Ethical question

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I work at a long term care facility, and one of our younger residents is suspected of "cheeking" her meds. The dr wrote an order to crush meds and give with applesauce. My question is does she have the right to refuse for them to be crushed?

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Is the resident is competent to make her own decisions?

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in MN, unless there is a court order stating they can be forced to take their meds, they can refuse, doctors orders or not.

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There's two questions here. One, can she refuse to have her meds crushed and two, can she refuse her medications, period. (The assumption here is that we're talking about oral meds.)

Answering the second question first - of course she can refuse her meds. Whether competent or not, no one can force her to take them.

The first question is trickier. When our doctors order medications to be crushed, it's generally because of swallowing difficulties. Then the order is phrased as nurses 'can crush'. But if the order is phrased as medications 'must be crushed' (because the doctor suspects the patient of pocketing narcotics or something like that), it needs to be documented.

Personally I'd go by the order. If it says 'can be crushed', it's up to the patient. If it says 'must be crushed', than that's the only way you can offer/give it and if the resident has problems with it, she needs to work it out with the doctor.

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Specializes in Pedi.

Has anyone addressed this with the resident? Why is she doing this? Is it because she doesn't want to take her meds or is she saving a stash of something for later? Is she competent? If so, she can refuse her medications but one also wonders why she would be cheeking them as opposed to just saying "I'm not taking those."

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The fact that this question has to be asked terrifies me. I commend the OP for coming out and asking but I wonder how many do not? We must keep in mind that our patients, clients, customers are human beings underneath it all with certain inherent unalienable rights and we have a sacred duty to be their advocate.

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The fact that this question has to be asked terrifies me. I commend the OP for coming out and asking but I wonder how many do not? We must keep in mind that our patients, clients, customers are human beings underneath it all with certain inherent unalienable rights and we have a sacred duty to be their advocate.

That duty isn't sacred (in respect of those who don't believe it has anything to do with any supreme being)-- it's statutory. Acting as a patient advocate is in the state nurse practice acts and also in the ANA Scope and Standards of Practice, which is binding on all RNs.

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That duty isn't sacred (in respect of those who don't believe it has anything to do with any supreme being)-- it's statutory. Acting as a patient advocate is in the state nurse practice acts and also in the ANA Scope and Standards of Practice, which is binding on all RNs.

I was not using it in the religious associated form but rather in the modern "highly valued an important" form. The term was used to differentiate it from a simple legal duty and show that the duty went beyond legal requirements and was a moral obligation to society for the trust of being a nurse.

Do you advocate for your patients ONLY because the law requires it of you?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I work at a long term care facility, and one of our younger residents is suspected of "cheeking" her meds. The dr wrote an order to crush meds and give with applesauce. My question is does she have the right to refuse for them to be crushed?
My first question is why is she doing this? Has anyone asked her why? What meds is she cheeking? Is she competent?
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I was not using it in the religious associated form but rather in the modern "highly valued an important" form. The term was used to differentiate it from a simple legal duty and show that the duty went beyond legal requirements and was a moral obligation to society for the trust of being a nurse.

Do you advocate for your patients ONLY because the law requires it of you?

No, I advocate for my patients, as should we all, because performance of our moral duty is both intrinsic (dependent on a system of ethics) and extrinsic (dependent on a legal system).

I hear you about your use of the word "sacred," but like it or not, it does have a specific meaning with religious association. "Moral" might have been a better choice. We don't disagree on that part.

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Thank you all for your replies. The patient is competent to make decisions. I understand that she can refuse her medication, but the order states to crush all meds. Patients can refuse any aspect of their care so in my opinion, it seems like she could still refuse that. Am I wrong in my thinking?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

but why is she cheeking them? Is she looking to hoard them for future used/abuse? Is she suicidal?

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