A Principlist Justification of Physical Restraint in the Emergency Department

The ethics of physical restraint in the Emergency Department (and elsewhere) has always been an emotive and controversial issue. Recently a vanguard of advocacy groups and regulatory agencies have been aiming to reduce and optimize its use, resulting in new guidance around physical restraint. This article considers prevailing opinions surrounding physical restraint in the Emergency Department using a Principlist model of medical ethics (specifically that of Beauchamp and Childress' four pillars). It also examines the ethical underpinning of the new guidance on the usage of restraint. Ultimately, examination from a Principlist perspective suggests the use of physical restraint in the Emergency Department is justified, as long as it is used carefully. Despite this, physical restraint can have severe physical and psychological consequences for patients, and work needs to be continued into its reduction and optimization.