Least restrictive, yet effective. A stepwise approach to care interventions

Alexandra Olmos-Pérez, Provincial Health Services Authority (PHSA), Ethics Services, Vancouver, BC, Canadá
Thivia Jegathesan, Provincial Health Services Authority (PHSA), Ethics Services, Vancouver, BC, Canadá

The principle of “least restrictive, yet effective” has been used as a way to balance the potential benefits of any clinical or public health interventions with the potential harms of the intervention, including those associated with overriding autonomous choice. A stepwise approach systematically determines whether a restrictive measure is required, if there are less intrusive measures to be applied first that are as effective and at what point a more restrictive measure is justifiable. The following considerations are proposed to adopt this approach. These are intended to be dynamic as evidence and the situation evolves: a) There is an identified/certain risk of serious harm that needs to be imminently removed; b) Other less intrusive options or measures to mitigate, avoid or remove risks/harms have been exhausted/proved ineffective; c) The proposed intervention or option will be effective to remove the identified harm, based on best evidence; d) The proposed intervention is reasonably expected to result in a positive and fair balance of benefits/harms to the patient; e) It is feasible to attempt the proposed intervention; f) The proposed measure or treatment would be pursued in similar situations, and it is fair and equitable to do so in this case.

Keywords: Autonomy. Risk. Effectiveness. Ethics. Least restrictive. Equity.