Guidry-Grimes Laura, Dean Megan, Victor Elizabeth Kaye
Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Philosophy, Hamilton College, Clinton, New York, USA.
J Med Ethics. 2020 Feb 14. doi: 10.1136/medethics-2019-105763.
The covert administration of medication occurs with incapacitated patients without their knowledge, involving some form of deliberate deception in disguising or hiding the medication. Covert medication in food is a relatively common practice globally, including in institutional and homecare contexts. Until recently, it has received little attention in the bioethics literature, and there are few laws or rules governing the practice. In this paper, we discuss significant, but often overlooked, ethical issues related to covert medication in food. We emphasise the variety of ways in which eating has ethical importance, highlighting what is at risk if covert administration of medication in food is discovered. For example, losing trust in feeders and food due to covert medication may risk important opportunities for identity maintenance in contexts where identity is already unstable. Since therapeutic relationships may be jeopardised by a patient's discovery that caregivers had secretly put medications in their food, this practice can result in an ongoing deception loop. While there may be circumstances in which covert medication is ethically justified, given a lack of suitable alternatives, we argue that in any particular case this practice should be continually re-evaluated in light of the building moral costs to the relational agent over time.
对无行为能力的患者在其不知情的情况下秘密给药，这涉及某种形式的蓄意欺骗，即对药物进行伪装或隐藏。在食物中秘密添加药物是一种在全球范围内相对常见的做法，包括在机构护理和家庭护理环境中。直到最近，它在生物伦理学文献中很少受到关注，并且几乎没有法律或规则来规范这种做法。在本文中，我们讨论与在食物中秘密给药相关的重大但经常被忽视的伦理问题。我们强调饮食具有伦理重要性的多种方式，突出如果在食物中秘密给药的行为被发现会有什么风险。例如，由于秘密给药而对喂食者和食物失去信任，可能会在身份已经不稳定的情况下危及身份维持的重要机会。由于患者发现护理人员在他们的食物中秘密添加药物可能会危及治疗关系，这种做法可能会导致持续的欺骗循环。虽然在缺乏合适替代方案的情况下，可能存在秘密给药在伦理上合理的情况，但我们认为，在任何特定情况下，都应根据随着时间的推移关系主体所累积的道德成本，对这种做法进行持续重新评估。
