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  • Writer's pictureSociety of Bioethics and Medicine

Cuffed Patients

By - Christine Kuang

Healthcare workplace violence is on the rise. Unsurprisingly, when one walks into the Emergency Department, they are likely to witness individuals in a vulnerable state, detained and supervised by a law enforcement escort rolling into the Emergency Department cuffed to the stretcher.

A patient requires this restraint when he/she is a danger to themselves or others around them. Under the General Duty Clause Section 5(a)(1) of the Occupational Safety and Health Act of 1970, employers require to provide a place of employment that is "free from recognized hazards that are causing or are likely to cause death or serious harm" (Henkel 2015.) This protocol obtains to but is not limited to the detainees such as those with mental illness and other lesser misdemeanors offenses. The 'restraints' include handcuffs, hinged cuffs, rigid cuffs, thumb cuffs, shackles, manacles, flex cuffs, zip ties, and other similar devices.

International Association for Healthcare Security & Safety (IASHSS) Foundation calls to action a common goal of the workplace to meet federal agencies' requirements while providing a safe environment for staff, patients, and visitors. Yet, IASHSS Foundation emphasizes that the placement of restraints compromises the individuals' physical state and leads to emotional deprivation.

Prolonged wearing of handcuffs attributes to additional discomfort and bruising. In some cases, this includes the occasional bowel movements. When are these restraints necessary?

On one account, Bill Carruthers, age 35, was locked in a county jail in Georgia after experiencing severe psychosis symptoms, beaten up till he was unconscious, and woke up at a local hospital (Carruthers 2002.) Carruthers was labeled for aggressive behavior with restraints on his arms and legs for immobilization purposes.

From a civil perspective, healthcare workers are obligated to provide quality healthcare to all patients alike. In contradiction, inhumane treatment in a setting where high standards of equality and unbiased should exist, restrained patients expose to humiliation and feeling of inferiority prevails.

To ensure patients' safety and emotional response, a proactive, evidence-based evaluation from both the justice system and medical staff should request a risk assessment, addressing aggressive behavior. Restraints should be ill-advised in a hospital setting, allowed only when necessary.


Pickles, H., Norton, E., Ginn, E., & Schleicher, T. (2015, August). Physical restraint and the protection of the human rights of immigration detainees in hospitals. Retrieved July 23, 2020, from

Gillison, B., Carruthers, B., Gillison, D., Gillison @DanGillison, A.,

Carruthers, B., Gillison @DanGillison, D., . . . Says: D. (2020, July 02). People in mental health crises need help, not handcuffs. Retrieved July 23, 2020, from

Henkel, S., International Association for Healthcare Security and Safety Foundation - Education and Professional Advancement. (n.d.). Retrieved July 23, 2020, from


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