Saturday, December 29, 2012

Restriction in medical situation

I saw a decision paper of the Supreme Court of Japan about physical restriction of a patient in a hospital.

Ichinomiya Shintai-kosoku saiban shiryo (Resource of Ichinomiya restriction court case, in Japanese)

The case summary is below;
An old lady admitted to a hospital for medical treatment. Then she contracted a delirium, probably due to severe physical status and noisy environment. She tried to walk around and cried for help some time. So the nurses at work in the hospital putted mittens on her hands not to manipulate any medical devices.
The patient  felt humiliated after that. So she and her family sued the hospital for violation of human rights.

The first decision of a Distinct Court rejected the complaint of the plaintiff. However the Higher Court judged the restriction by the hospital staff to be illegal. This decision affected medical organizations widely.

And at last, the Supreme Court rejected the complaint of the plaintiff again.

Restriction in medical situation is a complicated problem. As a practitioner of mental health, I believe that restriction is inevitable in some cases to protect the patients and bystanders. Of course, restriction itself is a evil behavior essentially. Excessive restriction must be prohibited. But there are some court decisions that treatment without restriction, result in an accident of the patient, was medically inappropriate. If in similar cases restrictions were authorized to be illegal, medical practitioner would hardly offer treatment for the patients with danger of delirium. Moreover,  aging is rapidly progressive in Japanese society. The cases that an aged patient falls in a hospital will be increasing.

I deny blind restriction. However medical safety must be discussed in multiple angles.

Well, there is a legislation about restriction in mental hospital. But there is no legal rule about it in general hospital in Japan. It is another problem, I think.

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