My patient's in shackles: Can we take these off?

We might assume that a patient who is chained to their hospital bed must be restrained for good reason, but our guest challenges that assumption in a published account of a man in shackles who is intubated, sedated, and paralyzed in the ICU.  He and his co-author write that "Over-policing and mass incarceration have led to Black prisoners being disproportionately represented in jails and prisons. Those of us in positions of power may disregard the shackle, or not question its purpose, or even propose that it is justified."  But how often do incarcerated patients actually try to escape while receiving medical care?  Should a physician ask the guards to take off the shackles? What are the legal and ethical consequences of doing so? What is the right thing to do? What are the implications of not speaking up? We explore these questions and more.