Concealing Medication in Food and Drink

When we were kids, our parents used to conceal medication in our food and drink when we were sick. It is admissible when there is no other way to give a drug. Covert administration of drugs for adults is an entirely different matter, even for mentally ill patients who will not or cannot take their medicine.

Is it ethical to conceal medication in food and drink? Should drug concealment be medically sanctioned and recorded? How common is it?

The extent of concealing medication

Studies about the extent of covert drug concealment are patchy but suggestive. A 2000 study revealed that medications were administered covertly at some point in 24 of 34 nursing, inpatient and residential units in southeast England. In Norway, a recent study of caregivers for patients with dementia in nursing home and special care units showed that 11%-17% of 1,362 patients were given drugs mixed in food or drink at least once every week.

The Norway study also found that only 40% of the nursing documents recorded the concealment of medication in food or drink. When a doctor authorized the concealment, it was found that medical records were more likely to have written confirmation of the practice, 57% as opposed to 23%.

According to former American Psychological Association (APA) President Paul Appelbaum, concealing medication is rare in inpatient settings in the United States. Overall, there is little information about the extent of this questionable practice in the country.

Support for the practice

Concealing medications in food and drink of patients has supporters. Try talking to a professional caregiver and he or she can often cite good examples of times when covert drug administration seemed logical and sensible.

Caregivers and physicians might consider concealing medications in food and drink to avoid delays in treatment. Delays in treatment could result in self-destructive behavior or means increased morbidity, prolong the patient’s agony, or worsen outcomes.

Criticisms of the practice

Critics of the practice argue that it is a violation of trust by the physician or the caregiver or by members of the family who administer the medications. Many patients are upset and refuse treatment when they learn that their doctor or family betrayed their trust. This in turn breeds paranoia.

It is illegal and unethical in the United States to perform this practice without the consent of a competent and responsible person. According to Spencer Eth, APA Ethics Committee Chair, "Can you treat someone without his or her consent? Not without violating the patient’s autonomy and the core ethical principle of consent. It is a paternalistic attitude that is an anachronism in psychiatric practice. You can’t justify it in the name of ‘the patient’s best interests.’"