What should I do if a patient brought to the Emergency Room (ER) by a policeman refuses an alcohol screening test?

Respecting Patient Autonomy in Alcohol Screening Refusal

You should respect the patient's refusal of alcohol screening and maintain patient confidentiality, as patient autonomy is a fundamental principle in medical ethics even when law enforcement is present. 1

Assessment of Patient Capacity

When faced with a patient who refuses alcohol screening in the ER, the following approach is recommended:

1. Assess cognitive ability, not blood alcohol level

   • Evaluate the patient's orientation, reasoning ability, and understanding of the situation 2, 1
   • The patient's cognitive abilities should be the basis for initiating any assessment, rather than a predetermined blood alcohol concentration 2

2. Ensure informed refusal

   • Explain the purpose of the screening and potential consequences of refusal
   • Document that the patient understands the implications of declining the test 1
   • Confirm the patient can make a conscious decision and express an explicit refusal 3

Managing Law Enforcement Requests

• The presence of law enforcement does not override patient autonomy or confidentiality 1
• Police requests for medical testing without patient consent cannot be honored unless specific legal provisions apply (such as court orders or specific statutory requirements) 1, 4
• Patient rights should be maintained even in the presence of police to uphold professional and ethical standards 1

Documentation Requirements

Thorough documentation is crucial when a patient refuses alcohol screening:

• Record the patient's refusal and your assessment of their capacity 1
• Document the information provided to the patient about the implications of refusal
• Note any concerns about the patient's safety or decision-making capacity

Special Considerations

• If the patient appears significantly impaired and may pose a danger to themselves or others, consider:
  • A period of observation to determine if symptoms resolve as intoxication decreases 2
  • Consulting with supervisors or hospital legal counsel if uncertain about the appropriate course of action 4

Common Pitfalls to Avoid

• Do not perform testing without consent simply because law enforcement requests it
• Do not assume intoxication automatically negates a patient's right to refuse care
• Do not release confidential medical information to police without proper authorization
• Do not discharge a patient who lacks capacity to make safe decisions about their care

The ethical obligation to respect patient autonomy remains paramount in emergency medicine, even in challenging situations involving law enforcement 5. While this may create tension between respecting patient rights and responding to police requests, maintaining patient confidentiality and autonomy should guide your decision-making.