Are You Ever Justified in Deceiving a Patient?

A patient’s irrational refusal to take medication can be frustrating for the nurse. Crushing the pill into applesauce or ice cream saves time and effort, and spares the patient the aggravation of quarreling. But while hiding medication is sometimes ethically justified, often it is not.

That’s the start of the “Putting the Meds in the Applesauce,” an article (free for March) by nurse ethicist Douglas Olsen in the current issue of AJN. Olsen notes that studies suggest hiding medications in food may be a relatively common practice, considers the ethical principles at play in such a decision, and offers advice for those who may be considering it. (Added: The column chiefly concerns the nursing care of cognitively impaired patients—not those who simply don’t want medications or those with with psychiatric illnesses who may be endangering themselves or others by refusing medication.)

Says Olsen, “

[t]wo factors must be considered in determining whether hiding medication is justified or not: the nurse–patient relationship and the patient’s rights.” He adds that such a decision “requires the nurse and surrogate decision maker to imagine how the patient might have reasoned: would the earlier, cognitively intact patient have agreed that, given the present impairment, the providers shouldn’t be morally bound to accept the patient’s decision to decline medication?”

Another question he suggests asking oneself is this: “could the deception survive public scrutiny, including that of professional peers?”

What’s your take? What’s your experience?—JM, senior editor

Bookmark and Share

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. jm March 2, 2012 at 10:10 am

    Yes, the article is focused mainly on cognitively impaired patients. We’ve added a note to the first paragraph to make that clear.–Jacob

  2. Debra Collins, RN, RAC-CT March 2, 2012 at 8:45 am

    If a person is confused to the point of being unable to make decisions about safety and the basic needs of life, common sense and compassion must prevail. That is also a case when a Living will would be helpful.

  3. Aimee Hansen March 1, 2012 at 5:58 pm

    We are never justified in deceiving our patient.
    When we alter the truth we take away our patient’s right to self-determination. No-one, least of all a nurse, should be considering such a thing.
    Sadly, we also eliminate trust – there is no such thing as a healthy relationship of which trust is not a part.
    This is a clear cut ethical decision point.
    The only exception would be when our patient is altered. But even then we should request the physician’s assistance, it is not an ethical decision we make solely on our own, as the nurse.
    If we have our patient’s best interests at heart, and a clear ethical education, it will make our decision making much easier!

Comments are moderated before approval, but always welcome.

%d bloggers like this: