Annual Report 2014 of the National Preventive Mechanism In addition, inmates should be able to give or not their free and informed consent to the treatment, with the sole exceptions contemplated by Act 41/2002, of 14 November, organic act regulating patient autonomy and rights and obligations relating to clinical reporting and documentation matters. 338. Centres of this nature should have the necessary protocols and plans in accordance with the profile of their residents, such as a suicide prevention plan, a protocol to report on documents of “early will” or “preliminary instructions” (to state in advance their wishes or instructions that should be taken into account related to medical actions should they find themselves in a situation in which the circumstances do not permit them to express their will freely) and a plan of ��palliative care” for patients in a serious and irreversible state. 339. Although these establishments do not have a disciplinary regime as such, they usually have systems of reinforcement by incentives or measures applied to certain inadequate conducts of the inmates. It would be advisable to define clearly which actions are therapeutic and to specify them in the individual therapeutic plans. 340. Physical and pharmacological restraints are used with relative frequency at psychiatric hospitals and senior citizen Residences, among other reasons, to prevent falls or injuries to oneself or to other persons, to avoid alterations of the therapeutic program (removal of intravenous medication, nasogastric tubes, etc.), or to handle violent or aggressive behaviour. It is necessary to regulate at the national level clearly and precisely the use of physical and pharmacological restraints in accordance with international criteria, particularly the definition of restraint, the events in which restraints should be applied, the proportionality and suitability of the means used, the temporary nature of the measure, the authorisation for its use, the personnel authorised to apply it, the documentation of the actions, the evaluation of the effects and results and all necessary safeguards. 341. Notwithstanding such regulation by the law, these centres should have a protocol for the use of restraints and a record in which to enter those instructed for each resident, the reason and medical instructions, the start and end times and observations of the infirmary, among other issues. Their use should always obey to the principles of need and proportionality, they should be applied only for the time strictly necessary and should never be used as punishment. In addition, training courses on restraints should be afforded to the professionals of each centre. 110