Preisz Anne, Preisz Paul
Clinical Ethics, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
School of Medicine, University of Notre Dame Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2019 Oct;55(10):1165-1169. doi: 10.1111/jpc.14607. Epub 2019 Sep 3.
Patient restraint in health care is currently under intense review. There are two disparate groups that should be considered. First, infants and young children are commonly restrained while undergoing simple medical procedures such as venepuncture or immunisation, and this practice may be better framed as 'hugging' not 'holding'. Second, there is a distinct but significant group of children and adolescents with serious psychiatric or organic illness with behavioural disturbances necessitating restraint, who are the primary focus of this paper. Nevertheless, the balance between restraining any young person in health care and causing preventable harm is delicate: any form of child restraint, whether physical, chemical or seclusion, merits ethical reflection and should be undertaken judiciously. All clinicians should prioritise the dignity and privacy of the young person while weighing the vulnerability of this cohort of patients.
医疗保健中对患者的约束目前正受到严格审查。有两个不同的群体需要考虑。首先,婴幼儿在接受诸如静脉穿刺或免疫接种等简单医疗程序时通常会受到约束,这种做法或许更应被界定为“拥抱”而非“控制”。其次,有一类特殊且数量可观的儿童和青少年,他们患有严重的精神疾病或器质性疾病并伴有行为障碍,需要进行约束,这是本文的主要关注对象。然而,在医疗保健中对任何年轻人进行约束与造成可预防的伤害之间的平衡很微妙:任何形式的儿童约束,无论是身体约束、药物约束还是隔离,都值得进行伦理反思,并且应该谨慎实施。所有临床医生在权衡这类患者的脆弱性时,都应将年轻人的尊严和隐私放在首位。