entity in addition to the loyalty (duty) to the patient (Solomon, 2005). A particularly important area of concern around dual loyalty relates to healthcare for persons who are legally detained. Healthcare for detainees raises serious issues or conflicts for any healthcare provider. These may include compromised judgments in care, imposing procedures on detainees for the benefit of the state (versus the patient), tolerating lower quality of healthcare, or remaining silent as a provider about unjust practices (Solomon, 2005). Forensic nurses also provide services to persons who are accused, suspected, or perpetrators of crimes. Hence, concern around dual loyalty in this context may be particularly valid to consider. Further exploration and research is needed to understand if forensic nurses who are directly employed by local, state or federal government agencies experience greater tensions or conflicts around potential dual loyalties. Recognizing the potential for direct or indirect patient harm from dual loyalties or dual role responsibilities is critical to developing, implementing and evaluating mechanisms such as formal peer review of forensic nursing practice to guard against patient harm. Conflicting Interests and Conflicts of Interest Considerations related to conflicts of interest in forensic nursing practice parallel those of other nursing and medical specialties. This includes research, entrepreneurial pursuits, consulting with industry, and providing expert consulting services or expert witness services. Unfortunately, 22 there is no one uniform definition of conflict of interest and the nuances of defining the concept have been debated for over two decades (Ruble, 2015). Thompson (1993) described conflicts of interest as a set of conditions where professional judgment concerning a primary interest may be unduly influenced by secondary interest. Primary interest may include responsibilities and duties to patients, research based on sound scientific inquiry, educational responsibilities, and leadership roles. Secondary interest may include financial gain for the individual, family members, company, and employing institution. Additional secondary interest may include prestige, power and privilege for self, family or friends or even nondisclosure of errors and protection from legal recourse. In addition to conflicting professional expectations and interests, ethical principles may also be in conflict. For example, acts of commission or omission enacted with the goal of beneficence may have a foreseeable negative effect. The weights and balances of positive and negative effects are perceived differently by the patient, forensic nurse, law enforcement officer, and victim advocate. Considering the value nurses place on respecting patient autonomy, focus on patient centered care for healthcare providers, and a national movement towards victimcentered responses by law enforcement, the informed choices of a patient with capacity should be respected. Yet coercive techniques to compel a patient to consent to a forensic medical examination, such as creating a feeling of guilt or responsibility to strangers in the community, are an area of active discussion (Downing & Mackin, 2012). The Code of Ethics for nurses clearly states this should not occur and is in direct conflict with the Code. Yet, this may be a common occurrence in forensic nursing practice due to the clinician’s strong beliefs around the potential good of collection samples for forensic analysis (“evidence”). Forensic nurses may also question if non-maleficence is actually feasible given external constraints in particular situations. 23 This can also lead to conversations of respect for persons as autonomous beings and the safety of others at the cost of the individual (e.g. chemical/physical restraints or search warrants to facilitate collection of samples). Justice is a complex principle within forensic nursing practice in that it carries a medical and a legal connotation. Justice from the perspective of the nurse can be quite different than justice from the perspective of the patient or law enforcement officer. Nurses may view justice from the perspective of fair and equitable care (including forensic nursing services) for all patients. This perspective represents distributive justice (Beauchamp & Childress, 2013). For victims of violence, accountability for harms caused to them at the hands of another person may include receiving deserved care, services, responses and even compensation for losses, both physical and social. These expectations of justice represent two additional perspectives - retributive justice and restorative justice. In retributive justice, a balance is sought between punishment for harms caused and the suffering experienced by the person harmed (Pollock, 2010). Whereas restorative justice takes into consideration the victim, offender and their community from a compensation perspective (Pollock, 2010; Brathwaite, 2004). Law enforcement professionals approach justice predominantly from a criminal justice perspective that incorporates both punishment and rehabilitation depending on the nature of the crime. Veracity, privacy and confidentiality become entangled when provision of nursing care intersects with laws related to acts of violence, especially for legally recognized vulnerable populations, whether they are labeled as victims, suspects, or accused (i.e.,