Medicolegal issues surrounding body packers, pushers and stuffers.

Body packing, pushing and stuffing are methods by which individuals conceal illicit drugs for the purposes of transporting them across borders or evading police discovery. Body packers swallow drugs in rubber or latex packets for trafficking; body pushers insert drug packets into their rectum or vagina, and body stuffers swallow wrapped or unwrapped drugs to dispose of the evidence when fearing apprehension by the authorities. Individuals who swallow or insert illegal substances can present to the ED in a number of ways. They might self-present with acute symptoms of drug toxicity and either withhold or disclose a history of body packing, pushing or stuffing. Police might have witnessed the individual ingesting an unknown substance in the course of an arrest, or the individual might have been detained by federal police at border control sites under suspicion of drug trafficking, before being taken to an ED for investigation. These patients represent a challenging cohort of individuals for ED staff, with each scenario raising complex ethical and medicolegal questions. The article in this issue by Mitra et al. highlights some of the difficulties faced by ED staff in managing cases that involve body packing. The article explores the issues of confidentiality and privacy in determining whether or not to report a suspected case of body packing to the police, and presents an argument for national guidelines surrounding mandatory reporting for medical practitioners in cases where a patient has used, or possesses, illicit drugs. There are currently few circumstances in which the ethical and legal responsibilities of medical practitioners are completely clear-cut in the provision of medical care. In most Australian jurisdictions, mandatory reporting is only stipulated for notifiable infectious diseases, impaired medical colleagues, and cases of suspected child abuse. Yet, on a day-to-day basis, medical practitioners are called on to make significant decisions in many other common scenarios where their ethical and legal responsibilities are ill-defined. The decisions that are made at the time, with little opportunity for reflection or consultation, might unwittingly lead to legal ramifications for both the practitioner and the patient. Despite this, medical practitioners receive little training in the field of law as it pertains to medical practice. Legislation varies between States, and there is often ambiguity surrounding the interpretation and application of specific provisions. Navigating through privacy laws and legislation covering health and criminal issues can be a daunting and indecipherable process. The question of whether to report a patient who presents with concealed illicit substances is but one aspect of a much wider debate regarding duty of care, and reporting to police in cases of body packing, pushing or stuffing. Related issues include the appropriateness of acting on police requests for medical investigations, the retrieval of the drugs for evidence, and the factors surrounding patient safety and discharge planning for persons in custody.