Ethical Issues Arising from the Prescription of Antipsychotic Medication in Clinical Forensic Settings

Abstract

This chapter covers ethical issues requiring consideration when prescribing antipsychotic medications, with particular focus on prescribing that involves high-dose antipsychotics or polypharmacy.

Prescription of antipsychotic medication currently holds a central place in the treatment of many with psychiatric disorders and it at times tends to dominate much of what psychiatrists do—certainly within secure settings where a major arm of the treatment options comprises use of these agents. Medications are prescribed in an attempt to treat mental illness but also to modify the behaviour of patients, both in terms of ameliorating internal distress and in reducing actual and potential violence. Psychiatrists can often find themselves the deliverers of care by virtue of the drugs at their disposal and this is where ethical mindfulness and sensitivity need to play a part in the decisions made.

This chapter offers a debate on considering the overriding principles of medical ethics, namely, autonomy, beneficence (to seek to do good), non-maleficence (to do no harm) and respect for justice when prescribing antipsychotics to forensic patients. As the issues are complex, it is discussed how these principles should be weighed against each other and hardly ever be considered in isolation. Pertinent issues in prescribing within forensic settings such as capacity and informed consent are also discussed.

Forensic psychiatrists quite often need to be able to balance and weigh up the ethical obligations they have to the patients in their care and the ethical obligations they have to the wider society in terms of management of risk. Dr. Hunt-Grubbe in this chapter argues that this dual role is never more apparent than when prescribing and administering high doses or complex regimes of antipsychotic medication to detained patients when consent to do so has been refused or revoked.