Restraint and seclusion (R&S) measures in psychiatric settings are applied worldwide, despite poor scientific evidence to back up their effectiveness. The medical, ethical and medico-legal implications of coercive interventions are broad-ranging and multifaceted. The review aims to shed a light on the most relevant and meaningful standards that have been laid out by international treaties, supranational institutions (United Nations, Council of Europe, World Health Organization), scientific institutions (American Medical Association, Australian Department of Health), legislative bodies and courts of law. Several court cases are herein expounded upon, with a close focus on meaningful analysis, decisions and conclusions that have laid the groundwork for a different, more restrictive and more clearly defined approach towards R&S imposed upon psychiatric patients. It is reasonable to assume that changing norms, civil rights enforcement, court rulings and new therapeutic options have influenced the use of R&S to such an extent that such measures are among the most strictly regulated in psychiatric practice; health care providers should abide by a strict set of cautionary rules when making the decision to resort to R&S, which must never be put in place as a substitute for patient-centered therapeutic planning. Case law shows that R&S should only be weighed in terms of their effectiveness towards therapeutic goals. Being able to prove that R&S was employed as part of a therapeutic path rather than used to maintain order or to exact punishment may go a long way towards shielding operators against negligence lawsuits and litigation.
Le misure di contenzione e isolamento in contesti di cura psichiatrica vengono applicate a livello mondiale, nonostante l’insufficienza di evidenza scientifica che ne suffraghi la validità. Le possibili implicazioni cliniche, etiche e medico-legali derivanti da tali misure coercitive non sono trascurabili e presentano molteplici complessità. La presente rassegna è stata concepita con il proposito di fare luce sui criteri e i parametri più significativi elaborati e sottoscritti da trattati internazionali, istituzioni sovranazionali (come l’Organizzazione delle Nazioni Unite, il Consiglio d’Europa, l’Organizzazione Mondiale della Sanità, ecc.), società scientifiche (American Medical Association, Australian Department of Health), enti legislativi e Corti di Giustizia. Gli autori illustrano diversi casi giudiziari, discutendo gli aspetti più significativi, le decisioni e le conclusioni che hanno aperto la strada a un approccio diverso, più restrittivo e più chiaramente delineato nei confronti delle misure di contenzione e isolamento che colpiscono pazienti psichiatrici. È ragionevole dedurre che i mutamenti legislativi, una maggiore attenzione nella salvaguardia dei diritti umani, le sentenze giudiziarie e le nuove opzioni terapeutiche siano tutti fattori che abbiano contribuito a influenzare l’incidenza e l’applicabilità delle misure di contenzione psichiatrica a un livello tale che, oggi, tali interventi risultano essere fra i più rigorosamente regolamentati nella pratica psichiatrica; gli operatori sanitari devono attenersi a precise regole cautelative quando decidono di ricorrere a tali interventi, i quali non devono mai essere impiegati al fine di sostituire una adeguata pianificazione terapeutica individuale. La casistica giudiziaria mostra come contenzione e isolamento debbano essere ponderati sempre nell’ottica del perseguimento degli obiettivi terapeutici; la capacità di comprovare e documentare che le misure contenitive siano state adottate nella dimensione di un percorso terapeutico, e non a fini punitivi o di “mantenimento dell’ordine”, nel rispetto delle linee guida e delle buone pratiche assistenziali, può giocare un ruolo fondamentale nel mettere al riparo gli operatori e le strutture sanitarie da accuse di malpractice e conseguenti contenziosi.
Restraints and seclusion in psychiatry: striking a balance between protection and coercion. Critical overview of international regulations and rulings / Zaami, S; Rinaldi, R; Bersani, G; Marinelli, E.. - 55:1(2020), pp. 16-23. [10.1708/3301.32714]
Restraints and seclusion in psychiatry: striking a balance between protection and coercion. Critical overview of international regulations and rulings
Zaami S;Rinaldi R;Bersani G;Marinelli E.
2020
Abstract
Restraint and seclusion (R&S) measures in psychiatric settings are applied worldwide, despite poor scientific evidence to back up their effectiveness. The medical, ethical and medico-legal implications of coercive interventions are broad-ranging and multifaceted. The review aims to shed a light on the most relevant and meaningful standards that have been laid out by international treaties, supranational institutions (United Nations, Council of Europe, World Health Organization), scientific institutions (American Medical Association, Australian Department of Health), legislative bodies and courts of law. Several court cases are herein expounded upon, with a close focus on meaningful analysis, decisions and conclusions that have laid the groundwork for a different, more restrictive and more clearly defined approach towards R&S imposed upon psychiatric patients. It is reasonable to assume that changing norms, civil rights enforcement, court rulings and new therapeutic options have influenced the use of R&S to such an extent that such measures are among the most strictly regulated in psychiatric practice; health care providers should abide by a strict set of cautionary rules when making the decision to resort to R&S, which must never be put in place as a substitute for patient-centered therapeutic planning. Case law shows that R&S should only be weighed in terms of their effectiveness towards therapeutic goals. Being able to prove that R&S was employed as part of a therapeutic path rather than used to maintain order or to exact punishment may go a long way towards shielding operators against negligence lawsuits and litigation.File | Dimensione | Formato | |
---|---|---|---|
Zaami_Restraints_2020.pdf
solo gestori archivio
Tipologia:
Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza:
Tutti i diritti riservati (All rights reserved)
Dimensione
110.82 kB
Formato
Adobe PDF
|
110.82 kB | Adobe PDF | Contatta l'autore |
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.