Was this ethical? - page 3

I overheard a fellow student talking to our clinical instructor about whether or not a certain patient had ever taken his meds. (He is notorious for refusing them.) When our instructor asked about... Read More

  1. by   XYcsccSN
    Quote from Daytonite
    Did the patient have dementia? You also have to consider that the very fact that being a patient and being present in the facility for care is consent to treat.
    No, its not. A patient can't be just forced into care simply because they are at a facility. That's why we have an informed consent processes for procedures. That thinking is way outdated, patients have to right to refuse or accept any part of the care they wish.
  2. by   nursesail
    In the light of what you said, the student behaved unethically.
  3. by   Sade
    ALL patients have a right to choose to or refuse to take there medications REGARDLESS of there condition or mental status. AS NURSES WE ARE NOT GODS and no this is not ethical. I get worried and a little angry when I hear nurses say anything otherwise. If a patient has the ability to speak, shake his head, close his mouth, etc... then as a nurse we should be respecting his/her wishes and right to refuse any medical procedure or medication administration regardless of his/her mental status. Of course DPO's can decide appropriate measures on medication administration. But until you know for sure the patient has a DPO and or what the wishes of the DPO are, I'd make sure you do EXACTLY what the patient wants. Just make sure you document everything. If needed PRN's and adjustments can be ordered by the Physician later. There's only a couple of things that really upset me and get me motivated to write on this website and patient's rights is one of them. The other is my objections to Government funded health care. A patient ALWAYS has a right to know the medications he is being given prior to administration. Period. INTEGRITY... Take care all.
  4. by   adoyo
    I have enjoyed sharing other peoples' response to this topic of patients refusing medication since I have had to make difficult decisions every now and then as the concerned authorities do not give clearcut policies on the issue.
    We had a resident with Dementia and experiencing severe distress reactions and was throughout the day refusing her mood stabilizers. This was all the time recorded in the MAR sheet and a behaviour monitor chart filled in for a whole week.
    All that the GP did on his next review day was to cancell all the medication and advised the social services and community Psychiatrist Nurse to schedule a date for review of the client!! This was going to take another week or so!!
    All this time the resident continued to swear and physically abusing staff and other residents. If we were allowed to treat each case differently, without a blanket of 'do not give medication covertly' in fear of court cases, this lady could have been saved the ordeal as well as the staff who had to continue chucking the medication and operating under stess!!
  5. by   dream a dream
    Quote from elkpark
    Every client, in any setting, has the right, under state and federal rules & regs, to refuse any medication or other treatment, unless s/he is incompetent and, in that case, the right is held by the guardian or POA. In the case of minors, the parent(s) or guardian has the right to give or withhold consent. In my specialty area, psych, every state has a legal mechanism (the procedures vary somewhat from state to state) for forcing psych meds on seriously mentally ill clients who are refusing treatment but are not acutely dangerous, but the process is usually fairly complicated and requires a fair amount of documentation. I have found over the years, though, that providers in med-surg settings are more likely to play "fast and loose" with the rules and laws than psych providers.

    Signing an admission "consent to treat" form and being present in a facility is not blanket consent to have meds forced on you against your will or without your knowledge.

    Unless the specific client (in the OP) has a duly authorized guardian or POA who has given consent for the medications, slipping the medication into food unbeknownst to the client is illegal and unethical. I'm surprised that the clinical instructor didn't raise these issues with the students.
    Totally agree... it is illegal and un-ethical. If the patient has demetia he/she still needs to have a MD state in the chart that they are incompetent... and then somebody has to be placed in charge... not the nurse.
    The proper steps that should have been taught by your instructor is to inform the MD that the patient continues to refuse the medications; the MD must take the next step of having the patient evaluated or abiding by the patient's choices.

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