When emergency medicine clinicians are caring for a patient in the custody of law enforcement, multiple ethical issues must be considered, says Eileen F. Baker, MD, FACEP, medical director of the ethics curriculum at University of Toledo (OH) College of Medicine and Life Sciences. Baker co-authored a paper analyzing this issue.1 The following are some ethical issues that can arise:
- Physicians should make every effort to maintain privacy and confidentiality.
“A physician’s first duty is to the care of his or her patient,” says Baker. “Respect for patient privacy and confidentiality of personal information is paramount.”
All patients, regardless of their legal status, should receive appropriate medical care. This includes criminal suspects, prisoners, or illegal immigrants, says Baker.
“Patients in custody have rights to provide informed consent and to refuse medical interventions,” notes Baker. Exceptions occur when statute or court order mandates otherwise.
“Medical professionals may override privacy or confidentiality in the reporting of dangerous infectious diseases,” notes Baker. The same is true when patients present a risk to themselves or others.
- Physicians may be asked by law enforcement agents to obtain toxicology screens or alcohol levels for patients presenting with intoxication or drug ingestion.
“If doing so is medically appropriate, the physician may perform these tests,” says Baker. As a rule, she adds, physicians should not volunteer the results of tests unless permission is granted by the patient, or if there is a subpoena.
- There may be a need for evidence collection in cases involving motor vehicle collisions, assaults, or intoxication.
Such evidence might involve abuse of adults or children, or traumatic injuries. “In the course of law enforcement investigations, official photography and other evidence collection may be legally and ethically permissible,” says Baker. A 2013 court ruling determined that intubating and administering medication to a patient to perform a rectal examination to retrieve drug packets was a violation of the patient’s constitutional rights.2
“Physicians are not law enforcement officers,” adds Baker. “Drug and alcohol abuse and immigration status are not reportable.”
REFERENCES
- Baker EF, Moskoop JC, Geiderman JM, et al. Law enforcement and emergency medicine: An ethical analysis. Ann Emerg Med 2016; 68(5):599-607.
- US v Booker (6th Cir. 2013, No. 11-6311).
SOURCE
- Eileen F. Baker, MD, FACEP. Medical Director, Ethics Curriculum, University of Toledo (OH) College of Medicine and Life Sciences. Email: [email protected].
When emergency medicine clinicians are caring for a patient in the custody of law enforcement, multiple ethical issues must be considered.
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