Prescription and administration of medicines is a key element of client care. Prescription drug use has increased hugely in recent years. Every day 7,000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). In 1993, 1.9 billion prescriptions were written and in 2001 the number had risen to 3.1 billion cited by Crigger and Holcomb (2008). Prescribers are bound by law and by the demands of good practice to consider the extent to which a person can make decisions regarding taking medications for themselves. The study of adult clients with intellectual disabilities is no exception. Although as adults they are legally eligible to consent or not to consent to their own treatment, persons with intellectual disabilities due to their mental incapacity are often judged to not have the ability to make such informed decisions. X is a 52 year old man with Down syndrome, profound intellectual disability, with a lifelong history of challenging behaviour. He has recently been admitted to reside on a full time basis in a community based home with five other men with varying degrees of intellectual disability following the death of his mother, he is under the care of a nursing and medical team. A number of weeks ago X presenting with severe aggression towards peers and staff and self-injury, he was seen by the consultant psychiatrist and prescribed an atypical antipsychotic drug to treat his behaviour problems. Antipsychotic drugs are used frequently for clients with intellectual disability to help control various behavioural problems, these drugs work by changing the activity of certain natural substances in the brain (Deb and Fraiser, 1994). It is noted in X’s care plan that he has in the past refused to take tablets, following discussion by the nursing team and since being dispensed nurses have administered the tablet concealed within foodstuffs. X is not aware that this is being done, it has however been noted in his drug administration kardex that “due to his level of intellectual disability client can neither consent nor refuse treatment”. X has had an excellent response to the medication, with staff seeing a significant decrease in his presenting challenging behaviour. No written local policy exists which deals with the administration of medications covertly in this way. After six weeks X was reviewed by the consultant psychiatrist and she recommended that he continue taking the medication for a further six weeks, it was brought to her attention at this point that X was being administered his medication covertly within foodstuffs. The psychiatrist had to consider recharting his medication for a further six weeks with the knowledge that no efforts have been made to give the medication openly in its normal tablet form, however following discussion with staff, the medication was recharted as the psychiatrist believed that staff have X’s best interests in mind and consider the administration of the medication to be essential for his health and well-being and for the safety of others. The author intends to discuss this case outlining the legal, ethical and professional issues it raises for all staff involved.
As a general principle of law, every human being of adult years and sound mind has a right to determine what shall be done with his or her body. The main legal issues that surround decision making for persons with intellectual disabilities are of capacity and consent. Every adult is presumed to have the capacity, but it is a presumption that can be rebutted. Once persons have reached adult age it is assumed in law that they are capable of making decisions. However, if a person has some form of intellectual disability and it can be demonstrated that they are not capable then different rules apply. Here a person must be able to understand the nature of the action and its consequences to be able to take a legal decision. Capacity is determined by a test of...
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