Intended for healthcare professionals

Observations Ethics Man

When is restraint appropriate?

BMJ 2010; 341 doi: (Published 04 August 2010) Cite this as: BMJ 2010;341:c4147
  1. Daniel K Sokol, honorary senior lecturer in medical ethics, Imperial College London
  1. daniel.sokol{at}

    All practicable and less invasive alternatives, such as persuasion and de-escalation techniques, must first have been exhausted

    I have encountered the issue of restraint three times in recent months. The first came in my involvement with a Ministry of Justice committee examining the use of a new pain compliance technique in young people in secure institutions. The committee was set up after the Observer ran a front page story detailing violent restraint techniques and the tragic deaths resulting from their use.1

    My second encounter with restraint was in an ethics committee meeting. The patient, who had severe learning difficulties, needed dialysis. Without it she would die in weeks or months. The problem was that she became extremely distressed when undergoing dialysis. The clinicians decided that restraint would not be in her best interests.

    Finally I came across a case that appeared in May 2010 before the Court of Protection, which makes decisions in relation to people who lack the capacity to make the decisions themselves. The patient was a 55 year old woman who needed an operation to treat an endometrial adenocarcinoma.2 Despite …

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