Medical ethics and interaction with law enforcement

Question

There are a few situations where the needs of law enforcement seem to encroach on medical ethics, and I wonder how medical professionals resolve the conflict. I'll offer a couple of specific examples:

1. When a person is arrested on suspicion of DUI often a blood test is ordered. However, when the phlebotomist draws the blood they are precipitating one of two outcomes -- either an unnecessary blood draw (with, for example, a minor risk of damage to a blood vessel or infection); or they are providing evidence that will cause considerable difficulties for the patient.

Given that the responsibility of any medical professional is to the patient, and neither outcome benefits the patient, how can they justify performing the procedure?

2. When someone comes into the ER with a gunshot wound the doctors are required to inform the police of this fact. However, in so doing they are disclosing the private medical records of the patient without their consent and without a specific court order. How can they justify this?

Please note, my question is not about the legality of these things, they are both obviously enacted in statutes and legal. The question is about the medical ethics associated with it. How can a doctor or other professional, sworn to do no harm and sworn to protect the privacy of their patients, participate in these procedures which seem to be in violation of their oaths?

Answer 1

Ethics, certainly in medicine, are very seldom absolute. There are often contradictions between different ethical frameworks, and different aspects of a scenario. One of the traditional forms of a medical oath is 'first do no harm', or in the Hippocratic oath, 'I will abstain from all intentional wrong-doing and harm' - but this is almost impossible to follow in a strict sense, as many medical treatments have side effects that are harmful. The aim is then to try to cause the smallest harm possible that is consistent with treating the patient.

In both the cases you describe, the clinician will be weighing up the potential harm to that individual patient, with the potential harm to others. If there are no consequences to driving while intoxicated, or if a shooter is not identified and stopped at an early stage, many other people may be harmed. The ethical duty to prevent harm to others outweighs the duty of confidentiality to the patient.

In the first scenario, it is also possible for the intervention to be beneficial to that individual - if a sample is taken that confirms no alcohol is present, it might stop an investigation and prosecution at an early stage.