Perinatal Shackling in the United States: An Ethics Perspective Open Access
Patel, Priya (Summer 2025)
Abstract
Perinatal shackling is the practice of restraining incarcerated women before, during and after labor. While case law has historically affirmed the health rights of incarcerated women, including the right not to be shackled, the United States’ legal and regulatory environment still falls short in defending them. This thesis seeks to understand perinatal shackling through a unique two-pronged approach: an empirical review of state-level anti-shackling statutes and a normative, context-based ethical analysis of case studies using moral principles and ethical theories.
This thesis found that as of February 2025, out of the 50 states and the District of Columbia, 9 states do not have any anti-shackling statutes in place. Furthermore, 8 states had no documentation requirements in place for incidents of shackling within their existing anti-shackling statutes. Therefore, 17 states currently do not have documentation requirements for incidents of shackling. Additionally, only 22 states were found to grant medical staff the authority to order the removal of shackles. Out of the remaining states, 7 states were found to grant limited authority, 13 states were found to grant no authority, and 9 states had no legislation in place at all. Hence, 22 states currently do not grant medical staff with the authority to order the removal of shackles.
Based on this data, this thesis argues for the following universal policy recommendations that are backed by ethical theory: 1) extension of authority to health care professionals, especially nurses, 2) implementation of documentation requirements and review protocols during incidents of shackling, and 3) integration of clinical ethics consultations. Firstly, documentation requirements help promote the development of inner virtues within correctional staff. Secondly, the extension of authority to health care staff merges the perspectives of care and justice. Finally, the integration of clinical ethics consultations reduces moral distress within correctional officers and health care staff and promotes ethical and fair decision-making. In conjunction, these policy recommendations are proposed to promote fair and just decision-making on the use of shackles.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Methodology 3
Chapter 3: Historical Review of Legal Frameworks 9
Chapter 4: Results 22
Chapter 5: Theoretical Framework: Introduction to Ethical Considerations 26
Chapter 6: Case Studies 40
Chapter 7: Policy Recommendations 56
Chapter 8: Conclusion 60
Chapter 9: Limitations and Future Directions 61
Appendix A 65
Appendix B 68
References 71
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