Introduction Our law enforcement officials have a duty to protect citizens as well as discourage crimes from taking place. Our health care officials also have a duty to provide the best care possible to those who need it. Often enough, there have been many cases where both parties have come in contrast with each other on different levels of professionalism. The ultimate debate arises when doctors and law enforcement take into account the respect and privacy of patients.

One of the issues that will be discussed in the paper focuses on the importance of doctors having to report gunshot wounds to the police. Many issues of ethics and morality come into play when judging which party is in favor. In our opinion, we believe that physicians should report patients that come in with gunshot wounds for reasons of discouraging criminal acts, protecting our society, and preventing future violence from taking place. This paper will explore the many moral, ethical and legal responsibilities of a physician, and analyze why it is important for them to report gunshot wounds to the police.

Contrary to the Code of Ethics of Physicians and the Medical Act, we believe there is a pressing issue for public concern that is being strongly overlooked in this matter. We will explore the areas of human rights, professional secrecy, civil responsibilities, as well as patient consent in order to justify our claim. The Law Article 9 of The Charter of Human Rights and Freedom states that, "No person bound to professional secrecy should disclose confidential information and that the tribunal will ensure professional secrecy is respected." We strongly believe this statement should not apply to gunshot wounds because it depicts that the law would only be protecting one person over society as a whole. A gunshot wound should not be bound by professional secrecy since; even professionals can determine a gunshot wound and it is not revealing a patient's confidential information other than his condition.

When a gun has been discharged the government has an obligation to protect society. In essence, the most important issues to consider in disclosure of confidential information are that the police have a specific role as well in protecting the well being of society. The police are responsible for assessing the risk posed by members of the public who are armed. Therefore, they have a need to consider the risk of further harm to those in the surrounding area. With the upscale growth of firearm violence throughout the country, police say hospitals have become safe havens for people who break the law, but some doctors say patient confidentiality trumps the need to report gunshot wounds.

Most physicians recognize the narrow public health and safety obligations to report a patient's communicable diseases, gunshot wounds, signs of child abuse, or serious violent intentions -- socially motivated exceptions to traditional pledges of confidentiality. As these social issues immerge, we believe it is best for society to inform the authorities of any crime. Many argue that a patient with a gunshot wound may himself have been part of gunfire and would therefore be discouraged from obtaining medical help if physicians were to report the wound. However, shouldn't a law protect society over one individual? When a patient is brought to the hospital for a gunshot wound it is crucial to take into account that the criminal is perhaps still at large and may harm someone else; that is, if the law enforcement is not informed.

Forty-five American states have some form of law providing for mandatory reporting of gunshot or other wounds. The Code of Medical Ethics states that the information disclosed to a physician during the course of the patient-physician relationship is confidential to the utmost degree, however they have permitted disclosures. Furthermore, article 20. 1 of the Professional Code of Physicians, argues, "A physician, in order to maintain professional secrecy, must keep confidential the information obtained in the practice of his profession." Again, we understand the importance of non disclosure of important information relevant to any patients privacy, however when their condition becomes a matter of public order it is important that those in the public should be protected against any harm that might be caused otherwise. In the case of a gunshot wound, the person being reported may or may not pose a risk to the public. There is no clear intervention that can be undertaken to mitigate or eliminate this undefined, and probably indefinable, risk.

In other words, it would only be fair to disclose any of the confidential information when the need for maintenance of confidentiality is outweighed by a reasonable concern for public safety. We can look at article 20. 5 of the Professional Code, which states that: ... May not divulge facts or confidences which have come to his personal attention, except when the patient or the law authorizes him to do so, or when there are compelling and just grounds related to the health or safety of the patients or of others... ." By addressing this statement, we can divulge the importance by law, of disclosing such relevant information to the police. Similarly, the Professional Code of Physicians states a set of articles (21.

4 to 21. 7) whereby if the victim, for any reason was a witness to the discharge of a firearm and was shot in the process, the doctor must divulge certain information to the authorities. By law, patients have a right to expect that their doctors will hold information about them in confidence. This is an important element of a relationship of trust between doctors and patients. However, it is extremely important to take into account the issue of consent. If the patient cannot give consent, or is in disagreement, information can still be disclosed if there are grounds for believing that this is the public interest or disclosure is required by law.

Disclosures in the public interest are justified where: . A failure to disclose information would put the patient, or someone else, at risk of death or serious harm... A disclosure may assist in the prevention, detection or prosecution of a serious crime. If there is any doubt about whether disclosure is justified, the decision to disclose information without consent should be made by, or with the agreement of, the chief person in charge. Personal information may be disclosed in the public interest, without the patient's consent, and in exceptional cases where patients have withheld consent, where the benefits to an individual or to society of the disclosure outweigh the public and the patient's interest in keeping the information confidential. In all cases where you consider disclosing information without consent from the patient, you must weigh the possible harm (both to the patient, and the overall trust between doctors and patients) against the benefits, which are likely to arise from the release of information.

Before considering whether a disclosure of personal information 'in the public interest' would be justified, you must be satisfied that identifiable data are necessary for the purpose, or that it is not practicable to the data. In such cases you should still try to seek patients' consent, unless it is not practicable to do so. If, for example, the patient is not competent to give consent, or if obtaining such consent would undermine the purpose of the disclosure, then the interest to the public would be justified and therefore would outweigh the confidentiality clause. Gunshot Wounds and the Law United States law states, By a health care provider to appropriate law enforcement personnel in the case of a gunshot wound reportable under section 11-47-48; and that any person who violates the provisions of this section may be liable for actual and punitive damages. We believe the reason why this law must have been applied is because they have a problem with gun control and gun related deaths. In the U.

S. in 1998, there were 30, 708 deaths from firearms, distributed as follows by mode of death: Suicide 17, 424; Homicide 12, 102; Accident 866; Undetermined 316. We can determine when we compare the U. S.

and Canadian statistics that there is a severe interval between both, however gun intervention will always remain a problem. The number of firearms-related injuries in the U. S. , both fatal and non-fatal, increased through 1993, but has since declined steadily.

Despite this, firearm injuries in the United State remain the second leading cause of injury-related death. Although Canada and the United States are two very different countries, they are nonetheless neighbors and should be attentive on the issue of having to be faced with a severe amount of violence. As gun-control is becoming a bigger problem, it is time to revise old policies as the evolution of people has brought us to a world filled with more hatred and violence than we have seen in the past. The US will enforce substantial criminal and non-criminal penalties for non-compliance such as: $100 per person, up to an annual maximum of $25, 000.

A gunshot wound's impact poses a threat on the criminal justice system as well as the health care system. The basic statistics speak for themselves and are important in understanding the magnitude and severity of the social and economic burden to Canada and the United States. The number of non-fatal injuries is considerable -- over 200, 000 per year in the U. S. Many of these injuries require hospitalization and trauma care.

This is a main concern for the society. The cost of the improper use of firearms in Canada was estimated at $6. 6 billion per year, so it's not simply a safety problem but increasing gunshot wounds are also a burden on our economy. Table 2, from the report, presents the costs for people who have died as a result of their wounds and for survivors. It shows, for example, that each fatality resulting from a gunshot wound costs Canadian society over $4 million. Table 2: Costs Per Gunshot Wound by Type of Treatment CATEGORY SURVIVED, TREATED IN EMERGENCY DEPARTMENT SURVIVED, ADMITTED TO HOSPITAL DIED AS A RESULT OF WOUNDS Medical care $4, 933 $28, 879 $3, 061 Mental health care 126 157 5, 171 Ambulance transportation 24 192 359 Loss in productivity to individual and employer 2, 427 50, 464 1, 024, 220 Funeral costs 0 0 2, 983 Lost quality of life 66, 772 228, 687 3, 094, 552 Total $74, 282 $308, 379 $4, 130, 346 Since it costs so much for treatment, we want to make sure that physicians can report gunshot wounds and that whichever party that was involved, be punished severely to discourage people from owning guns or at the very least discourage them from using their guns for any reason at all.

Ontario recently created a bill that would require hospitals to report anyone treated for gunshot wounds. The government believes that this bill will make a safer community. The McGuinty government is making Ontario communities safer by introducing legislation that would make it mandatory for hospitals to report to police whenever they treat someone for a gunshot wound. According to the chief of police, "Guns pose a unique threat to the safety of our communities." Statistics for 2002/2003 reveal that of the 196 cases admitted to Ontario hospitals for injuries resulting from firearms, 96 were the result of assault, 69 were accidental and 31 were self-inflicted. The government and law enforcements believes that there has been an unbalance in that specific area where the report had varied form hospital to hospital and even doctor to doctor. It is important to always keep in mind a physician's ongoing duty of confidentiality to patients.

Although no other province has a mandate to report gunshot wounds, we believe that this is a step in the right direction for minimizing criminal activities and reinforcing safety for others. Many believe that this legislation will build a safer and stronger community, and therefore will provide the Ontario people with a quality of life that is second to none. The bill will enforce the public hospitals and prescribed healthcare facilities to report to the law enforcement when a person comes in with a gunshot wound; they are required to disclose the names of the person being treated and the location of the facility. They must do so when it is reasonable and must not interfere with providing the treatment to the patient or disrupting the hospitals regular activities. Included in the legislation is good faith immunity for all heath care providers and facilities for reporting gunshot wounds. A survey was implemented in facilities in Ontario about the physician opinions on reporting gunshot wounds, and the results were impressive.

TABLE Results of survey question: "Do you feel that there should be mandatory reporting of G SWs (intentional or accidental) by ER physicians?" YES 75. 3% (171 ) NO 20. 3% (46 ) NO OPINION 4. 4% (10 ) N = 227 When we look at the results of the survey, 75. 3% of physicians believe they should report such acts. This is a large number that support the fact that the governing rules need to be revised.

The issue of gun possession came up very frequently in this survey, where, "lethal" was frequently a response as a rationale for violating confidentiality. Many doctors compared the risk to the public following a gunshot wound with that of unfit drivers, for whom reporting by physicians is mandatory. As citizens began researching these facts there became a tremendous amount of concerns for the safety of the community. Conclusion Basic to all public health is the reporting of communicable diseases, hazardous conditions, and injuries that are of public health significance. This information is used for tracking the course of epidemics and for intervening to protect the public health.

Reporting such cases transcend the patient's right to privacy and the health care provider's obligation to protect the patient's confidential information. At the same time, with the recent rise in gun crime, if police aren't given information, then it makes it very difficult to take an investigation forward and discourage further crime as set out in their code of ethics. Undoubtedly, we believe that the professional secrecy act has put physicians in a difficult position, and as increasing gunshot wounds have been processed, physicians have doubted both the law and themselves for holding back from reporting such injuries. Nonetheless, it becomes all the more difficult to help protect the well being of society as a whole if valuable and critical information is withheld from law enforcement. References Code of Ethics of Physicians, c. M-9, r.

4. 1 (R. S. Q.

, c. C-26, s. 87; 2001, c. 78, s. 6) web 2004. Professional Code, R.

S. Q. chapter C-26, 2001: web 2004. Health Protection Act: web 2004. Medical Professional Act, 1981: web 2004. web web web web web web FTI gJ: web web.