After briefly describing the various State reporting laws concerning domestic violence, this article analyzes the implications of statutorily mandating the reporting of domestic violence and how such reporting may be detrimental to patients who are living with ongoing abuse and violence. Also included is a discussion of the ethical issues involved in the decision by a health care practitioner to report a domestic violence case. Child abuse and elder abuse reporting are discussed briefly. The authors stress that if there is no effective response to reports of domestic violence, a mandatory reporting law may create expectations of services and protection that cannot be met, decrease patient trust in the provider and the system, diminish patient safety, and undermine goals of punishment and deterrence. Among the recommendations presented in the article, health care workers and the facilities in which they practice are urged to strive to implement policies that promote the well-being and autonomy of survivors of domestic violence and to minimize the harms of existing mandatory reporting laws. Policy directions as well as other ways to minimize harm under current reporting laws are considered. Tables, references