Do Anti-Psychotics Truly Harm Severely Demented Patients?

The ethical principle of double effect is well understood in Medicine. Basically, it states that unwanted and unintentional bad effects are acceptable when the intent is to do good. Patients who undergo procedures sometimes have unfortunate and unavoidable consequences that may include death. For every attempt to do good a possibility of doing harm exists. So, why is there alarm over the untoward effects of potent anti-psychotics on advanced demented/Alzheimer’s patients?

By the time demented patients required anti-psychotics, they have lost their sentience, i.e., awareness of self and others. So, the control of unruly behavior cannot include verbal appeals and medications are the only alternative. Not infrequently, the unruly behavior is so severe that only potent anti-psychotics manage to re-established some semblance of control.

Recently, some have reported alarming and fatal side-effects to the use of anti-psychotics in severely demented patient and have warned against their use. These alarms have probably lead to less inappropriate AND appropriate use of these agents of control.

In the past, the physical restraining of these patient was condemned and essentially regulated out of use. It now appears that medication restrains may be going the same way. This would leave medical care providers with no options but a padded room. Even then self-harm could not be prevented.

If a life-ending side effect in an unruly, non-sentient demented patient occurs where is the harm? Up to 3% of sentient patient going to coronary bypass surgery die before leaving the hospital and this untoward effect has NOT stopped these bypasses from being performed daily. The principle of double effects permits these procedures to go on.

In the same way, the appropriate use of potent medications, i.e., anti-psychotics, for unruly demented patients must also be permitted. If an unintentional life-ending side effect occurs, so be it. Their physical deaths are frequently not as painful as the psychological and social deaths that the dementia had caused.

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