Contemporary health care policy around the world promotes the use of evidence-based medicine and, as such, it is reasonable to assume that this would lead to similarities in health care practices in comparable economies. Interestingly, this does not seem to be the case with the use of restraining technologies and restraint policies implemented within hospitals and nursing homes. Definitional ambiguity surrounding what is an abusive act may in part account for these practice variations, given that interpretations of an abusive act are contingent on particular circumstances. For example, if a practitioner restrains a patient who is behaving aggressively, it might be interpreted as a justifiable act, or an act of abuse that may be criminal, depending on the situation. Examples of physical restraint used in acute hospitals and nursing homes include body belts, restraining vests, cuffs, and bilateral bedrails. Chemical restraints are any medication used to manage what are perceived to be challenging behaviors, such as agitation, aggression, or verbal abuse. A common feature of restraining policies is that a set of permissions is usually required before application of the restraint. These permissions often include authorization by senior medical and nursing staff, permission of relatives or a legally recognized alternate, and, where appropriate, the individual’s consent. Acquiring a restraining order is, however, an insufficient justification for restraint use, it is simply an organizational process requirement, and the decision to restrain, like any health care intervention, should be influenced by the best available evidence. Therapeutic justifications for commonly used physical and chemical restraints are usually couched in terms of safety measures associated with harm prevention and risk reduction.1 We examine this premise in terms of the strength of patient benefit evidence.1 In doing so, we are mindful of other determinants that influence practitioner decisions to use or not to use restraining devices in given situations. These broader determinants include staff perception of the benefits and acceptability of the restraining procedure, knowledge of adverse effects, local practice custom, staffing levels, opportunity to provide staff with intensive interventions, such as continuous supervision, the perceived legality of restraining devices, and societal and organizational cultural norms.