A 19 year old woman came to the ED reporting that she had been raped by a taxi driver. She wanted emergency contraception and wanted to be tested for sexually transmitted infections. She said that she was alone in the taxi, the driver took her to secluded park, raped her and left her at the park. She would not describe the taxi driver, say which company he worked for, or give any details about what happened. She did not want to press charges because she did not want to questioned by the police (she stated that her sister had been sexually abused and went through a terrible time having to relive her experience over and over again after she reported to the police). The attending (and I) were in a conundrum. If what happened to her isn't reported to the police, a taxi driver can very well rape (or murder) someone else. If what happened is reported to the police, we'd be breaking her confidentiality (and making her go through a lot of grief). Eventually, the nurses contacted the hospital lawyers who (probably to save their asses) said that legally we can't break her confidentiality. So, even though it gave both the attending and I a terrible feeling, we let her go and didn't report anything.
Later in the week I talked to a medical ethicist at our institution about this. He didn't say anything clear cut. But, he reminded me that confidentiality can be broken if the information we reveal has a high probability of saving the patient's life or the lives of others. So, assuming she's telling the truth (not sure if she is) and there is a high probability that the taxi driver would rape again (and statistically speaking, it is), ethically we should have reported the incident. Is that right? I'm still on the fence about this. I just hope I don't hear anything about a cab driver raping someone else on the news.
That's fucked up. And by fucked up I mean, well, fucked up, I guess. I can understand your conundrum completely, and I would have a really hard time possessing this information and knowing that something like this could happen again, especially as these perpetrators can turn violent if they keep doing this over and over again. However, the linkage between this patient's information and absolute predictable threat to life to her or others is too abstract to justifiably (i.e., legally) break confidentiality, so unfortunately I think you have to sit on this one. But my heart goes out to her, and I hope that taxi driver suffers some sort of penile leprosy for what he's done.
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