Case

Mrs. A is an 83-year-old patient hospitalized for a bowel resection for colon cancer. Her medical history includes a stroke that makes her gait unsteady and has already caused a fall which resulted in a broken hip. During the day Mrs. A is alert and oriented and enjoys the company of her family members. But at night, she "sundowns," becoming disoriented and confused and occasionally even combative with staff. During one of her disoriented episodes,

Mrs. A. wants to leave her room to buy some nachos, believing she's at a baseball game. Because of her unwillingness to stay in bed, the staff is concerned about her well-being. Her nurse believes that some kind of restraint is needed. The attending physician agrees and orders a restraint vest that wraps around Mrs. A's chest. Mrs. A does not want to be placed in the vest. The nurse's aide tells Mrs. A that the vest is actually a sweater to keep her warm and comfortable. She finally agrees to wear the vest. Most nights a family member is with her, but this night she is alone. The family learns the next day about the use of the restraint and is concerned about not being informed.

Questions for Discussion

1. Was Mrs. A's autonomy violated when she was placed in a vest?
2. Should the family have been notified before Mrs. A was placed in a restraint?
3. What do you think of the aide's use of deception to gain Mrs. A's consent?

See what the AMA Code of Medical Ethics says about this topic in Opinion 8.17 Use of restraints. American Medical Association. Code of Medical Ethics 1998-1999 Edition. Chicago, IL: American Medical Association; 1998.