TY - JOUR T1 - Covert Medication in Psychiatric Emergencies: Is It Ever Ethically Permissible? JF - Journal of the American Academy of Psychiatry and the Law Online JO - J Am Acad Psychiatry Law SP - 239 LP - 245 VL - 40 IS - 2 AU - Erick K. Hung AU - Dale E. McNiel AU - Renée L. Binder Y1 - 2012/04/01 UR - http://jaapl.org/content/40/2/239.abstract N2 - Covert administration of medications to patients, defined as the administration of medication to patients without their knowledge, is a practice surrounded by clinical, legal, ethics-related, and cultural controversy. Many psychiatrists would be likely to advocate that the practice of covert medication in emergency psychiatry is not clinically, ethically, or legally acceptable. This article explores whether there may be exceptions to this stance that would be ethical. We first review the standard of emergency psychiatric care. Although we could identify no published empirical studies of covert administration of medicine in emergency departments, we review the prevalence of this practice in other clinical settings. While the courts have not ruled with respect to covert medication, we discuss the evolving legal landscape of informed consent, competency, and the right to refuse treatment. We discuss dilemmas regarding the ethics involved in this practice, including the tensions among autonomy, beneficence, and duty to protect. We explore how differences between cultures regarding the value placed on individual versus family autonomy may affect perspectives with regard to this practice. We investigate how consumers view this practice and their treatment preferences during a psychiatric emergency. Finally, we discuss psychiatric advance directives and explore how these contracts may affect the debate over the practice. ER -