The Conditions for Ethical Chemical Restraints

Abstract

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints.

Keywords:

• Chemical restraints
• consciousness
• cognition
• liberty
• physical restraints
• sedation

This article is referred to by:

Preferences of Individual Mental Health Service Users Are Essential in Determining the Least Restrictive Type of Restraint

On Changes and Opportunities at AJOB Neuroscience

The Lived Realities of Chemical Restraint: Prioritizing Patient Experience

The Limitations of Principlism

On Being Conscious as a Basic Liberty

Basic Liberties, Consent, and Chemical Restraints

Chemical Restraints and the Basic Liberties

On the Relative Intrusiveness of Physical and Chemical Restraints

FUNDING

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 Though often the use of restraints for psychiatric patients is regulated by laws protecting patients undergoing treatment for mental illness.

2 Crutchfield et al. clearly have in mind wrist straps, or straps that bind a person’s wrists to their bed. But there are many types of physical restraints. Devices that restrain one’s fingers (mittens) and long tubes that prevent the bending of elbows (“No-nos”) are two common types. But these, like wrist straps, also restrict basic liberties, as presumably a person who has fingers but is prevented from using them is being prevented from living a free life.

3 Recall Charlton Heston at meetings of the National Rifle Association saying, “I’ll give you my gun when you pry it from my cold, dead hands.” There are clearly very many people who hold similar beliefs about the relative value of basic liberties and continued life. In clinical scenarios, similar reasoning is common—these authors have heard numerous family members say of a patient that they would rather die than spend one second on a ventilator.

4 Chemical restraints, however, need not do any of these things. Douglas (2022) has argued that arguments that “nudging” engages rational capacities (Levy 2019; Schmidt 2019) extend to nonconsensual neurointerventions such as some nonconsensual psychiatric interventions, though this class may not include chemical restraints. If Douglas is right, however, and it’s also true that the antecedent arguments are sound, then chemical restraints may not bypass reason, even indirectly.

5 This all presumes the commonly held view that liberty is at least pro tanto morally valuable.

6 On our view, this stated condition implies that the restraints should also not coerce a patient. Promoting a patient’s rational capacity requires not coercing them.

7 It is clear, however, that (i) is doing the heavy lifting.

8 Some might be skeptical of ceteris paribus clauses. But they are extremely common not only in theorizing about interventions of all types, but also in the provision of interventions themselves, including in medicine. Simply, it would be practically impossible to evaluate different interventions without controlling other variables.