The precepts and covert medication

Buddhist ethical conduct including the Five Precepts (Pañcasikkhāpada), and Eightfold Ethical Conduct (Aṭṭhasīla).
studentofdhamma
Posts: 2
Joined: Fri Sep 30, 2022 2:13 pm

The precepts and covert medication

Post by studentofdhamma »

Dear All,

I have a question about ethical conduct in regard to my university course.

I am studying a course in the medical field which requires me to go on placements. My upcoming placement will be in a ward that cares for patients with dementia and various psychiatric problems. I have been told that a common practice on wards like this one is covert medication. This involves covertly administering medication by mixing it into food or a drink and then giving this to a patient without telling them. It is used in cases where patients are unlikely to consent to taking a medication that it may be in there best interest.

I'm not sure it sits well with me, however. While it does not seem to be explicitly against the five precepts, as there is no explicit lying involved, it still seems to be somewhat deceptive, even if in the best interests of the patient.

I would be grateful for some advice on this topic.

May all beings be well,
Student of Dhamma.
dharmacorps
Posts: 2006
Joined: Thu Aug 06, 2015 7:33 pm

Re: The precepts and covert medication

Post by dharmacorps »

When someone has dementia, their mind and ability to reason is diminished. Each time you give them medication, it would be a new experience to them because they won't remember taking it before. As long as the medication is not harming them, I don't see a alternative. The intentions of medications is to treat disease and improve health. Many of these people would have been dead long ago were it not for the medications being given to them covertly. I don't see how this particular issue has much to do with the precepts though. If you navigate it the right way. I'm a retired PA so I am familiar with the matter although I worked in pathology, not clinical med.

Ajahn Amaro at a talk I saw once addressed a question from a family member about lying to a relative with dementia. When they ask "where is my brother?" and the brother died 25 years ago, from a strict sense of truth, are you obligated to tell the demented person "your brother is dead"? over and over again every time they forget?

Ajahn Amaro said no. In this situation that would be wrong. He said there are instances in the Pali canon where the Buddha gave answers he knew would be misunderstood by the listener, but were not lies either.

For example "where is my brother?" you could answer "he's not here right now". A fair and true response. Not a lie and not harmful to a demented person.

Hope this helps.
User avatar
lavantien
Posts: 97
Joined: Tue May 21, 2019 5:09 am
Location: HCM, Vietnam
Contact:

Re: The precepts and covert medication

Post by lavantien »

studentofdhamma wrote: Fri Sep 30, 2022 2:20 pm This involves covertly administering medication by mixing it into food or a drink and then giving this to a patient without telling them. It is used in cases where patients are unlikely to consent to taking a medication

that it may be in there best interest.
On careful examination, I conclude that this behavior is certainly a violation of the precepts, particularly lying, and another count on potentially bring intoxicant to another.

Another count is of wrong livelihood, particularly about the involvement in the trade of poisons.
"Then the Teacher, being sympathetic, and having compassion for the whole world,
said to me, “Come, monk!” That was my ordination.
Staying alone in the wilderness, meditating tirelessly,
I have completed what the Teacher taught, just as the victor advised me.

In the first watch of the night, I recollected my past lives.
In the middle watch of the night, I purified my clairvoyance.
In the last watch of the night, I shattered the mass of darkness."
- KN Thag 12.2
studentofdhamma
Posts: 2
Joined: Fri Sep 30, 2022 2:13 pm

Re: The precepts and covert medication

Post by studentofdhamma »

dharmacorps wrote: Fri Sep 30, 2022 6:44 pm When someone has dementia, their mind and ability to reason is diminished. Each time you give them medication, it would be a new experience to them because they won't remember taking it before. As long as the medication is not harming them, I don't see a alternative. The intentions of medications is to treat disease and improve health. Many of these people would have been dead long ago were it not for the medications being given to them covertly. I don't see how this particular issue has much to do with the precepts though. If you navigate it the right way. I'm a retired PA so I am familiar with the matter although I worked in pathology, not clinical med.

Ajahn Amaro at a talk I saw once addressed a question from a family member about lying to a relative with dementia. When they ask "where is my brother?" and the brother died 25 years ago, from a strict sense of truth, are you obligated to tell the demented person "your brother is dead"? over and over again every time they forget?

Ajahn Amaro said no. In this situation that would be wrong. He said there are instances in the Pali canon where the Buddha gave answers he knew would be misunderstood by the listener, but were not lies either.

For example "where is my brother?" you could answer "he's not here right now". A fair and true response. Not a lie and not harmful to a demented person.

Hope this helps.
Hi Dharmacorps,

Thanks for your reply, it was helpful. I suppose that's the question, whether it is harming them. For instance, if a patient is given some porridge with an added vitamin D supplement, what's the difference between this, and a cereal that may have come fortified with vitamins from the factory? However, how often is the medication truly for the patients benefit, and when is it some sort of anti-psychotic or sedative just being used to calm them down for the staff's convenience? Perhaps I will have to go in with an open mind and just be careful.
Last edited by studentofdhamma on Sat Oct 01, 2022 3:06 pm, edited 1 time in total.
studentofdhamma
Posts: 2
Joined: Fri Sep 30, 2022 2:13 pm

Re: The precepts and covert medication

Post by studentofdhamma »

lavantien wrote: Sat Oct 01, 2022 2:20 am
studentofdhamma wrote: Fri Sep 30, 2022 2:20 pm This involves covertly administering medication by mixing it into food or a drink and then giving this to a patient without telling them. It is used in cases where patients are unlikely to consent to taking a medication

that it may be in there best interest.
On careful examination, I conclude that this behavior is certainly a violation of the precepts, particularly lying, and another count on potentially bring intoxicant to another.

Another count is of wrong livelihood, particularly about the involvement in the trade of poisons.
Thanks for your reply Lavantient, I appreciate it. I do wonder whether the lines are blurred in the example of a dementia patient, who does not have the presence of mind to understand that a medication may be beneficial for them, and would refuse it without being able to weigh up the pros and cons. In this case a medical professional may have to step in. I will continue to reflect on it...
befriend
Posts: 2038
Joined: Thu Jun 09, 2011 11:39 am

Re: The precepts and covert medication

Post by befriend »

If it helps people what's the problem?
Take care of mindfulness and mindfulness will take care of you.
befriend
Posts: 2038
Joined: Thu Jun 09, 2011 11:39 am

Re: The precepts and covert medication

Post by befriend »

Speaking as someone who refused anti psychotic medication I think covertly giving them something that keeps them from harmful behavior is excellent. I was so psychotic i didn't want medicine for no reason whatsoever.
Take care of mindfulness and mindfulness will take care of you.
Jack19990101
Posts: 508
Joined: Wed Jun 09, 2021 4:40 am

Re: The precepts and covert medication

Post by Jack19990101 »

Medical area is very tricky in context of Kamma and also context of Sila.

I remember the autobiographic NDE of Dr. Carl Jung. Pardon if detail is inaccurate -
He was resurrected by a doctor at the moment he was about entering the temple of light.

He said, once he came to, he recognized that the doctor who brought him back, will die in his place.

I dk what to make of this. But the story indeed made me think kamma is unfathomable.
dharmacorps
Posts: 2006
Joined: Thu Aug 06, 2015 7:33 pm

Re: The precepts and covert medication

Post by dharmacorps »

studentofdhamma wrote: Sat Oct 01, 2022 3:05 pm

Hi Dharmacorps,

Thanks for your reply, it was helpful. I suppose that's the question, whether it is harming them. For instance, if a patient is given some porridge with an added vitamin D supplement, what's the difference between this, and a cereal that may have come fortified with vitamins from the factory? However, how often is the medication truly for the patients benefit, and when is it some sort of anti-psychotic or sedative just being used to calm them down for the staff's convenience? Perhaps I will have to go in with an open mind and just be careful.
The intention, it is done to help, not harm. Remember, you are a student and new. Its good to think about, but remember people in nursing homes are there for the express purpose of being cared for. There is a legal process to put them there. They must be cared for in a responsible way. I don't see a distinction between a vitamin supplement or medication. Its to care for them. I would recommend asking questions and learning before making judgements.
asahi
Posts: 2525
Joined: Wed Oct 07, 2020 4:23 pm

Re: The precepts and covert medication

Post by asahi »

dharmacorps wrote: Fri Sep 30, 2022 6:44 pm I'm a retired PA so I am familiar with the matter although I worked in pathology, not clinical med.
Hi what differences between pathology n clinical ? Just enquiring .
Peace is more precious than triumph
dharmacorps
Posts: 2006
Joined: Thu Aug 06, 2015 7:33 pm

Re: The precepts and covert medication

Post by dharmacorps »

asahi wrote: Tue Oct 04, 2022 5:56 am
dharmacorps wrote: Fri Sep 30, 2022 6:44 pm I'm a retired PA so I am familiar with the matter although I worked in pathology, not clinical med.
Hi what differences between pathology n clinical ? Just enquiring .
Clinical medicine would be anything with a patient and health professionals (adult medicine, pediatrics, neurologist, urologist, etc). This is most everything you've probably encountered being a patient in medicine. Patients almost never encounter a pathologist, though the tests pathology lab staff work on guide their treatment.
thepea
Posts: 3137
Joined: Sun Jul 06, 2014 11:06 pm

Re: The precepts and covert medication

Post by thepea »

studentofdhamma wrote: Fri Sep 30, 2022 2:20 pm Dear All,

I have a question about ethical conduct in regard to my university course.

I am studying a course in the medical field which requires me to go on placements. My upcoming placement will be in a ward that cares for patients with dementia and various psychiatric problems. I have been told that a common practice on wards like this one is covert medication. This involves covertly administering medication by mixing it into food or a drink and then giving this to a patient without telling them. It is used in cases where patients are unlikely to consent to taking a medication that it may be in there best interest.

I'm not sure it sits well with me, however. While it does not seem to be explicitly against the five precepts, as there is no explicit lying involved, it still seems to be somewhat deceptive, even if in the best interests of the patient.

I would be grateful for some advice on this topic.

May all beings be well,
Student of Dhamma.
You will find it difficult to attain peace in the medical industry.
User avatar
Sam Vara
Posts: 10881
Joined: Sun Jun 05, 2011 5:42 pm
Location: Sussex, U.K.

Re: The precepts and covert medication

Post by Sam Vara »

thepea wrote: Wed Oct 05, 2022 7:54 pm
studentofdhamma wrote: Fri Sep 30, 2022 2:20 pm Dear All,

I have a question about ethical conduct in regard to my university course.

I am studying a course in the medical field which requires me to go on placements. My upcoming placement will be in a ward that cares for patients with dementia and various psychiatric problems. I have been told that a common practice on wards like this one is covert medication. This involves covertly administering medication by mixing it into food or a drink and then giving this to a patient without telling them. It is used in cases where patients are unlikely to consent to taking a medication that it may be in there best interest.

I'm not sure it sits well with me, however. While it does not seem to be explicitly against the five precepts, as there is no explicit lying involved, it still seems to be somewhat deceptive, even if in the best interests of the patient.

I would be grateful for some advice on this topic.

May all beings be well,
Student of Dhamma.
You will find it difficult to attain peace in the medical industry.
Other things being equal, more difficult than other busy and challenging professions? I'd like to see the reasoning behind that.
thepea
Posts: 3137
Joined: Sun Jul 06, 2014 11:06 pm

Re: The precepts and covert medication

Post by thepea »

Sam Vara wrote: Wed Oct 05, 2022 8:49 pm
thepea wrote: Wed Oct 05, 2022 7:54 pm
studentofdhamma wrote: Fri Sep 30, 2022 2:20 pm Dear All,

I have a question about ethical conduct in regard to my university course.

I am studying a course in the medical field which requires me to go on placements. My upcoming placement will be in a ward that cares for patients with dementia and various psychiatric problems. I have been told that a common practice on wards like this one is covert medication. This involves covertly administering medication by mixing it into food or a drink and then giving this to a patient without telling them. It is used in cases where patients are unlikely to consent to taking a medication that it may be in there best interest.

I'm not sure it sits well with me, however. While it does not seem to be explicitly against the five precepts, as there is no explicit lying involved, it still seems to be somewhat deceptive, even if in the best interests of the patient.

I would be grateful for some advice on this topic.

May all beings be well,
Student of Dhamma.
You will find it difficult to attain peace in the medical industry.
Other things being equal, more difficult than other busy and challenging professions? I'd like to see the reasoning behind that.
Sadly, I don’t think you can Sam.
But for example I just read a pregnant woman’s story about her birthing experience.
She was in labour and they wanted to mask her, she refused. They fought her on this for 2 hrs before finally agreeing to let her in if she took the pcr test. She declined. So they threatened her to give birth alone in the room with Drs looking on from outside.
Kind of hard to meditate peacefully when you treat mothers in labour this way. Also this is not a one time event, this is how you are treated in hospitals today.
User avatar
Sam Vara
Posts: 10881
Joined: Sun Jun 05, 2011 5:42 pm
Location: Sussex, U.K.

Re: The precepts and covert medication

Post by Sam Vara »

thepea wrote: Wed Oct 05, 2022 9:14 pm
Sam Vara wrote: Wed Oct 05, 2022 8:49 pm
thepea wrote: Wed Oct 05, 2022 7:54 pm

You will find it difficult to attain peace in the medical industry.
Other things being equal, more difficult than other busy and challenging professions? I'd like to see the reasoning behind that.
Sadly, I don’t think you can Sam.
I might be able to if you present a cogent case.

But you seem to rely on an anecdote that you read somewhere, followed by an unwarranted and unqualified extrapolation of this to the entire medical profession.

So your sadness is justified in this case - I can't see it.

What I do see, though, is a number of practitioners and meditators who seem to have attained to levels of peace commensurate with their business and stress levels, despite being in or recently retired from medicine.
Post Reply