Opinion

No patient should have to die in shackles

Within 30 seconds, I am at the bedside performing chest compressions while other members of the care team pour into the room. We are all wearing maximal personal protective equipment, as this patient, a Black man in his mid-70s, was admitted for a covid-19 infection that became so severe that he required a machine to do the work of his lungs. I hear the familiar sounds that have become all too commonplace during my month in the ICU — the “hiss” of the ventilator filling the patient’s lungs with air, the sticking of the defibrillator pads, the shouts from other providers in the room.

But one sound is unfamiliar. From the foot of the bed comes a distinct jingling noise I do not recognize. Looking down, I realize it is the noise of the handcuffs shackling this man’s right ankle to the side of the bed, bouncing up and down with each compression. He has been critically ill in a medically induced coma for the past week, yet the shackles remain.

In the wake of the Black Lives Matter movement and the conviction of former Minneapolis police officer Derek Chauvin for the murder of George Floyd, the nation continues to scrutinize the role of policing in the community. Missing from this dialogue, however, are the impacts of policing in the hospital.

Incarcerated patients handcuffed to beds are a far too common sight in the hospital. The majority of incarcerated patients I have taken care of did not pose any flight risk or raise any concern for violent behavior whatsoever. The patient at the center of this story was intubated, heavily sedated and medically paralyzed, yet he was still handcuffed to the bed he was dying in. Meanwhile, patients who are not incarcerated, and therefore not shackled, often present a far more imminent threat to hospital staff, yet are still effectively managed without such demeaning measures.

Given the vulnerability of patients who are incarcerated — a fact that has only been magnified by the covid-19 pandemic — we cannot afford to introduce any additional bias that could harm their care. Our ethical mandate as physicians to treat every patient the same regardless of their background is compromised by the image of shackles. This has the potential to severely harm the physician-patient relationship and lead to suboptimal care. Most importantly, this is a punitive practice that humiliates and asserts domination over powerless patients at one of the most vulnerable moments of their lives.

There are circumstances when restraints are necessary in the hospital. The safety of the medical staff needs to remain a top priority. Violence against hospital staff is on the rise, though there is no evidence of incarcerated individuals contributing to this. There have been rare, isolated instances in which incarcerated individuals have attempted escape from a hospital. But just like the general population, the use of shackling should always be the justified exception rather than the indiscriminate rule.

The current practice of hospitals is to defer entirely to prison policy when interacting with incarcerated patients. This is not acceptable. We can no longer be bystanders in the mistreatment of people who arrive at our doors to receive care and neglect their right to be free of inhumane punishment. We can no longer passively defer to degrading policies that violate human rights. Hospitals need to change their policies to allow for physicians to negotiate with the prison system on a case-by-case basis. There must be clear exemptions outlined in state and federal policies, especially in end-of-life scenarios when there is no risk of harm or escape.

These patients were either convicted of crimes or in pretrial or immigration detention. While their freedom has been taken away, they have not forfeited their humanity and should be treated as such. At the very least, they should be able to die in dignity, free of the bare metal chain.

My patient died about two hours after that overhead page rang through the hospital. What remained after removing the breathing tube, monitoring lines and IVs was a human being and a lone metal handcuff shackled to his lifeless body. Nobody should die in shackles, whether they are being stopped by the police in the street or being treated by a doctor in a hospital bed.