Restraint therapy is instituted to prevent injuries to patients or others by restricting a patient's movement. Used appropriately, restraint therapy reduces patient risk and improves outcome. Otherwise, restraint can cause accidental injury or even death. Physicians are ethically obliged to limit the use of restraints to clinically and adequately justified situations so that associated risks can be reduced. Physicians should consider whether the benefits of restraint therapy are worth the harms. This chapter presents two case studies on the appropriate use of restraint therapy. In the first case, the desire for the restraints may have been misguided. The second case exhibits the effects of restraint therapy on the family. The ethical principles of respect for patient self-determination (including informed consent obtained from surrogate decision-makers), beneficence and non-maleficence should weigh heavily in the decision to employ restraint as a mode of treatment.

Do not resuscitate (DNR) orders developed in response to the realization that cardiopulmonary resuscitation (CPR) is not appropriate for all patients, particularly those with terminal illness and otherwise dismal prognosis. Pediatric patients may or may not have the capacity to participate in medical decision making. Parents function as surrogate decision-makers, acting in the overall best interest of the child. This chapter explains CPR, citing the case study of a 4-year-old boy with metastatic neuroblastoma undergoing stem cell transplantation following intensive chemotherapy and radiation. CPR became a nearly ubiquitous final procedure for all hospitalized patients experiencing cardiopulmonary arrest, regardless of circumstances. Automatic suspension of DNR orders in the setting of anesthesia and surgery does not sufficiently recognize patients' rights to self-determination. When patients or their surrogate decision-makers, such as parents, do not wish to suspend DNR orders in the setting of surgery, few ethical arguments support ignoring their wishes.