Covert Medication: The Pros and Cons

One of the great difficulties when treating mental illness is how to help patients adhere to their prescription. This has led to the practice of “covert medication”, administered without the patient’s awareness, despite practical and ethical concerns.

What Is Covert Medication?

Covert medication is medicine that is given without the patient’s knowledge, generally concealed in food or drink, in cases where they are incapable of giving informed consent to treatment. The circumstances when covert medication is acceptable are taught in courses about the safe handling of medication, such as at https://www.tidaltraining.co.uk/health-and-social-care-courses/safe-handling-of-medication-training/.

Pros of Covert Medication

The main advantage of covert medication is that the patient will receive the medicine they need, even in situations when they do not have the mental capacity to accept or reject it in an informed manner. It may even restore the ability to actively participate in treatment. The risk of long-term or serious harm is reduced, along with the costs associated with delayed treatment. It is also less intrusive than some approaches, such as restraint and physical force, and is easier to deliver in facilities that do not have the knowledge, experience or resources for alternative methods.

Cons of Covert Medication

Informed consent is one of the most important principles in medicine. It guards against the exploitation of patients and ensures that they are respected as autonomous individuals. In some cases, it is legally mandated. It is impossible to give informed consent when medication is covertly administered. You will not know what you are taking, the potential side effects or whether you need to avoid other medication at the same time. Covert medication also undermines trust between doctors and patients and may turn into a way to manage patients perceived as “difficult” without attempting to understand the reasons for non-compliance or helping the patient gain insight and control themselves.

There may be advantages to covert medication, but that does not remove the serious ethical concerns. It should not be practised without a full evaluation of these issues relative to the potential benefits, and only when less problematic approaches have been eliminated.