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Preventing, Identifying & Treating Violence & Abuse

Physicians have an ethical obligation to take appropriate action to avert the harms caused by violence and abuse.
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Code of Medical Ethics Opinion 8.10

All patients may be at risk for interpersonal violence and abuse, which may adversely affect their health or ability to adhere to medical recommendations. In light of their obligation to promote the well-being of patients, physicians have an ethical obligation to take appropriate action to avert the harms caused by violence and abuse.

To protect patients’ well-being, physicians individually should:

(a) Become familiar with:

  1. How to detect violence or abuse, including cultural variations in response to abuse
  2. Community and health resources available to abused or vulnerable persons
  3. Public health measures that are effective in preventing violence and abuse
  4. Legal requirements for reporting violence or abuse

(b) Consider abuse as a possible factor in the presentation of medical complaints.

(c) Routinely inquire about physical, sexual, and psychological abuse as part of the medical history.

(d) Not allow diagnosis or treatment to be influenced by misconceptions about abuse, including beliefs that abuse is rare, does not occur in “normal” families, is a private matter best resolved without outside interference, or is caused by victims’ own actions.

(e) Treat the immediate symptoms and sequelae of violence and abuse and provide ongoing care for patients to address long-term consequences that may arise from being exposed to violence and abuse.

(f) Discuss any suspicion of abuse sensitively with the patient, whether or not reporting is legally mandated, and direct the patient to appropriate community resources.

(g) Report suspected violence and abuse in keeping with applicable requirements. Before doing so, physicians should:

  1. Inform patients about requirements to report.
  2. Obtain the patient’s informed consent when reporting is not required by law. Exceptions can be made if a physician reasonably believes that a patient’s refusal to authorize reporting is coerced and therefore does not constitute a valid informed treatment decision.

(h) Protect patient privacy when reporting by disclosing only the minimum necessary information.

Collectively, physicians should:

(i) Advocate for comprehensive training in matters pertaining to violence and abuse across the continuum of professional education.

(j) Provide leadership in raising awareness about the need to assess and identify signs of abuse, including advocating for guidelines and policies to reduce the volume of unidentified cases and help ensure that all patients are appropriately assessed.

(k) Advocate for mechanisms to direct physicians to community or private resources that might be available to aid their patients.

(l) Support research in the prevention of violence and abuse and collaborate with public health and community organizations to reduce violence and abuse.

(m) Advocate for change in mandatory reporting laws if evidence indicates that such reporting is not in the best interests of patients.

AMA Principles of Medical Ethics: I, III

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