Recently you discussed a patient in a rehabilitation hospital whose abusive behavior was causing problems. I don't think your response fully considered the rights and safety of other patients. Allowing a patient to spit on others and call them insulting names isn't ethical. How can I protect my patients from aggressive and abusive individuals?-H.E., COLO.

I appreciate your concern. To get a better understanding of the situation, which involved a teenaged patient with a serious spinal cord injury, I followed up with the rehabilitation hospital in question. They told me that a psychologist had tried to work with the patient, but his disruptive behavior didn't change. To protect others from his potentially violent behavior, the nurses were forced to keep him isolated from other patients. But this just increased his distress. The stress of trying to balance one patient's rights against the rights of many others was time-consuming and emotionally draining for the staff.

Working with the psychologist and social worker, the nurses arranged for this patient to be transferred to a facility with a program for adolescents with spinal cord injuries. There, this patient became part of a peer support group where he felt accepted. He's now doing much better.

The best resolution to any ethical dilemma is one in which no one's rights are compromised. This case illustrates how important it is not to give up in seeking a fair resolution.