PART 1.
INTRODUCTION
We read in the Holy Book of the Christians (Bible), the story of a certain man who was robbed, beaten, helpless, and left to die. While many saw him in this dire state, only a soul moved by compassion came to his aid despite being in desperate need for help.
This story often emphasizes the actions of the one good man who rendered help, but it also raises important questions. Why did others not help? What could have possibly prevented them from coming to the aid of the dying man and many more?.
In today’s society, fear of legal consequences, financial commitment and sometimes, unexpected trouble with law enforcement agencies among others may culminate into why individuals might be hesitatant to assist victims in dire need of help.
Often time, considerable victims of kidnappers, ritualists, bandits, and armed robbery attacks survive their ordeals but are left on the brink of death owing to lack of timely medical intervention as a result of the reasons adduced above.
Generally, emergency healthcare is a fundamental right that cuts across societal, legal, and moral boundaries. However, in countries like Nigeria, the intersection of healthcare, law enforcement, and societal norms creates a complex scenario, especially when treating accidents, gunshot wounds, or victims of critical injuries.
For decades, hospitals in Nigeria have been faced with the dilemma of whether to provide emergency treatment without a police report.
In this article, we shall focus our attention on the legal and ethical implications of treating such cases and the evolving stance of the country’s healthcare laws and ethics.
Legal Framework
Historically, Nigerian hospitals and clinics often refused to treat patients with gunshot wounds, critical injuries, or accidents until a police report was presented. This was primarily driven by regulations ambiguities and fear of being implicated in criminal investigations.
However, this stance has gradually changed due to legislative reforms and increased awareness of the importance of timely medical intervention.
Continuous awareness is however, required by the relevant agency as many of the hospitals still insist on police reports before commencing treatment for such victims.
THE ‘OLD PRESUMED LAW’
While the Police Act (CAP p19, laws of the Federation of Nigeria, 2004), section 4 1 mandates police reports for injuries caused by firearms or other dangerous weapons. It is important to note that the regulation was a mere police rule and never a law or legislation of the Federal Government of Nigeria. It’s also noteworthy that many lives have been lost because of these reckless and insensitive bottlenecks.
Whilst the Constitution of the Federal Republic of Nigerian (1999 as amended) guaranteed every citizen the right to life and before such life can be taken, such person must not only be found guilty of an offence by a competent court of record, he must be so convicted and sentenced accordingly.
Further to the above, Coronal Law (CAP C35, laws of the federation of Nigeria, 2004) section 9 (1) mandates healthcare workers to report deaths or injuries caused by violence or which in their opinion is unnatural causes.
THE LAWS.
- Gunshot Wounds Act (2017): One of the most critical legislative interventions came in 2017 with the passing of the Compulsory Treatment and Care for Victims of Gunshot Wounds Act. This law mandates that hospitals and healthcare professionals treat gunshot victims immediately, without the need for a police report. Under this Act, hospitals, whether public or private, must provide immediate treatment to any person with gunshot wounds. See Section 1 of the Act.
However, as an addendum to the Act, such Healthcare providers are mandated to report such cases to the police within two hours after commencing treatment, but the lack of an immediate report should not delay medical care. See Section 3 (1), while failure to comply with this law may result in sanctions, including fines or imprisonment for healthcare professionals. See Section 5 of the Act.
This act is a significant departure from past practices and reflects Nigeria’s commitment to aligning healthcare with global human rights standards. Prior to this law, gunshot victims were often left untreated due to fears that treating them without police approval would involve medical personnel in legal issues or criminal investigations.
- The National Health Act (2014): The National Health Act also plays a critical role in ensuring the rights of emergency patients. It states that all citizens have the right to emergency treatment, and refusal of such treatment due to the absence of a police report or upfront payment is illegal. This law sets a standard for all healthcare providers and reinforces the human right to life-saving treatment. The Act ensures that emergency care, including road accidents and critical injuries victims can not be denied healthcare due to financial or bureaucratic reasons. See Section 20 of the said Act even though enforcement remains a challenge, with many healthcare providers still hesitating to treat victims without police involvement, largely due to fear of legal repercussions, inadequate training, or lack of proper awareness of the law.
ROLES OF INDIVIDUAL, LAW ENFORCEMENT OFFICERS AND MEDICAL PERSONEL
Section 2 of the Act provides:
Every person, including security agents, shall render every possible assistance to any person with gunshot wounds and ensure that the person is taken to the nearest hospital for immediate treatment.
Accordingly-
(a) a person with a gunshot wound shall be received for immediate and adequate treatment by any hospital in Nigeria with or without initial monetary deposit, and
(b) a person with a gunshot wound shall not be subjected to inhuman and degrading treatment or torture by any person or authority, including the police or other security agencies.
According to the above provision, the law mandates that everyone, including security agents and medical personnel, must promptly and without hesitation attend to victims of gunshot wounds, accidents, and other emergencies. This is a mandatory requirement of the law without more. See also Section 20 of the National Health Act.
Ethical Responsibilities.
The ethical responsibilities of healthcare professionals come into sharp focus when handling emergency cases. The Hippocratic Oath, which emphasizes a duty to preserve life and prevent harm, is at odds with practices that delay treatment pending police clearance. From an ethical standpoint, the decision to prioritize administrative procedures over a patient’s immediate care contradicts the core values of medical practice.
- Ethical Dilemma of Life versus Law: Healthcare professionals in Nigeria have faced a long-standing ethical dilemma—whether to prioritize life-saving treatment over bureaucratic processes like obtaining a police report. For instance, a good number of patients have died due to delayed treatment caused by hospitals insisting on a police report before providing care. This situation raises critical ethical questions about the role of the medical community in preserving life above all else.
- Patient Confidentiality and Trust: Another ethical concern is patient confidentiality. Reporting to the police, especially in gunshot cases, may compromise patient privacy and trust in the healthcare system. Although the law mandates reporting after initial treatment, healthcare professionals must navigate the delicate balance between cooperating with law enforcement and upholding patient confidentiality and,
- Access to Emergency Care. Access to emergency care without unnecessary obstacles is fundamental. Denying or delaying treatment due to the absence of a police report can be seen as a violation of a patient’s right to life and dignity. Nigeria’s efforts to improve this situation through the aforementioned laws represent an important step toward ensuring that medical ethics align with international human rights standards.
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