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The use of restraint in health and social care is controversial, both in legal and moral terms. Restraint is defined in the New Shorter Oxford English Dictionary 1 as the "deprivation or restriction of liberty or freedom of action or movement". Restraint may involve the physical containment of one individual by another person or persons, with or without the use of mechanical aids. It may comprise the use of equipment (for example door locks) to ensure that an individual cannot move outwith a prescribed area. More subtle restraints may also be employed, for example removing walking aids from an individual's reach, or ensuring that the environmental temperature in certain areas within care settings discourages loitering. The application of electronic tagging devices can alert staff to the movement of an individual outwith a desired area and thus enables their apprehension. Chemical restraint of individuals may be achieved by the use of sedative medication, on either a short or long term basis.
While the foregoing measures breach individual autonomy-that is, the right to make one's own decisions-the justification in health and social care settings is usually that restraint is in the service user's best interest (the ethical principle of beneficence) and/or is carried out in order to prevent the individual coming to harm (the principle of non-maleficence). If a further rationale is provided, it may be that, while autonomy is a prima facie principle (that is, at first sight appears to be one that should be upheld), it is predicated upon an individual having insight into the consequences of their actions. This then is used to justify, for example, the restraint of a young child while they are given an injection, or of a vulnerable adult who attempts to leave a care setting. A further principle, however, that must be taken into the equation is that of justice, which may be applied in strictly legal terms, or may include the morality or otherwise of an action or inaction, aside from its legal repercussions.
The purpose of this review article is to examine the circumstances under which it may be justifiable to restrain a patient and the acceptable means by which such restraint may be achieved. It is, however, emphasised that, wherever possible, the use of restraint should...