Study questions ethics of covert medication

Carers of patients with dementia believe that it is sometimes justified to give medication secretly, a new study says. Nearly three quarters of care units surveyed admitted giving drugs, hidden in food or drink, without consent from patients. Moreover, 96% of carers in the community believed that the practice was sometimes justifiable, although most believed that there should be consultation with doctors beforehand.

Some 34 residential, nursing, and NHS units caring for patients with dementia in south east England were surveyed and reported in the Journal of the Royal Society of Medicine (2000:93:408-11). In some cases, the dementia is so severe that patients do not realise they need medication in the first place. Dr Adrian Treloar, author of the study, said, “The alternative to not administering medication within food or drink may be that individual patients suffer badly, when the problem can effectively be treated.”

Owing to the fear of disciplinary action, however, many carers do not properly record any covert treatment given, and few of the care units had a formal policy on the matter. That, said the study, is “a cause for concern.”

“The climate of secrecy and the fear of litigation is driving this problem underground,” said Dr Treloar. “The key issue in deciding what treatment is right is the purpose of that treatment.”

The report suggests that covert treatment should be considered only after discussion with the nursing and medical care team and with the family: “The practice should be recorded and regularly monitored.”

A man with dementia with his wife, who cares for him at home. Covert medication is a cause for concern, says a new report

(Credit: ALFREDO CEDEO/PANOS PICTURES)