Patient rights at the heart of updated AMA position statement

Balancing a patients’ rights to self-determination, protection from harm and the possibility of harm to others guides the AMA’s position on the use of restrictive practices in residential aged care.

The application of restrictive practice should always be based on an individual assessment of the patient and their needs taking into consideration ethical, legal and medical factors.

The AMA takes the position that before a clinical decision to prescribe chemical restraint is taken, a medical practitioner must understand the patient’s needs, the acute health issue being addressed, and understand the options available to address that issue, weighing the positive and negative aspects of each option, including the option of not prescribing.

A patient’s right to self-determination and their right to live their best lives is at the heart of any decision to prescribe chemical restraint and should not occur in isolation. It should balance protection from harm and the possibility of harm to others through a process of patient assessment, care team involvement and consent by either the patient or substitute decision-maker within an ethical and legal framework.

Then, only the least restrictive form of chemical restraint should be used and only as temporary solution, in the lowest effective dose and for the minimum necessary period, subject to regular reviews and clearly defined goal of treatment.

The revised position statement emphasises using Advance Care Directives to outline the known wishes and preferences of patients for their medical care.

It also reiterates the importance of creative, friendly physical environments and the staff to resident ratios in aged care in managing behavioural and psychological symptoms of Dementia.

The AMA says evidence demonstrates that after a patient has developed dementia and/or has moved into residential aged care, continuity of care can result in better patient outcomes, reduced need for restrictive practices and prevent inappropriate provision of psychotropic medicines.

AMA Position Statements are usually updated every five years. The updated version can be viewed here.