Regulating the use of restraints in healthcare: recommendations issued

2023-11-21

Restraining patients is common practice in healthcare, not only in psychiatric care but also in somatic care settings. The practice is regulated in different ways in different countries, but with one major challenge everywhere: ensuring patients with reduced decision-making capacity get the care they need while simultaneously making sure patients with sufficient decision-making capacity are not forced to receive care they don’t want. A recent publication issues recommendations for how to regulate the use of restraints, whether physical or chemical, in somatic healthcare. 

“It is mostly nurses who carry out these coercive measures. The most common motive for forcing patients is to protect them from harming themselves or others: patients may be confused or aggressive and try to pull out vital ports for intravenous drug administration or abuse staff, often without understanding what they are doing themselves. Because the staff act in a legal and moral grey zone, they often feel moral stress exercising coercion,” Niklas Juth, professor of clinical medical ethics and one of the authors, writes on the Uppsala University Ethics Blog.

The authors argue that regulation that includes an assessment of the patients’ decision-making capacity and takes the patient’s best interests into account is preferable to regulations based on psychiatric diagnoses or regulations where there are almost no legal possibilities to practice coercive care at all within somatic care. The authors hope their work can help decision-makers shape regulation in a way that balances ethically relevant considerations about restraints in a way where healthcare staff have the guidance they need and no longer feel they are operating in a grey area.

By Anna Holm Bodin

Guenna Holmgren A, von Vogelsang A, Lindblad A, Niklas Juth. Restraint in somatic healthcare: how should it be regulated? Journal of Medical Ethics. Published Online First: 18 October 2023. doi: 10.1136/jme-2023-109240

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Last modified: 2022-01-10