Navigating Ethical and Legal Tensions in Mandatory Reporting of Intimate Partner Violence: Insights from Norwegian...

The aim of this study was to examine how health-care professionals in assault centers in Norway navigate biomedical ethical principles, health-care legislation, and the mandatory reporting law when working with victims of intimate partner violence (IPV). The study was guided by the following research questions: How do health-care professionals in assault centers apply the law for mandatory reporting of IPV (MR-IPV)? How do they navigate various factors when they consider applying the MR-IPV law?.

This qualitative, explorative study is built on 12 individual, semi-structured interviews with nurses and medical doctors working at assault centers. The data were analyzed using Braun and Clarke's reflexive thematic analysis, with themes developed based on biomedical ethical principles, including relational autonomy.

Two main themes were found. First, MR-IPV was perceived as subsequent but parallel to emergency medical treatment. Some participants used risk assessment tools, and they all emphasized the importance of making patients safe following medical treatment. However, only a few acknowledged that their duty to respect the MR-IPV law was a factor in prioritizing patient safety. Second, ethical principles and health-care legislation were recognized more than the MR-IPV law, which created dilemmas for nurses and medical doctors. These actors faced challenges in navigating patients' autonomy and beneficence in relation to the MR-IPV legislation. Conflicts between patient autonomy and beneficence can lead to paternalistic behavior, which creates ethical dilemmas.

The findings show tensions between medical practices and legal and ethical standards, which contributed to hesitation in reporting severe IPV cases to the police. Health-care professionals prioritized therapeutic relationships and patient confidentiality, sometimes at the expense of their responsibilities concerning the MR-IPV law. Addressing these challenges requires enhancing legal literacy and fostering a cultural shift in health care to align professional autonomy with legal requirements and institutional responsibilities.