Ethical issues of psychotropic medication for people with intellectual disabilities
| Date | 27 September 2010 |
| DOI | https://doi.org/10.5042/amhid.2010.0541 |
| Published date | 27 September 2010 |
| Pages | 34-38 |
| Author | Raghu Raghavan,Pradip Patel |
| Subject Matter | Education,Health & social care |
34 Advances in Mental Health and Intellectual Disabilities Volume 4 Issue 3 September 2010 © Pier Professional Ltd
10.5042/amhid.2010.0541
PRACTICE
Introduction
People with an intellectual disability (ID) are one of the
highly medicated populations in our society. The Royal
College of Psychiatrists published guidelines on the use of
high doses of antipsychotic medication following concern in
the media about sudden deaths with such drugs (Thompson,
1994). It is estimated that between 20% and 45% of people
with an intellectual disability are on antipsychotic drugs;
14–30% of these people are on such medication to manage
behaviour problems or challenging behaviour (Deb &
Fraser, 1994). The most common reason for prescribing
antipsychotic medication to people with an ID is, in fact,
not psychosis but for management of behaviour problems
(Molyneaux et al, 2000). Clarke and colleagues (1990)
reported that 36% of people with an ID in three residential
settings were on psychotropic medication without a formal
psychiatric diagnosis. Although use of such medication in the
treatment of psychiatric disorders can be justified, its use
in the management of behaviour problems alone is more
controversial. There is continued concern that medication is
over-used and/or used too quickly for behaviour problems
without adequate evidence to support its use. For example,
a recent trial (Tyrer et al, 2008) of haloperidol, risperidone
and placebo RCT in treatment of aggressive behaviour in
people with ID concluded that antipsychotic drugs should no
longer be regarded as an acceptable, routine treatment for
aggressive challenging behaviour in people with intellectual
disability. Use of antipsychotic medication under such
circumstances is out of licence. This brief paper will explore
some of the key ethical issues in the use of psychotropic
medication for people with a learning disability.
Historically, Western medical ethics may be traced to
guidelines on the duty of physicians in antiquity, such as the
Hippocratic Oath.
Six of the values that commonly apply to medical ethics
discussions are:
autonomy – the patient has the right to refuse or
choose their treatment (Voluntas aegroti suprema lex)
beneficence – a practitioner should act in the best
interest of the patient (Salus aegroti suprema lex)
non-maleficence – ‘first, do no harm’ (primum non
nocere)
justice – concerns the distribution of scarce health
resources, and the decision of who gets what
treatment (fairness and equality)
dignity – the patient (and the person treating the
patient) have the right to dignity .
truthfulness and honesty.
Values such as these do not give answers on how to handle
a particular situation, but provide a useful framework for
understanding conflicts.
Decision-making processes
In England the policy guidelines Valuing People (DH, 2001) and
the Valuing People Now (DH, 2009) strategy for people with
Raghu Raghavan
School of Health, Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK
Pradip Patel
Consultant Psychiatrist, Lancashire Care NHS Foundation Trust, Preston, UK
Abstract
There is over-use of psychotropic medication with people with intellectual disabilities. Many of these individuals do not have the capacity to
understand and retain the relevant information about the use and effectiveness of medication. Professionals and health care practitioners need
to be fully aware of the ethical and legal issues in the use and administration of psychotropic medication.
Key words
learning disabilities; intellectual disability; medication; ethical and legal issues
Ethical issues of psychotropic medication
for people with intellectual disabilities
To continue reading
Request your trial