Critical Appraisal of Carceral Logic and Safety Culture in the Emergency Department

Janice Firn, PhD, LMSW, HEC-C – University of Michigan

Abstract: In sociological theory, carceral logic is a system of thinking that views punishment, physical constraint, and control as a means of ensuring public safety. Carceral logic is increasingly pervasive in the United States healthcare system where growing concerns for workplace violence have led to zero tolerance for unsafe work practices. Carceral approaches to patient care include use of medications and physical restraints when patients are being treated over their objection (such as during psychiatric emergencies) or when patient behaviors are perceived as harmful to themselves or others. These strategies are particularly visible in the emergency department, the entry point to the hospital system and catch-all net for social challenges in the community. Using a case-based approach, I argue – as abolitionists have argued more broadly about the carceral system – that the use of tools motivated by carceral logic is ultimately ineffective, perpetuates patient trauma and mistrust, and risks being inappropriately applied. I also explore how current nebulous definitions of “safety,” which are prone to subjective interpretation, contribute to the use of tactics grounded in carceral logic. Finally, probing carceral logic within healthcare is understandably polarizing in a time where there are objective instances of violence toward healthcare workers. However, a critical assessment of safety culture and the tools that are used to control patient behavior are vital to combat carceral logic in the moment and work toward a future in which the means we use to influence patient behavior can be reimagined.

Keywords: Carceral, Restraints, Clinical Ethics