An unusual case of subterfuge in the emergency department: covert administration of antipsychotic and anxiolytic medications to control an agitated patient.
Pediatric, nursing home, and institutionalized psychiatric patients frequently receive medications covertly or against their will. Surreptitious medicating of emergency department (ED) psychiatric patients may occur but has not been reported. We discuss competing ethical, therapeutic, and legal issues in potential conflict during the treatment of an acutely psychotic patient who had homicidal and suicidal ideation and presented to a busy, urban ED. The practice of covertly medicating may not be uncommon in EDs, but fear of professional censure probably inhibits open discussion and documentation of such events. No specific statutory, ethical, or case law in the United States seems to control this type of situation.
Lewin
Matthew R
MR
University of California, San Francisco, CA, USA. aplysia99@yahoo.com
Montauk
Lance
L
Shalit
Marc
M
Nobay
Flavia
F
D000284:Administration, Oral; D000328:Adult; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D001628:Beverages; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D002140:California; D004363:Drug Utilization / Q000941:ethics; D004637:Emergency Services, Psychiatric / Q000941:ethics* / Q000379:methods*; D006220:Haloperidol / Q000008:administration & dosage; D006801:Humans; D007258:Informed Consent; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D012308:Risk Management / Q000379:methods; D016312:Treatment Refusal / Q000941:ethics*
D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D006220:Haloperidol; D008140:Lorazepam