24 " The patient is entitled to be informed when the doctor is acting in the role of expert " Doctors shall seek to establish trust, protect integrity, respect privacy and the duty of confidentiality, promote welfare and provide treatment based on the patient’s informed consent. A doctor may also serve in a role as expert, however. In this role, the doctor acts on behalf of the state, not the patient. The two contradictory roles, so-called ’dual loyalty’, can challenge each other, and handling these roles requires clarity and transparency in relation to the patient. The patient is entitled to be informed when the doctor is acting in the role of expert. Health personnel’s relationship to detainees in police custody Detainees are often escorted to municipal accident and emergency units by the police. This may be due to alcohol and drug problems or other health matters that it may be important to investigate. As the detainee will continue to be deprived of his/her liberty during the medical examination, the accident and emergency unit becomes a temporary place of detention. This is why the NPM conducts visits to the municipal accident and emergency unit during visits to police custody facilities. During these visits, the NPM has found that some doctors at accident and emergency units perform their professional role in relation to detainees in an unclear, and, in part, unfortunate manner. If, for example, a detainee is brought to the accident and emergency unit after being arrested for driving under the influence, the doctor at the accident and emergency unit performs work as an expert on behalf of the police when he/ she collects blood and urine samples. In this type of situation, the patient’s right to privacy and the duty of confidentiality will not be upheld in the same manner as when the doctor is working for the patient, because, among other things, the police are generally NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism against Torture and Ill-Treatment ANNUAL REPORT 2015 present. In such case, it is important that the doctor informs the detainee about his/her role as expert. The same detainee may also have sustained an injury or have health issues that require medical treatment. When the doctor treats the detainee for an injury, he or she acts in their capacity as health personnel and is then obliged to safeguard the doctor-patient relationship, which includes protecting the patient’s right to privacy and respecting the duty of confidentiality. The patient is entitled to speak alone and in confidence with the doctor, unless the doctor for security reasons asks for the police to be present. The NPM has visited police custody facilities where detainees have been brought to the accident and emergency unit to be ’cleared for remanding in custody’. In several custody logs, wording has been used describing the detainee as having been ’cleared’ or ’approved’ for custody by the doctor, and ’clearance for remanding in custody’ has even been documented in patient records at the accident and emergency unit. This is problematic. The doctor’s role is to assess a patient’s health status and provide treatment, not to give his or her seal of approval to the detention. If a patient’s health is such that it will deteriorate significantly as a result of deprivation of liberty, the doctor has a responsibility to protect the patient’s welfare. However, a doctor should never contribute to a decision to approve depriving a person of his/ her liberty. This could potentially destroy confidence in the doctor-patient relationship. " The doctor’s role is to assess a patient’s health status and provide treatment, not to give his or her seal of approval to the detention "