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“I can put the medicine in his soup, Doctor!”
  1. J G W S Wong1,
  2. Y Poon2,
  3. E C Hui3
  1. 1Department of Psychiatry, Faculty of Medicine, The University of Hong Kong, Hong Kong
  2. 2Queen Mary Hospital, Pokfulam, Hong Kong
  3. 3Faculty of Medicine, The University of Hong Kong, Hong Kong
  1. Correspondence to:
 Dr J G W S Wong
 Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong; jgwswonghku.hk

Abstract

The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his soup. Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the “four principles” ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy.

  • decision making
  • truth telling
  • psychiatric ethics

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Footnotes

  • Disclaimer: An earlier draft of this paper was presented at the 28th International Congress on Law and Mental Health, Sydney, Australia, October 2003.

  • The work should be attributed to: Faculty of Medicine, the University of Hong Kong

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