Ethics England Wales

Last updated:

7. Restraint

What is restraint?

There may be occasions when health professionals need to consider the use of restraint in treating an individual lacking capacity. The Act states that restraint is the use or threat of force, to make someone do something they are resisting, or restricting a person’s freedom of movement, whether they are resisting or not.

The Act only refers to restraint to prevent harm to the patient. Health professionals have a common law right to use restraint to prevent harm to others.

 

Types of restraint

Restraint can be overt, such as the use of bed rails. It can also be covert and indirect such as doors that are heavy and difficult to open or putting patients in low chairs from which they find it difficult to move. Restraint may be:

  • physical – holding by one or more persons
  • mechanical – the use of equipment such as bed rails or mittens to stop patients removing nasogastric tubes or catheters
  • chemical – involving medication, for example sedation
  • psychological – telling patients that they are not allowed to do something, or taking away aids necessary for them to do what they want, for example spectacles or walking aids.

 

When is restraint lawful?

Restrictive measures should be a last resort and alternatives to restraint must always be considered.

Anybody proposing to use restraint must have objective reasons to justify that it is necessary. They must also be able to show that the patient is likely to suffer harm unless proportionate restraint is used.

A proportionate response means using the least intrusive type and the minimum amount of restraint to achieve the objective, in the best interests of the patient lacking capacity. If these conditions are met, it is permissible to restrain a patient to provide necessary treatment. It also follows that in such circumstances there would be no liability for assault.

The restraint must not amount to a deprivation of liberty and if it is considered necessary to go so far as to deprive someone of their liberty in order to safeguard their interests, special safeguards must be employed. (For further information on deprivation of liberty, see card 8).

 

Next card

 

Download

Card 7 (PDF)