Responding to abusive patients: A primer for ethics committee members

Effectively dealing with abusive patients involves striking a balance between respecting the patient's autonomy and protecting health care staff and other patients. Although in some cases, emergent decisions make the involvement of an ethics committee impractical, there are several potential areas of appropriate committee input into the issues that arise from cases involving abusive patients. The case of a patient who resorted to physical abuse in the process of refusing a medical procedure raises questions about decisional capacity, consent to treatment, and the scope of health care providers' duties to care for patients. The case of a family member who wrote threatening messages on an ED exam room dry erase board raises questions about abusive behavior and limits that can and should be placed on patients'/family members' behaviors. Both of these cases raise questions about "zero tolerance" policies for abuse in health care facilities and implications of OSHA's recommendations for a "violence-free workplace." Ethics committees should be prepared to intervene, educate, and advise when abusive behavior is an issue. Knowledge of appropriate responses and resources will best serve patients and the health care providers who care for them under a variety of challenging circumstances.