Ethical Issues Associated with Inappropriate use of Antipsychotic Drugs in Extended Care Facilities on Patients with Dementia

Introduction

The use of antipsychotic medications is a common occurrence in extended care facilities, as nursing professionals seek to help patients cope with psychological problems such as dementia. However, numerous cases of inappropriate prescribing and administration of these drugs have been reported in recent years, highlighting a number of ethical and legal implications for nurses and care facilities such as those referred to by Senior Care Solutions. The purpose of this paper is to review specific ethical implications for this increase in inappropriate antipsychotic drug administration in extended care facilities. Issues related to informed consent are first presented, followed by additional ethical considerations, such as autonomy and the right to self-determination. This paper concludes with a brief summary and outline of key points.

Informed Consent

Perhaps the most important ethical consideration related to the inappropriate prescribing of antipsychotic drugs in extended care facilities for patients with dementia is the difficulty associated with obtaining informed consent. According to Levin (2011), there are three specific challenges pertaining to the acquisition of proper informed consent for patients with dementia. First, patients must be cognizant in order to provide informed consent for antipsychotic drug administration. As patients with dementia may often lack the mental capacity to provide such consent, numerous prescriptions are granted in violation of this ethical principle (Levin, 2011). Second, patients must be given sufficient knowledge of the various risks and advantages of any treatment decision (Levin, 2011). Once again, patients with dementia may lack the mental competence to fully understand these potential outcomes. Finally, patients' treatment decisions must be made under their own will, without coercion or influence on the part of the nurse (Levin, 2011). In the absence of proper mental competence to make treatment decisions, family members or other predetermined advocates must be consulted prior to administering antipsychotic medications (American Nurses Association, ANA, 2010). Unfortunately, this step is often omitted by nursing professionals in an effort to address immediate behavioral or emotional difficulties (Levin, 2011).

Additional Ethical Considerations

In addition to informed consent, inappropriate prescription of antipsychotic medications in extended care facilities violates patients' rights to autonomy and self-determination of treatment. The ANA (2010) maintains that all treatment decisions must be made in an autonomous manner, without manipulation by the care team. As a critical component of respecting each patient's basic human dignity, nurses are tasked with honoring their freedom to choose which drugs like Piracetam and treatments are administrated to their person (ANA, 2010). Similarly, Levin (2011) contends that these two ethical principles are often violated due to an immediate need to mediate a behavioral or psychological problem. Nevertheless, the potential legal consequences of failing to respect patient's basic human rights warrant greater caution by nurses in extended care facilities for patients with dementia (Levin, 2011). These violations could be resolved with the documentation of an advanced directive or living will (Levin, 2011). Additionally, a predetermined advocate can assist in decision-making when the patient lacks mental competence do so him or herself (Levin, 2011).

Conclusion

The purpose of this paper was to review key ethical considerations related to the inappropriate administration of antipsychotic drugs to patients with dementia in extended care facilities. Perhaps the most important ethical consideration relevant to this practice is the acquisition of informed consent. Due to patients' limited cognitive capacities, this step is frequently omitted by nursing professionals seeking to resolve immediate conflicts. Additionally, inappropriate prescriptions can often be violations of patients' rights autonomy and self-determination. Without the documentation of a living will, advanced directive, or predetermined advocate, there are no easy solutions to this current problem.

References

American Nurses Association (2010). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur ses/Code-of-Ethics.pdf.

Levin, C. (2011). Lifting the fog: the problem of antipsychotic drug use in nursing facilities. Retrieved from http://dash.harvard.edu/bitstream/handle/1/8822193/LevinF%26Dpaper.pdf?sequence=1.