When Protection From Risk-to-Self Causes Harm: A Brief Analysis of Restraint Use to Prevent Elopement.

Abstract

gated to make the same decisions that June would make if June had full capacity. If it is practical for Tasha to execute June’s wishes, she should do so. But, if June’s wishes regarding this particular situation are unclear, ambiguous, or unreasonably dangerous, then Tasha must make decisions that maximize June’s overall best interest. In general, patients are permitted to make unwise or risky decisions for themselves, but surrogates are not afforded the same privilege. Surrogates have an additional obligation to also minimize unreasonable, avoidable risks. The use of either physical or chemical restraints on a patient contemplating leaving the hospital against medical advice can be ethically justified. But the restraints must be emergently necessary, or consented to by the patient, or, if she is deemed to lack decision-making capacity, a surrogate, such as Tasha. Also, the restraint use must be medically necessary to achieve a legitimate clinical goal. Finally, the restraints must be the least liberty-restricting means of achieving the goal. Application of chemical or physical restraints merely for convenience or threatening the deployment of restraints to coerce compliance are ethically problematic. Is the application of chemical restraints to prevent June from leaving the hospital against medical advice ethically justifiable? It depends. FUNDING