Using Ethical Lenses to Reduce Restrictive Practices
By James Hourihan | Director, JL Academy
When the culture within a health or social care setting turns sour, the risks to vulnerable individuals escalate dramatically. Environments where staff feel disempowered, undervalued, or operate under immense pressure without clear ethical guidance are breeding grounds for poor practice.
Without a strong moral compass, abuse can occur, and the excessive use of restrictive interventions can take root.
To combat this, we must shift our focus from mere compliance to the cultivation of a deeply ethical operational ethos. This blog explores how embedding ethical decision-making—guided by Clark’s (2015) frameworks and participatory ethics—serves as a powerful antidote to toxic care cultures.
The Cost of Toxic Environments
The shadows of potential abuse and an over-reliance on restrictive practices can loom over any care setting. Confronting these issues is not just a professional duty; it is a moral imperative.
At JL Academy, we believe that training must go beyond technique. It must direct organisations toward safer, humane, and truly person-centred care. By utilizing specific ethical lenses, we can empower staff to identify and dismantle the conditions that lead to harm.
Clark’s 8 Ethical Lenses: A Framework for Safeguarding
Within the Timian Programme, JL Academy utilizes an adapted version of Clark’s (2015) eight ethical perspectives. This offers a practical toolkit for dissecting workplace dilemmas and safeguarding against toxic environments.
Here is how applying these eight lenses helps us address the risks of abuse and undue restriction:
1. Fairness
Clark (2015) posits that decisions must be acceptable to all, regardless of position. A commitment to fairness challenges power imbalances where abuse often hides. It demands that we scrutinize every intervention:
- Is this restrictive practice applied equitably?
- Would this be acceptable if roles were reversed?If a strategy feels unfair to the person receiving care, it signals a potential breeding ground for resentment.
2. Merit
While often associated with performance, in care, “Merit” encourages recognizing an individual’s intrinsic worth and their efforts toward positive change. It moves us away from a deficit-based model (which often precedes restrictive measures) toward a strengths-based approach. It also means valuing staff for their ethical practice, not just their compliance with systems.
3. Markets (The Exchange)
This lens ensures that the ‘exchange’ in the care relationship is positive and empowering. Toxic environments rely on coercive control. The Market lens prompts us to ask: Is the individual genuinely benefiting? respecting choices reduces the frustration that leads to challenging behaviour, thereby reducing the need for restrictive responses.
4. Democracy
“No one should be subject to a regime in which they have no say” (Clark, 2015). This principle is a direct challenge to authoritarian care models. Embedding democratic principles means actively involving individuals in their care plans (Co-production). As noted by the Department of Health (2014), giving people a genuine voice inherently reduces the likelihood of imposed, restrictive measures.
5. Well-being
Prioritising actions that promote health, happiness, and fulfilment is fundamental. Abuse and restriction are antithetical to well-being. This lens compels services to ask whether an intervention enhances quality of life or merely controls behaviour for the system’s convenience. This aligns perfectly with Positive Behaviour Support (PBS) (Gore et al., 2013).
6. Rights and Duties
A culture that minimizes abuse is one where human rights (Human Rights Act 1998) are paramount. Staff must understand their duty to uphold these rights. Any restriction used must be lawful, proportionate, and an absolute last resort.
7. Character
We must develop the best ethical character for our roles. In non-toxic environments, staff are supported to cultivate compassion, patience, integrity, and courage—specifically, the courage to challenge poor practice. When expediency replaces character, the risk of abuse rises.
8. Handing Down (Legacy)
We have a responsibility to pass on our stewardship undamaged. A care service that relies on restrictive practices creates a damaging legacy. We must build services that contribute to a future where such negative outcomes are unthinkable.
The Collective Shield: Employees as Ethical Guardians
A top-down approach to ethics is insufficient. As Sinkkonen and Laulainen (2019) assert, employees play an “unnoticed role in ethical leadership.”
When we empower employees through ethical understanding, they become a collective shield against harm:
- Early Warning Systems: Staff recognize subtle signs of a deteriorating climate and raise concerns before abuse occurs.
- Challenging Restrictions: An ethically aware workforce questions the necessity of restrictive interventions, advocating for less intrusive alternatives.
- Supportive Peer Cultures: Colleagues support one another in navigating dilemmas, fostering openness rather than the silence that enables abuse.
- Championing Positive Practice: Employees become proactive agents for person-centred, rights-respecting care.
Conclusion: Building a Bulwark Against Harm
The challenge of preventing abuse and minimising restrictive practices is ongoing. By adopting frameworks like Clark’s Ethical Lenses and nurturing the ethical leadership of every employee, organisations can stop reacting to problems and start preventing them.
For JL Academy and all care providers, embracing these ethical tools is the essence of providing care that is safe, dignified, and supportive.
James Hourihan BScEcon, MScEcon, MIoD, FRSA
Director, JL Academy
Lead Senior Trainer, Timian Learning and Development
References
- Clark, S.J.A. (2015) Ethical Decision Making: Eight perspectives on workplace dilemmas. London: CIPD Publishing.
- Department of Health (2014) Positive and Proactive Care: reducing the need for restrictive interventions. London: Department of Health.
- Gore, N.J. et al. (2013) ‘Definition and scope for positive behavioural support’. International Journal of Positive Behavioural Support, 3(2), pp. 14-23.
- Human Rights Act 1998, c. 42.
- Sinkkonen, M. and Laulainen, S. (2019) ‘Unnoticed role of employees in ethical leadership’. In: The Management of Wicked Problems in Health and Social Care. Abingdon: Routledge.
