Dilemmas in mandatory reporting of domestic violence: carative ethics in emergency rooms

Laws are clear when it comes to reporting child abuse, elder abuse, or maltreatment of the disabeled; however, the fuzzy area of domestic violence, or injury to women by their husbands or intimates, puzzles the system ethically and legally. Experts are divided on the issue of mandatory reporting of domestic violence by health care professionals. As exemplified by the Florida law, the crux of the problem may be twofold. First, the law requires reporting of certain incidents that are ambiguously defined. Second, reporting may be mandatory without the patient's consent. Many experts in the field of domestic violence suggest that mandated reporting by health care workers is not in the best interests of the victims; it may lead to more violence and increase the victim's reluctance to get needed health care. This victim vulnerability creates ethical dilemmas in the emergency department, often the first outside contact after a violent incident. This paper examines the implications of reporting applied to emergency practice in the context of basic ethical standards. The application of mandatory reporting laws to competent adult victims presents questions related to nonmaleficence, beneficence, autonomy, confidentiality, and a variety of contextual issues that arise from these main ethical domains.