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Key points
- The use of physical restraint is ubiquitous in our relationships with companion animals.
- Physical restraint can cause physical pain and acute psychological discomfort.
- We may sometimes need to use force for compassionate reasons but can offset the harm by increasing animals' sense of empowerment.
A central feature in our lives with companion animals is the use of force. Instances of physical restraint in the home are ubiquitous. We hold our animals still so often that we might not even be aware that we are doing it: when we are clipping nails, giving a bath, allowing a child to hug a dog or cat who is struggling to get away, physically pushing a dog or cat into a crate against their will, even holding our dog down as we try on his Homelander Halloween costume. It almost goes without saying that dogs and cats will experience restraint at the veterinary clinic; otherwise, they simply wouldn’t cooperate.
Indeed, physical restraint has been so normalized in our relations with companion animals that we hardly give it a second thought. But it needs a second thought, and a third, because it has the potential not only to inflict fear in the short-term, but it also can have long-term negative psychological fallout.
Why Is Restraint Harmful?
Discussions about the ethical appropriateness of using force for “someone’s own good” arise mainly in the context of institutionalized psychiatric patients who attempt to harm themselves or who refuse care. Patients may be held down by staff or cuffed to a bed so they can be injected or fed. Although protocols that involve physical or pharmaceutical restraint may be clinically justifiable, they are ethically fraught because they erode trust, undermine the physician–patient relationship, and exacerbate emotional distress for patients.
Physician Massimiliano Beghi and colleagues estimate that up to half of all patients admitted to psychiatric wards experience some form of restraint—a percentage they seem to consider alarmingly high.1 Within veterinary medicine, some form of restraint will be experienced by nearly all canine and feline patients at some point in their care. Dogs and cats are physically held down by technicians and veterinarians, are muzzled and crated, wrapped in towels, and given intramuscular injections of tranquilizers. As veterinarian Lore Haug notes in a DVM360 article on restraint of animals, “Effective restraint is one of those aspects of veterinary medicine that we…take for granted.”2
The risks of using restraint, even in situations involving force applied for compassionate reasons, are clearly outlined in the medical literature. Psychiatric patients questioned about their experiences before, during, and after restraint reported deeply negative perceptions of coercion at all stages. During restraint, they experienced both physical pain and acute psychological discomfort. The perception of being controlled was associated with feelings of mental abuse, humiliation, and disempowerment. After coercion, patients cited long-term effects such as fear, helplessness, and loss of trust.3 There is no reason to think that dogs and cats under restraint would experience any less emotional trauma than these human psychiatric patients.
Indeed, we know from a huge body of literature in human psychology—most of it involving experiments on animals in a laboratory setting—that involuntary physical restraint is stressful and can result in psychological injury. Studies of mental disorders, including learned helplessness and depression, have historically involved the use of restraint as part of the experimental protocol: The experience of restraint, paired with painful or scary stimuli, induces mental breakdown. Think, for example, of Ivan Pavlov’s “restraining harness,” which held dogs in place as electric shocks were delivered. It was the inescapability of the shocks that drove dogs mad. Just as a sense of control can help reduce negative emotional reactions to aversive stimuli, so too can powerlessness or a perceived lack of control heighten the stress response.
Why, Then, Is Forceful Restraint a Core Component of Care?
You might say that the reason is obvious: Animals wouldn’t agree to our interventions. They would run away or try to bite us. But aren’t these escape behaviors communicating something important?
A helpful lens through which to examine the ethical terrain of using restraint in our care of animals is by way of a concept borrowed from human medical ethics: compassionate force. The words “compassion” and “force” rarely appear in the same context; indeed, they seem to be mutually exclusive. But the use of force is sometimes compassionately motivated. We can use force for compassionate reasons. Moreover, explicit attention to maximizing compassion can offset the harm imposed by using force. We can use force compassionately.
As medical resident Matthew Lin notes in a commentary on the use of compassionate force, use of restraint is “largely regarded by expert consensus as a last resort in the treatment of behavioral emergencies when patients pose an acute danger to themselves, medical staff, or other patients.” Less-traumatic, less-restrictive alternatives are “professionally preferred.”4 The unabridged quote from Lore Haug in DVM360 points us in this direction: “Effective restraint is one of those aspects of veterinary medicine that we simultaneously take for granted but also wish we could do better.” We can “do better” by learning to restrain in ways that reduce feelings of fear and distress and that minimize invasiveness.
We also need to recognize that restraint is, by its nature, a harm, no matter how good our techniques. As Haug says, “Restraint dictates that we move into the animal's personal space without the animal's permission.”5 This move is not morally neutral. Whereas in human medicine the trend, at least over the past few decades, has been toward greater and greater respect for patient autonomy, the same trend is not recognizable in veterinary medicine. We move into the personal space of animals as a matter of course and without really thinking about it. Indeed, the use of the term “autonomy” in relation to animal patients is generally met with resistance and even puzzlement. The Fear Free movement emphasizes that forcing treatment on dogs and other animals is stressful and potentially traumatizing for them. Saying we should reduce fear is still a long way from saying we should get consent or respect autonomy, but it is a step in the right direction.
Where Does This Leave Us?
Physical restraint may be unavoidable at some junctures in our care of dogs and cats. If we do decide that use of forceful restraint is necessary, we can then set our minds to minimizing harm and maximizing compassion. In the human context, compassion maximization involves maintaining patient engagement and respecting autonomy to the greatest degree possible. We can think hard about what this might look like with our dogs and cats.
Is the use of force ever justified against our pets? Probably yes. But we need to be cognizant of the potential for harm, think through situations where force seems necessary, use force only as last resort, and find ways to maximize compassion if we do resort to force.
References
1. Beghi et al., “Prevalence and risk factors for the use of restraint in psychiatry: a systematic review,” cited in Lin, “Who Should Implement Force When It’s Needed and How Should It Be Done Compassionately?”
2. Haug, “Improving Patient Restraint in the Veterinary Clinic.”
3. Lin, “Who Should Implement Force When It’s Needed and How Should It Be Done Compassionately?” p. 313. See also Tingleff et al., “Treat me with respect.” A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion.”
4. Lin, “Who Should Implement Force When It’s Needed and How Should It Be Done Compassionately?” p. 312.
5. Haug, “Improving Patient Restraint in the Veterinary Clinic.”
