Skip to main content
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 2005 May;31(5):262–265. doi: 10.1136/jme.2003.007336

"I can put the medicine in his soup, Doctor!"

J Wong 1, Y Poon 1, E Hui 1
PMCID: PMC1734145  PMID: 15863680

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.

Full Text

The Full Text of this article is available as a PDF (59.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benn P. Medicine, lies and deceptions. J Med Ethics. 2001 Apr;27(2):130–134. doi: 10.1136/jme.27.2.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blustein J. The family in medical decisionmaking. Hastings Cent Rep. 1993 May-Jun;23(3):6–13. [PubMed] [Google Scholar]
  3. Hardwig J. What about the family? Hastings Cent Rep. 1990 Mar-Apr;20(2):5–10. [PubMed] [Google Scholar]
  4. Harrison G., Hopper K., Craig T., Laska E., Siegel C., Wanderling J., Dube K. C., Ganev K., Giel R., an der Heiden W. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. 2001 Jun;178:506–517. doi: 10.1192/bjp.178.6.506. [DOI] [PubMed] [Google Scholar]
  5. Honkanen L. Point-Counterpoint: is it ethical to give drugs covertly to people with dementia? No: Covert medication is paternalistic. West J Med. 2001 Apr;174(4):229–229. doi: 10.1136/ewjm.174.4.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Nelson J. L. Taking families seriously. Hastings Cent Rep. 1992 Jul-Aug;22(4):6–12. [PubMed] [Google Scholar]
  7. Ramsay S. UK nurses receive guidance on covert medication of patients. Lancet. 2001 Sep 15;358(9285):900–900. doi: 10.1016/S0140-6736(01)06092-5. [DOI] [PubMed] [Google Scholar]
  8. Scott H., William E. R. Suspension of nurse who gave drug on consultant's instructions. Concealed administration of drug treatment may represent thin end of the wedge. BMJ. 1997 Jan 25;314(7076):300–301. [PMC free article] [PubMed] [Google Scholar]
  9. Treloar A., Beats B., Philpot M. A pill in the sandwich: covert medication in food and drink. J R Soc Med. 2000 Aug;93(8):408–411. doi: 10.1177/014107680009300805. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Treloar A., Philpot M., Beats B. Concealing medication in patients' food. Lancet. 2001 Jan 6;357(9249):62–64. doi: 10.1016/S0140-6736(00)03578-9. [DOI] [PubMed] [Google Scholar]
  11. Wong J. G., Scully P. A practical guide to capacity assessment and patient consent in Hong Kong. Hong Kong Med J. 2003 Aug;9(4):284–289. [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES