Canada: Not on the same team: Police presence in health-care settings is at odds with professional obligations and trauma-informed care

By Claire Connors, Elizabeth Dayo, Natalia Kruger, Sara Alavian, Jacqueline Vincent & Allison Brown

Physicians interact with law enforcement personnel in a variety of ways and settings. Many argue that these uniformed personnel play an important role in the health-care system and that their presence is beneficial in certain clinical circumstances. Police presence in clinical settings, however, has the potential to impact patient care in a way that is detrimental to the fundamental goals of health-care providers: to provide high-quality, patient-centred care and optimize health outcomes.

As hospitals, medical schools and health-care organizations publicly denounced police violence last year, these acts of solidarity neglected to acknowledge how police presence and power imbalances manifest within the health-care system and how this is at odds with the professional and moral obligations of physicians.

While these encounters may be complex, it is the responsibility of health-care providers to advocate for their patients. The presence of an officer at the bedside directly compromises the right to privacy and confidentiality that all patients have. Whether or not the police are immediately present at the bedside can still influence care by impacting patient autonomy and informed decision-making. A lingering police presence can pressure patients into agreeing to treatments or interventions to appear cooperative to police. Patients may perceive that their care team is colluding with police, resulting in a belief that their best interests are no longer being prioritized. That could translate to patients withholding information vital to their care, questioning their providers’ motives and non-adherence to care recommendations.

Additionally, while the use of physical restraints may be common practice in policing, these practices can, unfortunately, translate to the bedside when restraints are inappropriately enforced. For example, pregnant patients escorted by an officer may labour and deliver while handcuffed to the bed – a cruel practice that is banned across many jurisdictions and prohibited by many human rights organizations.

Many of our institutional policies remain misaligned with evidence and best practices for patient-centred, trauma-informed care and are not in keeping with the Canadian Medical Association’s Code of Ethics or rulings from the Supreme Court of Canada. This lack of standardized policies to protect vulnerable patients is a structural barrier that allows police presence and actions in hospitals to often go unchallenged.

Despite the myriad potential consequences to care, health-care professionals are not adequately trained to reflect on and question the role and presence of police officers in the health-care system. Police presence influences how members of the health-care team perceive and treat patients, creating the assumption of guilt and exacerbating biases even when there is no risk of violence from police-escorted patients. It also amplifies existing stereotypes associated with policing and criminality that are reflected within hospitals through the disproportionate use of physical restraints and overrepresentation of Black people in the forensic psychiatric system.

Without adequate training, health-care professionals may also fail to recognize the degree to which they participate in policing behaviour. For example, in psychiatric settings, doctors have the authority to detain patients in hospital and may oppose them in legal hearings if patients appeal. While this is typically done with the best of intentions, providers also must be aware that patients may experience this as coercive and alienating. The knowledge that their health-care provider may also act in a policing and detaining role can undermine a patient’s trust in the therapeutic relationship, resulting in poorer care.