Constructing a Systematic Review for Argument-Based Clinical Ethics Literature: The Example of Concealed Medications

Abstract

The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual “Clinical Ethics” issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed:

1. identify a focused question;

2. conduct a literature search using key terms relevant to the focused question;

3. assess the adequacy of the argument-based methods of the papers identified; and

4. identify conclusions drawn in each paper and whether they apply to the focused question.

We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia.

Keywords:

• systematic review
• argument-based ethics
• concealed medications
• mental illness
• dementia