Covert Administration of Medication to Persons with Dementia: Exploring Ethical Dimensions.

The literature, although sparse, reports that covert administration of all types of medications is prevalent in nursing homes. Whether it is ever ethically defensible, however, to administer medications covertly to persons with significant dementia is a complex and contentious question. Some scholars contend that deception is inherently wrong and is never acceptable, while others believe that deception is intrinsic to providing care to persons with dementia. With an aim to begin to reconcile these polarized positions and to objectively study this contentious issue, the authors undertake an ethical analysis of the covert administration of medications by utilizing the principles of respect for autonomy, nonmaleficence, beneficence, and justice. Our approach examines covert administration within the context of all persons with significant dementia who are administered medications, and is aimed at providing ethical and practical guidance to clinicians who, when confronted with a patient who refuses medication, must choose the "least bad" option from among various courses of action, all of which have ethical implications. Components of a possible guideline for practice are proposed.

Living with paraplegia: tensions and contradictions.

Although it is well established that paraplegia results in dramatic lifestyle changes, little is understood about living in the community with paraplegia, especially from the perspective of the person with paraplegia. To develop insight into this experience, in-depth, personal interviews were conducted with seven individuals with paraplegia who had been living back in the community for less than two years. Qualitative analysis of their transcribed interviews suggests that the transitional process revolved around their struggle to reposition themselves in a holististic way that reflects the injury while moving beyond it. Four interrelated challenges textured the experience: maintaining an identity beyond the medical; contending with the stigma of difference; addressing the invisible work of day-to-day living; and balancing independence and dependence. Implications for practice are discussed.

Using a harm reduction approach with clients who have alcohol/drug dependencies in a spinal cord rehabilitation program.

BACKGROUND: Dissatisfied with the frequently adversarial nature of relationships with clients who use alcohol or drugs while rehabilitation inpatients, and the often less than optimal outcomes for these individuals, the Spinal Cord Program at the G.F. Strong Rehabilitation Center in Vancouver, BC, decided to pilot a new approach. OBJECTIVE: The goal of the pilot project is to promote successful rehabilitation, including less conflict in rehabilitation, a completed rehabilitation program, and continued connection after discharge if needed. METHOD: A dedicated team was formed and trained to work with these clients using harm reduction principles. PARTICIPANTS: From its inception in December 2000, through May 2001, the team worked with 6 inpatients, 12% of admissions to the Spinal Cord Program during that period. RESULTS: Outcomes based on the above goals have been positive. There have been no discharges against a client's will or instances of significant conflict with the team. Several clients have returned to the center for assistance or to visit post-discharge. Only 1 client left rehabilitation prematurely.