The New York Times headline would read “Three Enemas Later, and Still No Drugs.” The backstory, in a nutshell, was that the police had come to my emergency department with a 54-year-old man whom they had noted to be standing “erect and with his legs together” after pulling him over for rolling through a stop sign, a posture that apparently led them to believe he was hiding drugs in his rectum. They had with them a search warrant, signed by a judge, ordering a cavity search for Mr. Eckert. As the headline indicates, he in fact had no drugs and settled a lawsuit with the parties involved for $1.6 million.

The good news is that I did not perform the cavity search. Something told me that, search warrant or not, I, as a physician, had an obligation to my patient that forbade the performance of an invasive examination in an effort to collect evidence that would be potentially incriminating.

Not all of the physicians involved recognized this. Mr. Eckert was taken to another medical facility and received serial rectal examinations, 3 enemas, a computed tomography scan, and a colonoscopy, all of which had negative results.

Although in retrospect it seems like this decision was easy and obvious, the reality is not so black and white. I am sympathetic to the other physicians involved in this case, who I suspect almost certainly thought they were simply doing what was appropriate and required. Had illegal drugs been found, I suspect that no one would have ever heard about this case, and I very much doubt Mr. Eckert would now be a millionaire.

This case is hardly unique. Just recently I read a newspaper article about a man in Vermont who was pulled over under similar circumstances. The police obtained a search warrant and the man was taken to a hospital for a cavity search, in which 1,428 bags of heroin were discovered. This case has been reported in the media not as a civil rights case, but more or less as a Ripley’s Believe it or Not anomaly, with emphasis on the sheer number of heroin bags this man managed to hide in his rectum.

There are a multitude of similar cases. In some, the suspected contraband is discovered and in others it is not. Such scenarios can be confusing. The legal and ethical issues involved are complex and poorly understood by the average emergency physician, who most likely has had no formal training surrounding this topic.

With this as the background, I was thrilled to see American College of Emergency Physicians (ACEP) Council Resolution 22 receive such overwhelming support at the annual meeting this year. The resolution requests that ACEP “study the moral and ethical responsibilities of emergency physicians within the context of court-ordered forensic collection of evidence in the context of patient refusal of consent, and if appropriate, develop policy to support emergency physicians’ professional responsibilities when in conflict with court-ordered forensic collection of evidence and/or medical treatment.”

It is my hope that this resolution creates a serious dialogue within the emergency medicine community because the issue extends far beyond the rare court-ordered body cavity search that many of us may never encounter in the course of our careers. It is, at its heart, an issue of patient advocacy. Although physicians are generally highly aware of the need to respect the rights and wishes of their patients, there are, of course, special circumstances in medicine where we make exceptions to this practice. Suicidal patients, intoxicated patients, patients who make threats against others, and patients who test positive for certain mandatory-to-report diseases are just a few examples of unique circumstances where a physician may be required to do something against a patient’s will. These are all situations where the potential for harm to the patient or to society as a whole have been deemed to be great, and the emergency medicine community has done a commendable job of scrutinizing the rules and regulations that apply to these circumstances.

There’s a good reason for the tedious documentation surrounding patient restraints, or that 2 physicians have to be involved in an involuntary admission, or that suspected elder abuse is mandatorily reported. These situations have all been carefully considered and debated in great detail. It is time that we add court-ordered forensics collection to this list.