Covert administration of medication in food: a worthwhile moral gamble?

Abstract

The covert administration of medication occurs with incapacitated patients without their knowledge, involving some form of deliberate deception in disguising or hiding the medication. Covert medication in food is a relatively common practice globally, including in institutional and homecare contexts. Until recently, it has received little attention in the bioethics literature, and there are few laws or rules governing the practice. In this paper, we discuss significant, but often overlooked, ethical issues related to covert medication in food. We emphasise the variety of ways in which eating has ethical importance, highlighting what is at risk if covert administration of medication in food is discovered. For example, losing trust in feeders and food due to covert medication may risk important opportunities for identity maintenance in contexts where identity is already unstable. Since therapeutic relationships may be jeopardised by a patient’s discovery that caregivers had secretly put medications in their food, this practice can result in an ongoing deception loop. While there may be circumstances in which covert medication is ethically justified, given a lack of suitable alternatives, we argue that in any particular case this practice should be continually re-evaluated in light of the building moral costs to the relational agent over time.

Covert medication and patient identity: placing the ethical analysis in a worldwide context

“…Though certain extreme cases might necessitate their involvement due to a lack of acceptable alternatives, this option should be a last resort. 1 The basis of this call is clear enough from the article. A person's loved ones are often the anchor for the relational aspects of identity, and the basis of their social support.…”

“…Eating is also a relational practice, one that entails significant vulnerability to and dependency on others. 1 Placing relationships at the moral hub of their analysis they aim to 'give an analysis of the ways that these relationships can be undermined and trust eroded through using food for the covert administration of medication'. 1 The analysis adds to ethical reasons for hesitating to use CM, at least when food and drink are the vehicle.…”

“…We contend that while there may be instances in which using food for covert medication is ethically justified, given a lack of suitable alternatives, in any given case this practice should be continually reevaluated in light of the building moral costs to the relational agent over time. 1 Here, I aim to place Guidry-Grimes, Dean and Victor's paper, within a wider context, and in particular within the wider moral framework in which the use of CM (including CM given via food and drink) may be analysed, and within the wider cross-cultural context of the practice of CM.…”

“…However, in support of this fear relating to CM, Guidry-Grimes, Dean and Victor cite a finding about the impact of coercive treatment: 'Involuntary or forced psychiatric treatment 'can give the perception of an isolated event', but 'the moral weight of the act is ongoing throughout the relationship''. 1 (citing 18 18) This suggests that even isolated instances of coercion may remain with a patient, having a long-lasting impact on the relationship in question, and (one might surmise) on subsequent relationships.…”

Who Should Implement Force When It's Needed and How Should It Be Done Compassionately?

“…Deception prevents patients from gaining insight into their illness and might lead to further medication refusal and an ongoing deception loop, and, if discovered by the patient or public, deception might damage the therapeutic relationship and trust in the medical profession more broadly. 13,14 Additional harms of covert medication include potential decreased drug efficacy and increased adverse effects from dose form modification of medications, which deceived patients might not be able to recognize or articulate. 12,15 Restraint.…”