Medicolegal issues

Physical restraint can usually be avoided with adequate nursing care and medication. The psychiatrist should not become party to dubious practices in this area, such as the use of de facto restraint with tight blankets or deliberately induced parkinsonism with major tranquillizers. If continued physical restraint is necessary in rare cases, it should be as an explicit part of the treatment plan after medicolegal advice.

Informed consent to treatment also involves important medicolegal issues. (!6> Patients with delirium are often very ill, and frequently require surgery or other invasive procedures that they are incapable of understanding and consenting to. The legal position is complex, and will vary in different jurisdictions. However, legal capacity should certainly be assessed before seeking consent. It is almost always wise to involve relatives in decisions in these circumstances. It may be necessary to consult medicolegal advisers, including the hospital authorities.

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