Mandatory reporting of domestic violence: The law, friend or foe?

Should physicians be mandated to report domestic violence involving a competent adult patient regardless of whether or not he or she consents to the report? This is a complex ethical and moral issue; in some states such as California, Colorado, Kentucky, New Hampshire, Rhode Island and New Mexico it has become a legal one as well. The Federal health privacy regulation instituted in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses issues of privacy protection for survivors of domestic violence, but it does not preempt those state laws that are less (or more) protective of patient privacy. In the above states, physicians and/or health care providers are mandated to report acts of domestic violence to an agency, under their own circumstances, regardless of whether the physician or health care worker believes that reporting the violence is in the patient's best interest or not. But is mandatory reporting truly "good" or "bad" for the patient, the physician or society as a whole? This article explores the laws and the evidence (including evidence-based research) surrounding the issue of mandatory reporting of domestic violence when it pertains to a competent adult.