Ethical dilemmas: a student reflection on safeguarding in adult domestic abuse

Abstract

This reflective account discusses a case where a patient refused a safeguarding referral after disclosing domestic abuse to a student paramedic on an MSc programme. The author examines the medical, ethical and legal evidence when determining whether the right path was taken in caring for this patient. It is argued that the care delivered was lawful and ethical but the student paramedic did not have sufficient awareness of the support options available to those experiencing domestic abuse. Their oversimplification of the dilemma to the patient having capacity to refuse referral omitted key aspects of the medico-legal framework, potentially to the detriment of the patient's care. Reflective learning has allowed the author to recognise the limits of his understanding of the complex medico-ethico-legal framework surrounding domestic abuse, consent, coercion and controlling behaviour. In response, he has established a new methodology to assess the underlying reasons for refusing a safeguarding referral.