Background:

The medical profession holds a unique obligation to care for the physical and mental well-being of every person, simply by virtue of being human—regardless of their actions or social status. This duty includes preserving a person’s dignity and privacy. This commitment becomes especially critical in contexts of imprisonment or detention, where such values are at particular risk due to society’s need for self-protection.

So how should a physician act when required to treat a prisoner or detainee who arrives at the hospital in restraints? The legal authorities have already determined that these individuals must be held behind bars. However, although their freedom is denied upon entering the hospital, it is vital to remember that this does not strip them of their dignity.

Providing medical treatment while a person is shackled undoubtedly violates their dignity and privacy. Restraint causes suffering, sometimes harm, and may compromise the quality of medical care. Furthermore, agreeing to treat a restrained person may appear to align the physician with the enforcement system, forsaking medical ethics in favor of authority.

The ethical guidelines presented here aim, in the view of the Ethics Bureau members, to bridge the conflicting obligations of the physician: the duty to care for the individual prisoner or detainee, and the broader responsibility to safeguard societal security and integrity.

In preparing this update, the Bureau reviewed a previous position paper dated August 6, 1997, the report of the Committee for the Examination of Restraint Procedures of Prisoners and Detainees in Hospitals (chaired by then Deputy Attorney General Meni Mazuz, published December 1998), and guidelines issued by the Medical Administration of the Ministry of Health (44/2005, dated November 30, 2005).

Since 2020, the Ethics Bureau has addressed the inappropriate phenomenon of excessive restraint of prisoner and detainee patients receiving hospital treatment. This focus emerged from a growing concern that restraint is often applied in an unreasonable and disproportionate manner, contrary to Israeli law, Health Ministry procedures, and the positions of the ethics bureaus of the Israeli Medical Association and nursing organizations.

To validate the scope of the problem, the Ethics Bureau initiated a data collection project on the manner of restraint applied to prisoners and detainees. This data, gathered over an extended period, led to articles published in the journal Harefuah and The Lancet.

Based on these findings, the Ethics Bureau has re-examined the issue and decided to update its position paper to emphasize the physician’s obligation to act when restraints endanger a patient’s health.
 

Position Paper:

• The physician has an ethical obligation to protect the dignity, privacy, and health of every individual and to prevent suffering and pain. This duty is even more critical under conditions of imprisonment or detention.
• However, this ethical duty may sometimes conflict with society’s need to limit individual freedom for self-protection.
• As a general rule, every prisoner or detainee has the right to be examined and treated like any other person—without restraints.
• The authority to determine the necessity of restraining a patient in custody lies with the law enforcement body responsible for the patient.
• Restraints during medical treatment or hospital stays must not be routine. They should only be used when no lesser alternative is available.
• Restraint must not serve as a substitute for staff shortages in guarding the prisoner/detainee patient.
• In any case where the physician believes that the restraints may harm the patient’s physical or mental health, or are unnecessary (e.g., sedated patient, amputee), the physician must request the security personnel to remove the restraints and apply alternative security measures if needed.
• A physician must not participate in treatment that includes torture-like restraint or restraints that violate procedures (e.g., cross-restraint, use of plastic zip-ties, blindfolding).