Domestic violence and the law – the role of health professionals

We all know that domestic violence has an adverse impact on the health and wellbeing of victims and theirfamilies. We also know that it is illegal to commit such acts of violence. However, in most states (Northern Territory being the exception (1), it is not mandatory for health professionals to report suspected or known adult abuse resulting from domestic violence.

Mandatory reporting, as enacted by the NT, is highly contentious and questions whether this further depletes a woman’s autonomy to decide on the best course of action with regards to her (and her family’s) safety and wellbeing. It also introduces potential for further danger in the home where police following up a report of domestic violence can exacerbate retaliation by the perpetrator against their partner, as well as introducing fear of having children removed from home or the process resulting in homelessness (2). In addition, health professionals and others are also concerned that women will avoid seeking treatment or legal advice based on mandatory reporting measures, preferring to keep their affairs private.

Across all states, it is also mandatory for health professionals to report suspected child abuse. Depending on the state in which you are practicing, however, the definition of child abuse may include exposure to domestic violence (3). Given that domestic often occurs in a family setting where children are present, is important to consider how a child’s health is impacted on with exposure to domestic violence (regardless of whether the child is directly exposed to acts of violence or is witness to them). The Royal Australasian College of General Practitioners (RACGP) has published an excellent resource for General Practitioners on how to address, manage and assist patients who experience acts of violence, including children, the elderly, and Indigenous persons. The Department of Health website provides a response guide for health practitioners specifically dealing with women who are pregnant and experiencing intimate partner violence.

So at what point should a health practitioner step in and break patient confidentiality? There is no clear answer to this question, and the decision that a health professional makes with respect to mandatory reporting of domestic violence is fraught with ethical, as well as legal, consequences. It is also important to remember that if you are working for an organisation or institution, such as a hospital, you are obligated to follow the employee guidelines. The Department of Health WA has a resource manual for managing patients in hospital who may be experiencing domestic violence. The manual mentions that in the context of upholding patient safety, patient confidentiality must be weighed against duty of care (4). Again, immediate threat to life appears to be the driving factor in making the decision to report the incident to police where a patient does not consent to the disclosure of information.

The bottom line is that a patient’s health and safety is the health professional’s priority, and that the more equipped we are to deal with such incidents, the more confident we will be in supporting the patient experiencing domestic violence to seek out options unique to their situation.

Would you like to know more?

DV-alert is a Domestic Violence Response Training government funded course for health professionals (and students in relevant disciplines). It is run by Lifeline and teaches health professionals how to recognise, respond to and refer patients to the appropriate services. They also have an online E-Learning module that covers the topic in greater detail.