Ethical Principles

Doctors who practice as forensic physicians (forensic medical examiners [FMEs], forensic medical officers, or police surgeons) have a special responsibility toward detainees, subjects whose liberty is already infringed and who are at serious risk of future curtailment of their liberty. Although enactments in Europe, such as the Human Rights Act of 1998, have afforded better protection of the rights and liberties of citizens, the forensic physician has a real part to play in acting honorably by ensuring that the rights of the detainee are upheld in accordance with medical professional codes of ethics. A forensic physician who believes that the rights of the detainee are being ignored or abused may have a duty to report the concern to an authoritative person or body.

It is not always appreciated that forensic physicians have two roles. First, they are independent medical assessors of victims and/or alleged perpetrators of crimes and, as such, no conventional therapeutic relationship exists. It is most important that this be made clear to the victims or detainees by the doctor, so that properly informed consent is secured for the proposed examination. Second, a therapeutic relationship may arise when advice or treatment or other therapeutic intervention is offered, but the nature of the therapeutic relationship will be constrained by the circumstances and by the forensic physician's duty to pass information to police officers who will be responsible for observing the detainee or victim. Great care is necessary concerning issues of consent and confidentiality in such circumstances.

Some ethical codes are national, drawn up by such bodies as national medical associations and medical boards or councils set up by the state (such as the British Medical Association and the General Medical Council [GMC] in the United Kingdom). Other codes of ethics are regional (e.g., the European Convention on Human Rights), whereas still others are international, such as the many codes and declarations prepared and published by the World Medical Association (see Appendix 1).

Most of the ethical principles will be familiar to doctors who practice in countries that derive their laws from the Anglo-American common law system, but the detail of local rules and regulations will vary from nation to nation and state to state.

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