Responding Ethically to Violence From Patients and Families in the Hospital Emergency Department: A Symbiotic Empirical Ethics Study.

Violent behaviour by patients and families is a significant issue facing healthcare providers, with a particularly high prevalence in hospital emergency departments. Occupational violence and aggression (OVA) puts both staff and patients at risk of physical and psychological harm and can affect the delivery of timely patient care. To help address this issue, many healthcare settings have adopted zero-tolerance language in relation to OVA. Drawing on interviews with 25 emergency department staff in one Australian hospital, we argue that a more nuanced ethical approach is needed and develop a framework of values for responding ethically to OVA incidents in the emergency department. Staff are ethically and legally entitled to a safe working environment, and their safety should be protected. Yet some patients acting aggressively, including patients without capacity, need emergency medical or psychiatric healthcare and ways must be found to deliver such care. For some other patients and visitors however, removal from the hospital is ethically appropriate. The unique uncertainty and urgency of emergency department work means that six values are important in ethical responses to OVA: staff safety, the health needs of the patient acting aggressively, the patient's decision-making capacity, community safety, fair resource allocation, and compassion. We argue for an approach which prioritizes staff safety while also considering the other values, in order to generate nuanced ethical decisions which are sensitive to the range of OVA situations that arise in emergency departments.