Mayer B
College of Nursing, University of South Florida, Tampa, USA.
Nursingconnections. 1998 Winter;11(4):5-21.
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.
在报告虐待儿童、虐待老人或虐待残疾人方面，法律规定很明确；然而，家庭暴力这一模糊领域，即妇女遭受丈夫或亲密伴侣的伤害，在伦理和法律层面给整个体系带来了困扰。医疗保健专业人员是否应强制报告家庭暴力这一问题，专家们意见不一。以佛罗里达州的法律为例，问题的关键可能有两方面。其一，法律要求报告某些定义模糊的事件。其二，未经患者同意，报告可能成为强制要求。家庭暴力领域的许多专家认为，医护人员强制报告不符合受害者的最佳利益；这可能导致更多暴力行为，并增加受害者不愿寻求所需医疗保健的抵触情绪。这种受害者的脆弱性在急诊科引发了伦理困境，而急诊科往往是暴力事件发生后受害者与外界的首次接触场所。本文在基本伦理标准的背景下，探讨报告在急诊实践中的影响。将强制报告法律应用于有行为能力的成年受害者，会引发与不伤害原则、行善原则、自主权、保密原则以及源于这些主要伦理领域的各种具体情况相关的问题。
