Non-clinical uses of antipsychotics in resource-constrained long-term care facilities

Ethically justifiable as lesser of two evils

Bibliographic Data

ID21514651
AuthorsHojjat Soofi (0000-0002-7429-6970, Macquarie University, corresponding author)
Year2023
Volume49
Issue10
Pages694-698
Publication date2023-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueJournal of Medical Ethics (JOURNAL)
Journal identifiersISSN: 0306-6800 • E-ISSN: 1473-4257
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/jme-2022-108639
PMID36585244
OpenAlexW4313308079
LanguageEN
Citations received1
References cited24

Residents with dementia in long-term care facilities (LTCFs) often receive antipsychotic (AP) medications without clear clinical indications. One non-clinical factor influencing the use of APs in LTCFs is low staff levels. Often, using APs is viewed and rationalised by healthcare professionals in LTCFs as a lesser evil option to manage low staff levels. This paper investigates the ethical plausibility of using APs as a lesser of two evils in resource-constrained LTCFs. I examine the practice vis-à-vis the three frequently invoked conditions of lesser evil justifications as specified in the wider philosophical literature. These conditions include (1) the necessity condition, (2) the condition of sensitivity to both deontic (ie, constraint-based) and non-deontic (ie, outcome-based) considerations and (3) the commensurability condition. I argue that there are considerable difficulties in demonstrating that the practice in question satisfies the conditions of lesser evil justifications. In particular, there are major difficulties in satisfying the condition of sensitivity to deontic and outcome-based considerations, and the commensurability condition. I also argue that the current philosophical debate on lesser-evil justifications is not straightforwardly applicable to the practice of using APs for non-clinical purposes in LTCFs. I contend that caregivers are not so-called ‘generic’ agents, and the assumed rarity of lesser evil cases is questionable. I conclude that until further work is done to resolve these issues, the lesser evil reasoning cannot be, at least routinely, used to formulate robust moral justifications for the practice in question

Deontic logic · Epistemology · Health care · Neglect · Political science · Psychiatry · Ethics in medical practice · Healthcare Decision-Making and Restraints · Law · Medicine · Patient Dignity and Privacy · Philosophy · Psychology

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