The Ethics of Rape Reporting and Examination

“Consider what it might be like to be a victim of sexual assault who has come to a health care facility for a medical forensic examination. Sexual assault is a crime of violence against a person’s body and will. Sex offenders use physical and/or psychological aggression to victimize, in the process often threatening a victim’s sense of privacy, safety, and well-being. Sexual assault can result in physical trauma and significant mental anguish and suffering for victims. Victims may be reluctant, however, to report the assault to law enforcement and to seek medical attention for a variety of reasons. For example, victims may blame themselves for the sexual assault and feel embarrassed. They may fear their assailants or worry about whether they will be believed. A victim may also lack easy access to services. Those who have access to services may perceive the medical forensic examination as yet another violation because of its extensive and intrusive nature in the immediate aftermath of the assault. Rather than seek assistance, a sexual assault victim may simply want to go somewhere safe, clean up, and try to forget the assault ever happened. It is our hope that this protocol will help jurisdictions to respond to sexual assault victims in the most competent, compassionate, and understanding manner possible.”

This is the first paragraph of the September 2004 “A National Protocol for Sexual Assault Medical Forensic Examinations (Adults/Adolescents)” from the United States Department of Justice Office on Violence Against Women.

The reason I started this thread on a socio-medical issue is to learn from my visitors how they look at rape and its consequences both to the victim and to society but in terms of the ethics and ethical responsibilities of both the victim and those in the medical and justice system.

For example, what ethical responsibility does the victim of rape have to herself but also to the social community to report the rape to authorities and be subjected to examination and later participate in legal proceedings against the accused? Should privacy concerns, modesty and embarrassment by the victim ever be considered to be sufficient reasons to hinder investigation of a crime or if indicated prosecution of the suspected criminal?

The Protocol sets informed consent by the victim as a basis for allowing history taking, physical examination, photography and specimen removal and testing. Is “informed consent “obtained in an atmosphere of acute emotional and physical trauma a fair and just consent? If not, what are the alternatives? Any ideas on this topic? ..Maurice.

Graphic: Illustration from U.S. Government DNA Initiative and modified by me for this topic with Picasa 3.