Clinical Radiology (1990) 41, 228

Editorial Radiography of Suspected Drug Smugglers

Numerous letters have been sent to the College expressing concern regarding a radiologist, complying with a request from a police or customs authority to radiograph a suspected drug smuggler. It is appreciated that this request may not be based on appropriate clinical grounds and that the referral to the radiologist is in this case not from a medical colleague. The request to radiograph is not accompanied by the consent of the people concerned. The radiologists involved were rightly worried that they might be accused of assault. In Scotland, the Sheriff can make an order to have a suspected drug smuggler radiographed but there is no similar system in England and Wales. This problem was discussed at a liaison meeting with the Medical Defence and Protection Societies and legal opinion was obtained.

I shall quote directly from the letter written by a legal advisor. The important issues in that advice are prior to any examination:

'1 There must be due authority obtained from a Super- intendent or occasionally a Chief Inspector. That author- ity should be in writing or at least issued directly to the medical practitioner concerned. 2 The doctor may wish to satisfy himself/herself that grounds do exist for suspecting the concealment of drugs. 3 Have all alternatives to detect smuggled drugs been tried within reason before requesting radiographic exam- ination? 4 The extent of the propriety of the suspect's consent or at least acquiescence must be established by the doctor in question, certainly in person and preferably in private consultation with the suspect.'

The legal advice continues that 'No medical practitioner can be required by law to carry out a procedure which is not justified in the medical and clinical interest of the patient. Thus any radiographer or radiologist who refuses

to carry out radiographic examinations of suspected drug smugglers, in circumstances in which he/she believes to be inappropriate, can not be challenged, in my view, by the criminal law nor can he/she be criticised by the General Medical Council for such a refusal. It must, however, be in the public interest and in the interests of the fair administration of justice that this facility should be available to the Customs and Excise Officers, and it seems that the rationale which justifies radiographic examin. ation in safe circumstances is the interest of the suspect.

If there is a suspicion of controlled substances having been ingested then the suspect can either be retained in custody for the maximum period which the law permits (which may permit the natural passage of the said substance) or he/she can agree to proceed to an immediate radiographic examination which may crystallise matters one way or the other expeditiously.

The medical practitioner may then be faced with the essence of the matter, namely the quality of the consent to the examination he may obtain. He certainly needs consent or at least acquiescence in the light of a full explanation. In the face of an outright refusal by the suspect concerned then no medical practitioner would be safe in acceding to a police or customs request for radiographic examination, given that hospital medical practitioners are not part of the judicial process and therefore cannot be invoked as part of the processing of drug smuggling suspects at the various entry points of the country. '

It would appear to me that the above advice is clear and helps to settle many of the problems concerning radiolo- gists asked to carry out and give an opinion on such examinations. As in many situations, clinical judgement must be exercised and care taken over informed consent.

J. O. M. C. CRAIG President

Royal College of Radiologists