DOCSLIB.ORG

The Covert Administration of Psychotropic Medication to Adult Inpatients Determined to Be Decisionally- Incapable in Ontario’S Psychiatric Settings

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Covert Administration of Psychotropic Medication to Adult Inpatients Determined to Be Decisionally- Incapable in Ontario’S Psychiatric Settings Meds on the Menu: The Covert Administration of Psychotropic Medication to Adult Inpatients Determined to be Decisionally- Incapable in Ontario’s Psychiatric Settings by C. Tess Sheldon A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Dalla Lana School of Public Health University of Toronto © Copyright by C. Tess Sheldon 2015 Meds on the Menu: The Covert Administration of Psychotropic Medication to Adult Inpatients Determined to be Decisionally- Incapable in Ontario’s Psychiatric Settings C. Tess Sheldon Doctor of Philosophy Dalla Lana School of Public Health University of Toronto 2015 ABSTRACT Drawing on the fields of human rights and public health, this research explores the covert administration of medication: the concealment of medication in food or drink so that it will be consumed undetected. Adopting a rights-based approach, it explores multiple understandings of the impact of the practice on inpatients’ rights- experiences. Relying on critical approaches, it also explores the practice’s underlying socio-political-legal structures. The common themes of policies, protocols or guidelines that govern its practice in Ontario are identified. Focus groups and individual interviews were held with three groups of stakeholders (nurses, legal experts and psychiatrists), relying on fictional clinical scenarios. Few policies, protocols or guidelines govern the practice in Ontario’s psychiatric settings. The practice impairs access to knowledge by patients and substitute decision-makers. It also precludes healthcare practitioners’ access to information about side effects and underlying reasons for medication refusal. It may interfere ii with therapeutic relationships and patients’ meaningful recovery as they transfer from hospital without knowledge of the fact of the covert medication. It may be characterized as autonomy restoring since patients may become capable of making treatment decisions after having received the medication surreptitiously. Covert medication reflects an inflexible approach to capacity determination; it is distinguishable from approaches that imagine capacity as able to be fostered with support. It is primarily concerned with the management of “risky” inpatients in the short-term. The practice relies on a faith that medication will be effective, deferring to medical decision-making. While covert medication is understood to have “something to do” with rights, there is confusion about how those rights play out on the ground. Institutional silences underlie and reinforce the practice. This research will support the development of effective, safe and appropriate approaches to treatment non-adherence that maximize patient dignity. Most pressing, this research concludes that the covert administration of medication warrants an overt discussion. iii ACKNOWLEDGEMENTS I am so grateful to Lori Ferris, my thesis supervisor and mentor. With her immeasurable support, vision and generosity, I gained confidence to push further into murky interdisciplinary fields, to remain faithful to what was important to me, and to critically consider all angles (even when it was uncomfortable). She is a leader who delights in sharing success. I am proud to share the success of the completion of this project with her. I also offer my sincerest gratitude to my thesis committee, Dr. Elizabeth Peter and Dr. Trudo Lemmens for their critical and insightful feedback during all stages of the project. In particular, I thank Elizabeth for her expert methodological guidance and Trudo for his expert legal and research ethics support. I thank the stakeholders who participated in this study and generously shared their time, experience and expertise. I am unspeakably indebted to my dear family and friends for their unwavering optimism, patience and encouragement. A thousand thanks to Raja, especially, for making everything more fun. It makes me happiest of all to offer the biggest thanks to the littlest people in my life (Sabi and Liv). You send me over the moon! iv TABLE OF CONTENTS Acknowledgements .................................................................................................................................. iv List of Tables ............................................................................................................................................ viii List of Figures ............................................................................................................................................. ix List of Appendices ..................................................................................................................................... x CHAPTER 1: INTRODUCTION ............................................................................................................... 1 I. Language ............................................................................................................................................... 2 II. Context ................................................................................................................................................. 3 III Statement of Focus and Exclusions ......................................................................................... 6 IV. Research Questions ....................................................................................................................... 8 V. Public Health Significance ............................................................................................................ 8 i) State Power including Use of Coercion and Restraint .............................................. 13 ii) Population Focus ..................................................................................................................... 15 iii) The Centrality of Social Justice, including the Health of Marginalized Communities ................................................................................................................................... 16 iv) Engaging Questions of the Nature and Value of Rights .......................................... 19 VI. Roadmap ......................................................................................................................................... 22 CHAPTER 2: THEORETICAL FRAMEWORKS .............................................................................. 25 I. Rights-Based Approaches ........................................................................................................... 25 i) Law Commission of Ontario’s Framework .................................................................... 26 ii) Broad Conceptualization of "Rights" ............................................................................... 30 iii) Challenges to Rights-Based Approaches ...................................................................... 32 II. Critical Theories of Rights ......................................................................................................... 34 i) Critical Legal Studies ............................................................................................................... 35 ii) New Legal Realism .................................................................................................................. 37 iii) Critical Disability Studies .................................................................................................... 38 III. Synergistic Combinations of Rights-Based and Critical Approaches .................... 41 CHAPTER 3: LEGAL AND GOVERNANCE LANDSCAPE ........................................................... 43 I. Ontario Legislation ........................................................................................................................ 43 i) Health Care Consent Act, 1996 ............................................................................................. 45 ii) Substitute Decisions Act, 1992 ............................................................................................ 48 iii) Mental Health Act, 1990 ...................................................................................................... 49 iv) Long-Term Care Homes Act, 2007… ................................................................................ 50 II. International Legal Materials .................................................................................................. 54 III. Highlights – Canadian Jurisprudence ................................................................................. 63 i) With Protections, Forced Treatment May Not Offend the Charter ...................... 64 ii) The Determination of Treatment Capacity Must be Contextually Driven ...... 65 iii) Application of Restraints to Effect Treatment May Not Offend the Charter . 67 v iv) The Availability of Claims of Assault, Battery and False Imprisonment ........ 69 v) Mental Health Tribunals Have Tangentially Approached Covert Medication71 IV. Professional Guidance: Domestic and International .................................................... 74 V. Summary ........................................................................................................................................... 81 CHAPTER 4: LITERATURE REVIEW ............................................................................................... 82 I. Search Strategy ................................................................................................................................ 83 II. Reviews (most relevant first) .................................................................................................
Load more

Recommended publications
  • Academic Search Complete
    Academic Search Complete Pavadinimas Prenumerata nuo Prenumerata iki Metai nuo Metai iki 1 Technology times 2021-04-01 2021-12-31 20140601 20210327 2 Organization Development Review 2021-04-01 2021-12-31 20190101 3 PRESENCE: Virtual & Augmented Reality 2021-04-01 2021-12-31 20180101 4 Television Week 2021-04-01 2021-12-31 20030310 20090601 5 Virginia Declaration of Rights and Cardinal Bellarmine 2021-04-01 2021-12-31 6 U.S. News & World Report: The Report 2021-04-01 2021-12-31 20200124 7 Education Journal Review 2021-04-01 2021-12-31 20180101 8 BioCycle CONNECT 2021-04-01 2021-12-31 20200108 9 High Power Computing 2021-04-01 2021-12-31 20191001 10 Economic Review (Uzbekistan) 2021-04-01 2021-12-31 20130801 11 Civil Disobedience 2021-04-01 2021-12-31 12 Appeal to the Coloured Citizens of the World 2021-04-01 2021-12-31 13 IUP Journal of Environmental & Healthcare Law 2021-04-01 2021-12-31 14 View of the Revolution (Through Indian Eyes) 2021-04-01 2021-12-31 15 Narrative of Her Life: Mary Jemison 2021-04-01 2021-12-31 16 Follette's Platform of 1924 2021-04-01 2021-12-31 17 Dred Scott, Plaintiff in Error, v. John F. A. Sanford 2021-04-01 2021-12-31 18 U.S. News - The Civic Report 2021-04-01 2021-12-31 20180928 20200117 19 Supreme Court Cases: The Twenty-first Century (2000 - Present) 2021-04-01 2021-12-31 20 Geophysical Report 2021-04-01 2021-12-31 21 Adult Literacy 2021-04-01 2021-12-31 2000 22 Report on In-Class Variables: Fall 1987 & Fall 1992 2021-04-01 2021-12-31 2000 23 Report of investigation : the Aldrich Ames espionage case / Permanent Select Committee on Intelligence,2021-04-01 U.S.
    [Show full text]
  • Indian S&T Journals in International Indexing and Abstracting Databases
    Annals of Library and Information Studies Vol. 59, December 2012, pp. 247-279 Indian S&T journals in international indexing and abstracting databases: A study Rabishankar Giri1, Prakash Chand2 and B K Sen3 1Indira Gandhi Institute of Technology, GGS Indraprastha University, Kashmere Gate, Delhi-110006, Email: [email protected], 2,aEx-Scientist, CSIR-National Institute of Science Communication and Information Resources, 14-Satsang Vihar Marg, New Delhi – 110067, Email: [email protected] 3,bFormer Visiting Professor, University of Malaya, Malaysia, Email: [email protected] The coverage of Indian science and technology (S&T) periodicals in major international indexing and abstracting (I&A) services has been studied. It is found that about 1200 Indian S&T journals are being covered by at least one of the international I&A services and over 300 S&T journals are openly accessible. However, coverage of Indian S&T journals by major citation databases, Web of Science (WoS) & Scopus is relatively poor. The newly launched Indian Citation Index (ICI) promises to cover more Indian journals. Keywords: Indian S&T journals, indexing & abstracting services, citation measure, impact factor Introduction Zoological Record, Excerpta Medica/Embase. India is the world's second fastest growing Medline, Index Copernicus, Mathematical Reviews, economy only next to China, with a large R & D Zentralblatt MATH, INIS, GeoBase along with two infrastructure. According to a recent report of Ernst & citation databases Scopus and Science Citation Index Young, India’s current higher education spending is Expanded (SCI-E) besides DOAJ to understand the estimated at Rs. 4,620 billion and projected to grow new open access phenomenon.
    [Show full text]
  • City of Hamilton Planning and Economic Development Department Planning Division
    CITY OF HAMILTON PLANNING AND ECONOMIC DEVELOPMENT DEPARTMENT PLANNING DIVISION TO: Chair and Members Planning Committee COMMITTEE DATE: January 16, 2018 SUBJECT / REPORT NO: Preliminary Screening for the Request to Designate 650 and 672 Sanatorium Road, Hamilton, Under Part IV of the Ontario Heritage Act (Ward 8) (PED18001) WARD(S) AFFECTED: Ward 8 PREPARED BY: Jeremy Parsons 905-546-2424 Ext. 1214 SUBMITTED BY: Steve Robichaud Director, Planning and Chief Planner Planning and Economic Development Department SIGNATURE: RECOMMENDATION (a) That Council direct and authorize staff to undertake a Cultural Heritage Assessment of 650 and 672 Sanatorium Road, Hamilton, shown on Appendix “A” to Report PED18001, to determine whether the property is of cultural heritage value worthy of designation under Part IV of the Ontario Heritage Act; (b) That the Cultural Heritage Assessment work be assigned a high priority and be added to staff’s work plan for completion and presentation to the Hamilton Municipal Heritage Committee (HMHC) no later than December 31, 2018, as per the attached Appendix “G” to Report PED18001; (c) That should the Cultural Heritage Assessment determine that 650 and 672 Sanatorium Road, Hamilton, is of cultural heritage value or interest, a Statement of Cultural Heritage Value or Interest and Description of Heritage Attributes be prepared by staff for Council’s consideration for designation under Part IV of the Ontario Heritage Act; (d) Pursuant to Section 27(1.2) of the Ontario Heritage Act, that Council direct staff to add the respective buildings located at 650 and 672 Sanatorium Road, shown in Appendix “A” of Report PED18001, to the Register of Property of Cultural Heritage Value or Interest (the “Register”), following consultation with the HMHC as per the Council-approved Designation Process (see Appendix “D” to Report PED18001); OUR Vision: To be the best place to raise a child and age successfully.
    [Show full text]
  • Draft Recreational Trails Master Plan
    Hamilton Recreational Trails Master Plan DRAFT | NOVEMBER 2015 TABLE OF CONTENTS Table of Contents .......................................................................................................................................... i-v Acknowledgments ........................................................................................................................................ vi 1.0 Study Introduction ........................................................................................................................... 1 1.1 A History of Trails in Hamilton ..................................................................................................... 1 1.2 Trail Vision, Goals, & Objectives for the City of Hamilton ............................................................ 2 1.3 The Benefi ts of Trail Development ............................................................................................. 3 1.4 The Organization of the Master Plan Report ............................................................................... 5 2.0 The Trails Network ........................................................................................................................... 6 2.1 Understanding what has Already Been Done: The Previous Trail Master Plan (2007) ................... 7 2.2 The Trail Master Plan Update Process ....................................................................................... 7 2.2.1 Trails Master Plan Opportunities .............................................................................
    [Show full text]
  • HSR Customer C D O W Hunter St
    r r C D e k a r n o r s D o t b is t t r r a l Mo L s C n e D m e te s e e n g v n S r R o h i P M C o a C s m h o o r K W O i e C lo s ms a M a m n F d g s lk d u ff o A s i a H te on r e n C i r u a Dr t y N te a lic l r e a g y o v L rm ic C de 's u n r t R e P a a e D F A ld l s ti a Cumberlandd t o l n L v r t u a n iti n W i l r C in r gh a y n a u e o D D e o a D C Dr e w m S d r r a s m t A M n e r o C v a C C M e v A S F lv R h e l R c t t lm l v Guelph Line e or v e W G A r c r re a P a v v Laurentian en L n R en A R i c a l d s a yatt Rd b a r t D v A c e ni A t a s C r d e a T n t ie ie A t u C C o r k t h rt n D i r t r d g C a e la Dr C il r a r e a p e R e C M y A kvi D C T y a e n v O a d R w r C l a L o k B t w w F O A e e k T o L v l e o a La r a d a u r v n k f le R a is w D e or a d d to ic r sid t t Pear id P Fi c k Spruce e C C M s k M ge h P v S A t C ree gsbrid o D l Brant St M Kin s er H r ap New St Pi O im v T s o A n h G A m le e ak o t r r Ct Fisherv n r l e h a l C w r e D C n w il l s e C o l L i o o D o w o D r ve o r N o h d t n l p t M d Harvester Rd D r e a R ic r w C to r D y e y L d h w l o n t olson Ct o r o e M a p A l c f s e B s v il m z B a s R u u d r d ln B P a d U G a u r r o a er le W W e a v C n r t p c rtv T H l R D C ko e r S iew B mesbu d P r nd r y R B H ay Dr A r d r F a ingw D Concession 8 E C m y i a D o r l e u e t m C n R h s i t r e J tl C e S w e d o a t r C l l W n d c t l A a h C e a s s r l n t i d n e a l rpi D R J r e n e li s to r A r vl e e le n v n C t n v i t d g o C ffe
    [Show full text]
  • SNAP IT! Are You Hosting an Event in Ward 8? Sometimes Pictures Speak Louder Than Words
    ISSUE 7 • SPRING/SUMMER 2013 Dear Friends, Welcome to the 2013 Summer Issue of Saying Goodbye to The Honourable the Whitehead Report. As always, I am pleased to provide you with updates on what’s happening in and around our Lincoln M. Alexander community, and to share information On October 26, 2012 the City of Hamilton had the opportunity to about issues that affect our city. honour and remember a beloved Hamiltonian and Canadian; As your Councillor, I am committed to Ontario's 24th Lieutenant Governor, the Honourable Lincoln providing information, implementing Alexander. A number of agencies and individuals should be resolutions and sharing dialogue on thanked and recognized for their involvement in planning and issues of concern to you. That’s why coordinating this incredible state funeral including Mayor and every year I host over 22 issue and Mrs. Bratina, police, HSR, Hamilton Entertainment and budget oriented neighbourhood Convention Facilities Inc., parking, traffic and many other City meetings throughout the ward. I also departments, volunteers and residents. It was an honour to meet area residents each month during celebrate a proud Hamiltonian and to show our great City and my constituency days at Westcliffe residents to the rest of Canada. Mall. Photo Credit: Nick Westoll For those looking to contact me online, my new website with blog and Twitter posts is a great source for the latest Construction: Road Work in your Area information and happenings in and There are a number of construction projects taking place in • Sanatorium Rd. - Redfern to Chedmac/Rice around City Hall. You can also interact Ward 8, the main one to draw your attention to is the closure • West 5th - LINC to Marlowe • with me and other ward 8 residents by of the Queen Street Hill from June 01 to August 30th.
    [Show full text]
  • Medical Practice, Psychiatry and the Pharmaceutical Industry : and Ever the Trio Shall Meet
    The Academia - Industry Symposium Medical Practice, Psychiatry and the Pharmaceutical Industry : And Ever the Trio Shall Meet i The Academia - Industry Symposium Medical Practice, Psychiatry and the Pharmaceutical Industry : And Ever the Trio Shall Meet Ajai R. Singh, M.D. Shakuntala A. Singh Ph.D THE GOAL Mens Sana Research Foundation Mumbai, India iii ISSN 0973-1229 © Mens Sana Monographs (2005) Vol II, No. 6; Vol III, No.1-3, March 2005 - October 2005. Ajai R. Singh, M.D., Psychiatrist. Earlier, Hon. Editor, Psychology and Human Behaviour Digest, and Senior Research Fellow, WHO Collaborating Center in Psychopharmacology in India. Shakuntala A. Singh, Ph.D. Reader and Head, Department of Philosophy, Joshi- Bedekar College, Thane. Earlier, Fellow, Indian Council of Philosophical Research, New Delhi. Mens Sana Monographs are published bimonthly. This issue equals four regular issues. No part of this Monograph may be reproduced in any form without the written permission of the editors, except as brief quotations for the sake of scientific communication, and with due acknowledgment. About us The Mens Sana Monographs attempt to give in-depth understanding of Psychiatric/ Psychological/Philosophical consequences of social disorders / issues and current events, written in an easy to read format, avoiding technical jargon as far as possible, but based on evidence and research studies. Every monograph is to be followed by enlightened discussion on the issues raised by interested readers / scholars. You may forward your views / comments to the editors for incorporation, which may be suitably modified wherever necessary. The Mens Sana Monographs provide a wide platform for serious discussion by psychiatrists, social scientists, philosophers, psychologists, sociologists and other thinkers interested in exploring social issues with scientific rigour.
    [Show full text]
  • Attention Deficit Hyperactivity Disorder: a Reflection of Increased Medicalization in America? Schaeffer, Brooke 2020
    Lehigh Preserve Institutional Repository Attention Deficit Hyperactivity Disorder: A Reflection of Increased Medicalization in America? Schaeffer, Brooke 2020 Find more at https://preserve.lib.lehigh.edu/ This document is brought to you for free and open access by Lehigh Preserve. It has been accepted for inclusion by an authorized administrator of Lehigh Preserve. For more information, please contact [email protected]. Running Header: ADHD AND MEDICALIZATION IN AMERICA 1 Attention Deficit Hyperactivity Disorder: A Reflection of Increased Medicalization in America? Brooke Schaeffer Lehigh University BIOS 297, Professor Fink ADHD AND MEDICALIZATION IN AMERICA 2 Title: ADHD: A Reflection of Increased Medicalization in America? ​ Abstract: Medicalization in the United States has created more consistent classification and treatment guidelines for disorders and diseases nation-wide. However, the concept may foster a tendency toward premature diagnosis. The same can be said about pharmaceuticalization and quickness to medicate. Drug innovation and administration can be integral to quality of life, but how does this relationship shift when health becomes a commodity? How can the business end of medicine and pharmacy conflict with ethical responsibilities to patients? Here I utilize the increase in American Attention Deficit Hyperactivity Disorder diagnoses and psychostimulant prescriptions to illustrate potential repercussions of an increasingly medicalized and pharmaceuticalized society. I argue that the premature prescription of medication in response to rising ADHD diagnoses is an unethical course of treatment, thereby impeding the identification of the true causes underlying the symptoms and exposing the patient to unnecessary drug risks and side effects as a reflection of commercialized health. Introduction Over the past few decades, the number of Attention Deficit Hyperactivity Disorder (ADHD) diagnoses in America has increased significantly.
    [Show full text]
  • Assessment of Epidemiological Determinants of COVID-19 Pandemic Related to Social and Economic Factors Globally
    Journal of Risk and Financial Management Article Assessment of Epidemiological Determinants of COVID-19 Pandemic Related to Social and Economic Factors Globally Mohammad Mahmudul Hassan 1,* , Md. Abul Kalam 2 , Shahanaj Shano 3, Md. Raihan Khan Nayem 1 , Md. Kaisar Rahman 1,4 , Shahneaz Ali Khan 1 and Ariful Islam 4,5 1 Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh; [email protected] (M.R.K.N.); [email protected] (M.K.R.); [email protected] (S.A.K.) 2 Helen Keller International, Dhaka 1212, Bangladesh; [email protected] 3 Institute of Epidemiology, Disease Control and Research, Dhaka 1212, Bangladesh; [email protected] 4 EcoHealth Alliance, New York, NY 10001, USA; [email protected] 5 Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Geelong, VIC 3216, Australia * Correspondence: [email protected] Received: 24 July 2020; Accepted: 28 August 2020; Published: 1 September 2020 Abstract: The COVID-19 pandemic has manifested more than a health crisis and has severely impacted on social, economic, and development crises in the world. The relationship of COVID-19 with countries’ economic and other demographic statuses is an important criterion with which to assess the impact of this current outbreak. Based on available data from the online platform, we tested the hypotheses of a country’s economic status, population density, the median age of the population, and urbanization pattern influence on the test, attack, case fatality, and recovery rates of COVID-19. We performed correlation and multivariate multinomial regression analysis with relative risk ratio (RRR) to test the hypotheses.
    [Show full text]
  • 41 Bus Time Schedule & Line Route
    41 bus time schedule & line map 41 41a Chedoke Hospital View In Website Mode The 41 bus line (41a Chedoke Hospital) has 7 routes. For regular weekdays, their operation hours are: (1) 41a Chedoke Hospital: 12:00 AM - 11:20 PM (2) Gage at Industrial: 3:28 PM (3) Gage at Industrial Via Kenilworth: 12:25 AM - 11:51 PM (4) Gage at Industrial Via Ottawa: 12:03 AM - 11:33 PM (5) Lime Ridge Mall: 2:07 PM - 3:29 PM (6) Meadowlands: 12:20 AM - 11:40 PM (7) Mohawk at Upper James: 1:05 AM Use the Moovit App to ƒnd the closest 41 bus station near you and ƒnd out when is the next 41 bus arriving. Direction: 41a Chedoke Hospital 41 bus Time Schedule 79 stops 41a Chedoke Hospital Route Timetable: VIEW LINE SCHEDULE Sunday 12:28 AM - 11:47 PM Monday 5:02 AM - 11:20 PM Industrial Opposite Depew 42 Industrial Drive, Hamilton Tuesday 12:00 AM - 11:20 PM Gage at Burlington Wednesday 12:00 AM - 11:20 PM 950 Burlington Street, Hamilton Thursday 12:00 AM - 11:20 PM At 377 Gage Friday 12:00 AM - 11:20 PM 377 Gage Avenue, Hamilton Saturday 12:00 AM - 11:28 PM Gage at Beach 337 Gage Avenue, Hamilton Beach at Albemarle 140 Beach Road, Hamilton 41 bus Info Direction: 41a Chedoke Hospital Beach at Rowanwood Stops: 79 11 Rowanwood Street, Hamilton Trip Duration: 49 min Line Summary: Industrial Opposite Depew, Gage at Beach Opposite Gate 3 Burlington, At 377 Gage, Gage at Beach, Beach at 276 Beach Road, Hamilton Albemarle, Beach at Rowanwood, Beach Opposite Gate 3, Beach at Ottawa, Ottawa at Beach, Beach at Beach at Ottawa Woodleigh, Beach at Bayƒeld, Grenfell at Martimas,
    [Show full text]
  • Inequality Report 2021: India's Unequal
    Inequality Report 2021: India’s Unequal Healthcare Story Acknowledgements I want to express my gratitude to all the people who made this report happen. It has benefited from extensive discussions with Amitabh Behar. Professor Amitabh Kundu provided critical inputs at various stages of the report as an expert guide, which greatly improved the quality of the report. Dr Pavitra Mohan, a public health expert who is currently associated with Aajeevika Bureau’s Amrit clinics, provided guidance in improving the analysis of the report as a peer reviewer. I would also like to thank our colleagues in Oxfam India—Anjela Taneja, Ankit Vyas, Agrima Raina, Akshay Tarfe, and Amita Pitre—for their review of the draft versions of the report. I also take this opportunity to thank Outline India for conducting the primary survey in seven states of India on behalf of Oxfam India. I thank Apoorva Mahendru, Mayurakshi Dutta, Pravas Ranjan Mishra, Sucheta Sardar, Khalid Khan and Vikrant Govardhan Wankhede for their contribution in authoring the report. I thank Diya Dutta for conceptualizing and guiding the team in developing the report. I also acknowledge the support of Priyanka Sarkar in editing the report and of Anandita Bishnoi for designing the report. I want to acknowledge and thank the Operations and the Public Engagement team members—Satya Prakash Mishra, Tejas Patel, Savvy Soumya Misra and Rahul Sharma—for the support provided by them. Ranu Kayastha Bhogal Commissioning Editor CONTENTS Foreword by Amitabh Behar 01 List of Figures 03 List of Tables 04
    [Show full text]
  • Covert Medication in Psychiatric Emergencies: Is It Ever Ethically Permissible?
    REGULAR ARTICLE Covert Medication in Psychiatric Emergencies: Is It Ever Ethically Permissible? Erick K. Hung, MD, Dale E. McNiel, PhD, and Rene´e L. Binder, MD Covert administration of medications to patients, defined as the administration of medication to patients without their knowledge, is a practice surrounded by clinical, legal, ethics-related, and cultural controversy. Many psychiatrists would be likely to advocate that the practice of covert medication in emergency psychiatry is not clinically, ethically, or legally acceptable. This article explores whether there may be exceptions to this stance that would be ethical. We first review the standard of emergency psychiatric care. Although we could identify no published empirical studies of covert administration of medicine in emergency departments, we review the prevalence of this practice in other clinical settings. While the courts have not ruled with respect to covert medication, we discuss the evolving legal landscape of informed consent, competency, and the right to refuse treatment. We discuss dilemmas regarding the ethics involved in this practice, including the tensions among autonomy, beneficence, and duty to protect. We explore how differences between cultures regarding the value placed on individual versus family autonomy may affect perspectives with regard to this practice. We investigate how consumers view this practice and their treatment preferences during a psychiatric emergency. Finally, we discuss psychiatric advance directives and explore how these contracts may affect the debate over the practice. J Am Acad Psychiatry Law 40:239–45, 2012 Covert medication of patients, defined as the admin- was published in an article in Annals of Emergency istration of medicine to patients without their Medicine entitled, “An Unusual Case of Subterfuge knowledge, is a practice surrounded by clinical, legal, in the Emergency Department: Covert Administra- ethics-related, and cultural controversy.
    [Show full text]