However, it is the surgeon’s responsibility to decide
when a police presence presents an unnecessary breach
of confidentiality or places the patient’s health at risk.
The surgeon can, and must, prioritize the patient’s
interests over those of law enforcement. This is a challenging decision to make and rests almost entirely on
the shoulders of the individual surgeon, as very few
laws or hospital regulations address this concern.
Ethical bottom line
Physicians ask patients and their families to trust that
the medical care team will weigh the risks and benefits of all interventions and will do what is in the best
interests of the patient, while respecting the patient’s
goals and values. Pediatric patients who are brought
into the trauma bay are particularly vulnerable, especially when they are accompanied by police rather
than a parent or guardian. Surgeons enter each case
with the understanding that their fiduciary duty
requires that the care and protection of the patient
be the primary concern. The physician must act as
a gatekeeper and guardian for the patient to ensure
that privacy and confidentiality are maintained. 25
The ED and trauma bay are structured, proto-col-driven environments. The presence of police
officers is often beneficial, and yet is not always clearly
defined by either local law or hospital policy. Multiple
considerations must be taken into account, including
patient privacy, staff and public safety, local laws or
institutional guidelines regarding law enforcement,
any requirements regarding reporting a patient’s
status, and the effects on quality of patient care. 24 Ideally, a physician would consult with an ethics review
board; however, this may be less feasible in a trauma
situation where time is a critical and, ultimately, limiting factor. Hospitals should make an effort to clearly
delineate the role of law enforcement in these situations in order to aid the physician and to allow the
focus to remain on the patient’s medical care.
In the absence of specific laws or hospital policies, a physician must rely on four guiding ethical
principles—autonomy, benevolence, beneficence,
and justice—to determine when law enforcement
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2. Centers for Disease Control and Prevention. National
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6. Cutler BL. A sample of witness, crime, and perpetrator
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7. American Medical Association. AMA policy H-315.983:
Patient privacy and confidentiality. Available at: https://
2599.xml. Accessed August 14, 2017.
8. U.S. Department of Health & Human Services. When
does the privacy rule allow covered entities to disclose
protected health information to law enforcement officials?
Available at: www.hhs.gov/ocr/privacy/hipaa/faq/
Accessed August 14, 2017.
9. Wiler JL, Bailey H, Madsen TE. The need for emergency
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10. Green RS, Kureshi N, Erdogan M. Legal consequences
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11. American College of Emergency Physicians (ACEP). Law
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12. Lee F. Violence in the A&E: The role of training and self-efficacy. Nurs Stand. 2001; 15( 46): 33-38.
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