ETHICS IN ACTION
“A Patient Who Cannot Speak Freely Cannot Be Treated Appropriately” By Jeremy Simon, MD
SAEM PULSE | NOVEMBER-DECEMBER 2022
The Case
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One evening, police officers bring into the emergency department (ED) a 32-year-old male whom they’ve placed under arrest. According to triage, the prisoner himself has no complaints, but the police officers say that when they pulled him over, they saw him quickly put something in his mouth which they believe he swallowed. They are concerned that the “something” may have been drugs. After an initial evaluation, the physician assistant (PA) reports that the patient denies having swallowed anything, but the police repeat the observation they initially reported to triage. On exam, the patient has normal
“...it is important to remember that although the patient cannot leave against medical advice, he or she also cannot be compelled to accept treatment...” vitals, is in no apparent distress, and has no abnormal findings. The PA and attending agree that the case may be difficult for two reasons. First because the police have no apparent motive to report that the patient swallowed something and if the police are believed to be telling the truth, then the report is presumptively reliable. Therefore, since the patient does not provide any details
as to what he swallowed (in terms of both substance and quantity), the medical team feel obligated to admit the patient for prolonged observation until they are comfortable that any swallowed drugs have been passed or safely absorbed through the gastrointestinal tract. The second reason the case may prove difficult is that the police may ask that medical staff hand over any
