficulty, their pills must be converted to a more ingestible form. Their pills are therefore crushed and put into food or drink, yet by these methods other medications can be added that they are unaware of or have not agreed to. The older adults are not the only ones who have a role in this dilemma.

The healthcare professionals, especially the doctors and nurses who are directly involved in medication administration, play a role as well. According to the healthcare workers, the medications administered are to increase (or maintain in the case of degenerative diseases) the patient's health status. It is their moral and legal responsibility to decide what is best for a patient in the case where they are mentally unable to do so (Tweddle, 2009). If a patient is unaware that they are taking medicines to reduce or minimize a disease process and is refusing treatment, the nurse or doctor must use means necessary to ensure the patient's health is being treated.

Nurses are especially hit hard in this dilemma because they are the ones in direct contact with the patients, and they are the ones who administer these medications as well. They are the ones who must make the decision to hold a medication because the patient refuses to take it, crush it because they cannot swallow it, or ask for the ...