Reference has been made in Chapter 2 to situations where reduced legal and ethical issues may create potential areas of conflict. This chapter highlights one of these situations and explores the implications of such conflicts. The forensic physician (this term is used to describe the police surgeon or forensic medical examiner) fulfils two roles, which feature in almost all examinations, whether of detainees (prisoners), police officers, or victims. These are therapeutic and forensic.

THE THERAPEUTIC ROLE

The therapeutic role involves a traditional doctor–patient relationship, with all the demands of consent and confidentiality inherent in this relationship. The ethical principles involved will be familiar to any doctor working in primary care or hospital medicine. Information obtained should normally be kept confidential, but may be shared with others in the healthcare team, in this case other forensic physicians who may take care of the patient, a custody or forensic nurse, or any doctor to whom the patient is referred. The extent to which this information is shared depends entirely on a judgement as to what constitutes the best interests of the patient in terms of safe detention. Treatment must be given on the basis of fully informed consent. If this is absent, as in the case of incapacity due to alcohol, drugs, or illness, then the doctor proceeds on the basis of the patient's best interests or implied consent.