The inappropriateness of “least restrictive alternative” analysis for involuntary procedures with the institutionalized mentally ill

Abstract
The concept of the least restrictive alternative has been misunderstood and probably misapplied in relation to involuntary interventions common on inpatient wards: seclusion, restraint, and forced emergency medication. A brief historical review of the doctrine of the least restrictive alternative is presented, followed by a clinical and ethical analysis of problems in its application. The least restrictive alternative is demonstrated to be an inappropriate model for dealing realistically with issues raised by involuntary treatment of the institutionalized mentally ill.

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