Beyond Behavior Contracts: Responding Effectively to Disruptive Patient Behaviors
Workplace violence in healthcare settings has risen. One contributing factor is a troubling upward trend in aggressive and abusive behaviors in hospitals, exhibited by patients, their families, and hospital staff. A common mechanism for addressing this is the behavior contract, also known as a behavioral agreement, used in response to patient or family behaviors that the care team deems disruptive, offensive, threatening, or otherwise unacceptable. Behavior contracts typically list the behaviors that the team finds unacceptable and propose consequences that may be invoked if the behaviors continue. While frequently used, there is no evidence that supports their effectiveness in dealing with disruptive and concerning behaviors in hospital settings. This presentation will explore the ethical, legal, and clinical implications of the use of in-patient behavior contracts, along with recent evidence that raises concerns about inequities in their use.
L. Syd M Johnson, PhD, HEC-C, is a philosopher/bioethicist/neuroethicist and Professor at the Center for Bioethics and Humanities at SUNY Upstate Medical University, and an ethics consultant at Upstate’s three hospitals. She’s an Associate Editor for Neuroethics, and a member of the NIH BRAIN Initiative Neuroethics Working Group, and is the chair of Upstate’s Hospital Ethics Committee. Dr. Johnson’s books include The Ethics of Uncertainty: Entangled Ethical and Epistemic Risks in Disorders of Consciousness; The Routledge Handbook of Neuroethics; Chimpanzee Rights: The Philosophers’ Brief; Philosophical, Medical, and Legal Controversies About Brain Death; Neuroethics and Nonhuman Animals; and The Three Pillars of Ethical Research with Nonhuman Primates. Her research focuses on ethical issues related to research ethics, animal ethics, xenotransplantation, and brain injuries, including brain death and disorders of consciousness.
Rachel Fabi, PhD, HEC-C, is an Associate Professor and Vice Chair for Education in the Center for Bioethics and Humanities at SUNY Upstate Medical University in Syracuse, New York, where she also serves as a clinical ethics consultant. In 2021, Dr. Fabi was elected to the Board of Directors of the American Society for Bioethics and Humanities, and in 2024 she was elected to the position of Secretary. She teaches courses on health advocacy and public health ethics, and her research focuses on the ethics of policies that affect immigrant health.