Detention and Confidentiality

A forensic physician (or equivalent) should exercise particular care over confidentiality when examining persons who are detained in custody. When taking the medical history and examining the detainee, it is common for a police or other detaining official to be in attendance, perhaps as a "chaperone" or simply as a person in attendance, nearby to overhear the conversation. Such officials will not owe to the detainee the same duty of confidentiality that is owed by a medical or nurse practitioner nor be subject to similar professional sanctions for a breach of confidentiality.

The doctor called on to examine a detainee must take great care to ensure that the person being examined clearly understands the role of the forensic physician and the implications for confidentiality. The detainee must understand and agree to the terms of the consultation before any medical information is gathered, preferably giving written consent.

The examining doctor should do everything possible to maintain the confidentiality of the consultation. An accused person's right of silence, the presumption of innocence, rights under human rights legislation, and so forth may produce areas of conflicting principle. The doctor's code of professional conduct may conflict with statutory codes to which custody officials are bound (e.g., the duty on a police officer to record events). It may be essential to take the medical history in strict confidence, commensurate with adequate safeguards against violent behavior by the prisoner, and insist on a neutral chaper-one for a physical examination. In the rest of this chapter, it is possible only to highlight the issues; their resolution will vary according to local rules and circumstances. In the United Kingdom, guidance for forensic physicians is available from their professional bodies (25).

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