IV. Physical and pharmacological restraint of critically ill patients: Clinical facts and ethical considerations

In summary, we should not lose sight of the crucial differences between restraint which violates rights or dignity and restraint which does not violate any autonomously expressed wishes, protects the patient from self-harm is in the patient's best interests. Prolonged and repeated use of sedatives has the potential to cause many immediate and long-term complications. In the words of Pinel 'it is an art of no little importance to administer medications properly: but, it is an art of much greater and more difficult acquisition to know when to suspend or altogether omit them'. The importance of timely withdrawal of sedation cannot be overemphasized and the judicious use of physical restraints may legitimately be built into an overall treatment plan in a cohort of ICU patients to achieve this objective safely. The decision to use physical restraints (as all other interventions) should be subject to regular mandatory multi-disciplinary reviews as suggested by the University of Texas Cancer Centre Restraints Improvement Group. Such an approach, in our view, cannot rationally be considered unethical, cruel or primitive. © The Board of Management and Trustees of the British Journal of Anaesthesia 2004.