Noam Yehudai, Dalya Tedgi, Ziv Gil: Shackling incarcerated people in Israeli hospitals-a multicentre study followed by a national intervention programme (Lancet . )

Thousands of incarcerated people (individuals who have been imprisoned or detained) are treated in Israeli medical centres each year. The custodial authority during their hospital stay is the local police, the Israel Prison Service (IPS), or the Israeli Army. Positioned at the crossroads of security and human rights, the treatment of these patients almost invariably raises major ethical issues. Shackling during hospital stay is associated with physical, mental, and social effects, which inevitably impair treatment. International guidelines, such as the Mandela Rules, determine that health-care standards should not differ for incarcerated people and, given that most incarcerated patients do not pose a direct threat, unselective shackling is considered a disproportional measure. In this regard, Israeli law states that incarcerated patients should not be shackled, except in selected circumstances for which individual assessment is required (mainly if there is a direct threat of violence or escape). Numerous manuscripts have conceptually addressed the ethical, legal, and medical considerations of shackling of incarcerated patients, but, to our knowledge, quantitative data on the extent and nature of shackling during hospital stays have never been published.