Evidence Collection for the Unconscious and Unconsented Patient
Author(s)
Rose Constantino*,
Carol Stewart,
Polly Campbell,
Barbara Moynihan,
Susan Kagan,
Patricia Daugherty,
Kathleen Thimsen,
Lynda Tiefel,
Colleen O’Brien,
Jennifer Johnson
Affiliation(s)
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, USA. Harborview Medical Center, Seattle, USA. International Association of Forensic Nurses, Sexual Assault Forensic Examiner Program, Office of the Attorney General, Augusta, USA. Quinnipiac University, Hamden, USA. Collarborative BScN Nursing Program, Seneca College of Applied Arts & Technology, King City, Canada. Tennessee Department of Health, Health Related Boards/Office of Investigations, Greeneville, USA. Community Nursing Services, Southern Illinois University School of Nursing, Edwardsville, USA. Tiefel Legal Consulting, Tallahassee, USA. Wisconsin Department of Justice, Ridgeway, USA. Forensic Assessment Consultation and Treatment Program, Shawnee Mission Medical Center, Merriam, USA.
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, USA. Harborview Medical Center, Seattle, USA. International Association of Forensic Nurses, Sexual Assault Forensic Examiner Program, Office of the Attorney General, Augusta, USA. Quinnipiac University, Hamden, USA. Collarborative BScN Nursing Program, Seneca College of Applied Arts & Technology, King City, Canada. Tennessee Department of Health, Health Related Boards/Office of Investigations, Greeneville, USA. Community Nursing Services, Southern Illinois University School of Nursing, Edwardsville, USA. Tiefel Legal Consulting, Tallahassee, USA. Wisconsin Department of Justice, Ridgeway, USA. Forensic Assessment Consultation and Treatment Program, Shawnee Mission Medical Center, Merriam, USA.
ABSTRACT
Forensic nurses are faced with making an ethical decision when an unconscious patient presents with signs of sexual assault. If the patient is unable to consent, the nurses need to decide whether or not to perform a forensic exam. Hospitals have policies in place regarding consent for emergency care, but not all of them consider the collection of forensic evidence. The window of opportunity for forensic collection may disappear before contacts are made or proper consent is established. Ethical, legal, and policy considerations that complicate this scenario are discussed.
Forensic nurses are faced with making an ethical decision when an unconscious patient presents with signs of sexual assault. If the patient is unable to consent, the nurses need to decide whether or not to perform a forensic exam. Hospitals have policies in place regarding consent for emergency care, but not all of them consider the collection of forensic evidence. The window of opportunity for forensic collection may disappear before contacts are made or proper consent is established. Ethical, legal, and policy considerations that complicate this scenario are discussed.
Cite this paper
Constantino, R. , Stewart, C. , Campbell, P. , Moynihan, B. , Kagan, S. , Daugherty, P. , Thimsen, K. , Tiefel, L. , O’Brien, C. and Johnson, J. (2014) Evidence Collection for the Unconscious and Unconsented Patient. Open Journal of Nursing, 4, 287-295. doi: 10.4236/ojn.2014.44033.
Constantino, R. , Stewart, C. , Campbell, P. , Moynihan, B. , Kagan, S. , Daugherty, P. , Thimsen, K. , Tiefel, L. , O’Brien, C. and Johnson, J. (2014) Evidence Collection for the Unconscious and Unconsented Patient. Open Journal of Nursing, 4, 287-295. doi: 10.4236/ojn.2014.44033.
References
[1] Constantino, R.E., Zalon, M.L. and Young, S.E. (2013) The Ethical, Legal, and Sociocultural Issues in Forensic Nursing. In: Constantino, R.E., Crane, P.A. and Young, S.E., Eds., Forensic Nursing: Evidence-Based Principles and Practice, F. A. Davis, Philadelphia. [2] Fairchild, R.M. (2010) Practical Ethical Theory for Nurses Responding to Complexity in Care. Nursing Ethics, 17, 353-362.
http://dx.doi.org/10.1177/0969733010361442 [3] Downs, J.C. and Swienton, A. (2012) Ethics in Forensic Science. Academic Press, Boston. [4] Lee, P.M. (2001) In the Absence of Consent: Sexual Assault, Unconsciousness and Forensic Evidence. Women’s Health Reports. British Columbia Centre of Excellence for Women’s Health. [5] Pierce-Weeks, J. and Campbell, P. (2008) The Challenges Forensic Nurses Face When Their Patient Is Comatose: Addressing the Needs of Our Most Vulnerable Patient Population. Journal of Forensic Nursing, 4, 104-110. [6] Carr, M. and Moettus, A. (2010) Developing a Policy for Sexual Assault Examinations on Incapacitated Patients and Patients Unable to Give Consent, Global Health Governance. Journal of Law, Medicine, and Ethics, 38, 647-653.
http://dx.doi.org/10.1111/j.1748-720X.2010.00518.x [7] Eisert, P., Eldredge, K., Hartlaub, T., Huggins, E., Keirn, G., Obrien, P., Rozzi, H., Pugh, L. and March, K. (2010) CSI: New @ York, Development of Forensic Evidence Collection Guidelines for the Emergency Department. Critical Care Nursing Quarterly, 33, 190-199.
http://dx.doi.org/10.1097/CNQ.0b013e3181d913b4 [8] Linden, J. (2011) Care of the Adult Patient after Sexual Assault. New England Journal of Medicine, 365, 834-841.
http://dx.doi.org/10.1056/NEJMcp1102869 [9] Saferstein, R. (2011) Principles of Forensic Evidence Collection and Preservation. In: Lynch, V.A. and Duvall, J.B., Eds., Forensic Nursing Science, Elsevier Mosby, Philadelphia, 101-108. [10] Dumont, J., White, D. and MacGregor, M. (2009) Investigating the Medical Forensic Examination from the Perspectives of Sexually-Assaulted Women. Social Science and Medicine, 68, 774-780.
http://dx.doi.org/10.1016/j.socscimed.2008.11.010 [11] Chasson, S. (2011) Legal Issues for the Forensic Nurse. In: Lynch, V.A. and Duvall, J.B., Eds., Forensic Nursing Science, Elsevier Mosby, Philadelphia, 445-451. [12] http://depts.washington.edu/bioethx/topics/consent.html [13] Beauchamp, T.L. and Childress, J.F. (2013) Principles of Biomedical Ethics. 8th Edition, Oxford University Press, New York. [14] Jonsen, A., Siegler, M. and Winslade, W. (2006) Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, McGraw-Hill Companies Inc., New York. [15] Buchanan, A. and Brock, D. (1992) Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge University Press, New York. [16] Veatch, R. (1997) Medical Ethics: An Introduction. In: Veatch, R., Ed., Medical Ethics, 2nd Edition, Jones and Bartlett Publishers, Boston. [17] Barnett, P. (2001) Ethics in Forensic Science: Professional Standards for the Practice of Criminalistics. CRC Press, New York.
http://dx.doi.org/10.1201/9781420041620 [18] Matt, S.B. (2012) Ethical and Legal Issues Associated with Bullying in the Nursing Profession. Journal of Nursing Law, 15, 9-13. [19] Maine Revised Statutes Annotated (MRSA 2986).
http://www.mainelegislature.org/ros/LOM/lom122nd/14pub501-550/Pub501-550-121.htm [20] American Nurses Association (2008) Code of Ethics for Nurses with Interpretive Statements. American Nurses Association, Washington DC. [21] American Nurses Association (2010) Nursing’s Social Policy Statement: The Essence of the Profession. Nursesbooks.org, Silver Spring. [22] American Nurses Association and International Association for Forensic Nurses (2009) Scope and Standards for Forensic Nursing Practice. American Nurses Association, Silver Spring. [23] Constantino, R.E. and Privitera, P.R. (2011) Understanding Ethical, Legal, and Sociocultural Issues in Workplace Violence Prevention. In: Privitera, M.R., Ed., Workplace Violence in Mental and General Healthcare Settings, Jones and Bartlett Publishers, Boston. [24] Carter-Snell, C.J. (2013) Violence: Sexual Assault and the Forensic Nurse. In: Constantino, R.E., Crane, P.A. and Young, S.E., Eds., Forensic Nursing: Evidence-Based Principles and Practice, F. A. Davis, Philadelphia. [25] Northrop, C.E. and Kelly, M.E. (1987) Legal Issues in Nursing. Mosby, Washington DC. [26] US Department of Justice (2004) A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents. Office on Violence against Women. [27] Emergency Nurses Association Position Statement on Forensic Evidence Collection (2010) Emergency Nurses Association. [28] http://www.acog.org/Resources_And_Publications/Committee_Opinions/
Committee_on_Health_Care_for_Underserved_Women/Sexual_Assault [29] Macdonald, S. and Norris, P. (2007) Guidelines for the Collection of Forensic Evidence from the Person Who Is Unable to Provide Consent Provincial Coordinator for Sexual Assault & Domestic Violence Treatment Centres in Ontario. Ontario Network of Sexual Assault & Domestic Violence Treatment Centres. [30] Williams, J. and Williams, D. (2013) Disaster Forensic Nursing. In: Constantino, R.E., Crane, P.A. and Young, S.E., Eds., Forensic Nursing: Evidence-Based Principles and Practice, F. A. Davis, Philadelphia. [31] Hammer, R.M., Moynihan, B. and Pagliaro, E.M. (2013) Vulnerable Populations. Forensic Nursing: A Handbook for Practice, Jones & Bartlett, Burlington. [32] http://www.scu.edu/ethics/practicing/decision/framework.html [33] http://josephsoninstitute.org/MED/index.html
[1] Constantino, R.E., Zalon, M.L. and Young, S.E. (2013) The Ethical, Legal, and Sociocultural Issues in Forensic Nursing. In: Constantino, R.E., Crane, P.A. and Young, S.E., Eds., Forensic Nursing: Evidence-Based Principles and Practice, F. A. Davis, Philadelphia. [2] Fairchild, R.M. (2010) Practical Ethical Theory for Nurses Responding to Complexity in Care. Nursing Ethics, 17, 353-362.
http://dx.doi.org/10.1177/0969733010361442 [3] Downs, J.C. and Swienton, A. (2012) Ethics in Forensic Science. Academic Press, Boston. [4] Lee, P.M. (2001) In the Absence of Consent: Sexual Assault, Unconsciousness and Forensic Evidence. Women’s Health Reports. British Columbia Centre of Excellence for Women’s Health. [5] Pierce-Weeks, J. and Campbell, P. (2008) The Challenges Forensic Nurses Face When Their Patient Is Comatose: Addressing the Needs of Our Most Vulnerable Patient Population. Journal of Forensic Nursing, 4, 104-110. [6] Carr, M. and Moettus, A. (2010) Developing a Policy for Sexual Assault Examinations on Incapacitated Patients and Patients Unable to Give Consent, Global Health Governance. Journal of Law, Medicine, and Ethics, 38, 647-653.
http://dx.doi.org/10.1111/j.1748-720X.2010.00518.x [7] Eisert, P., Eldredge, K., Hartlaub, T., Huggins, E., Keirn, G., Obrien, P., Rozzi, H., Pugh, L. and March, K. (2010) CSI: New @ York, Development of Forensic Evidence Collection Guidelines for the Emergency Department. Critical Care Nursing Quarterly, 33, 190-199.
http://dx.doi.org/10.1097/CNQ.0b013e3181d913b4 [8] Linden, J. (2011) Care of the Adult Patient after Sexual Assault. New England Journal of Medicine, 365, 834-841.
http://dx.doi.org/10.1056/NEJMcp1102869 [9] Saferstein, R. (2011) Principles of Forensic Evidence Collection and Preservation. In: Lynch, V.A. and Duvall, J.B., Eds., Forensic Nursing Science, Elsevier Mosby, Philadelphia, 101-108. [10] Dumont, J., White, D. and MacGregor, M. (2009) Investigating the Medical Forensic Examination from the Perspectives of Sexually-Assaulted Women. Social Science and Medicine, 68, 774-780.
http://dx.doi.org/10.1016/j.socscimed.2008.11.010 [11] Chasson, S. (2011) Legal Issues for the Forensic Nurse. In: Lynch, V.A. and Duvall, J.B., Eds., Forensic Nursing Science, Elsevier Mosby, Philadelphia, 445-451. [12] http://depts.washington.edu/bioethx/topics/consent.html [13] Beauchamp, T.L. and Childress, J.F. (2013) Principles of Biomedical Ethics. 8th Edition, Oxford University Press, New York. [14] Jonsen, A., Siegler, M. and Winslade, W. (2006) Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, McGraw-Hill Companies Inc., New York. [15] Buchanan, A. and Brock, D. (1992) Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge University Press, New York. [16] Veatch, R. (1997) Medical Ethics: An Introduction. In: Veatch, R., Ed., Medical Ethics, 2nd Edition, Jones and Bartlett Publishers, Boston. [17] Barnett, P. (2001) Ethics in Forensic Science: Professional Standards for the Practice of Criminalistics. CRC Press, New York.
http://dx.doi.org/10.1201/9781420041620 [18] Matt, S.B. (2012) Ethical and Legal Issues Associated with Bullying in the Nursing Profession. Journal of Nursing Law, 15, 9-13. [19] Maine Revised Statutes Annotated (MRSA 2986).
http://www.mainelegislature.org/ros/LOM/lom122nd/14pub501-550/Pub501-550-121.htm [20] American Nurses Association (2008) Code of Ethics for Nurses with Interpretive Statements. American Nurses Association, Washington DC. [21] American Nurses Association (2010) Nursing’s Social Policy Statement: The Essence of the Profession. Nursesbooks.org, Silver Spring. [22] American Nurses Association and International Association for Forensic Nurses (2009) Scope and Standards for Forensic Nursing Practice. American Nurses Association, Silver Spring. [23] Constantino, R.E. and Privitera, P.R. (2011) Understanding Ethical, Legal, and Sociocultural Issues in Workplace Violence Prevention. In: Privitera, M.R., Ed., Workplace Violence in Mental and General Healthcare Settings, Jones and Bartlett Publishers, Boston. [24] Carter-Snell, C.J. (2013) Violence: Sexual Assault and the Forensic Nurse. In: Constantino, R.E., Crane, P.A. and Young, S.E., Eds., Forensic Nursing: Evidence-Based Principles and Practice, F. A. Davis, Philadelphia. [25] Northrop, C.E. and Kelly, M.E. (1987) Legal Issues in Nursing. Mosby, Washington DC. [26] US Department of Justice (2004) A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents. Office on Violence against Women. [27] Emergency Nurses Association Position Statement on Forensic Evidence Collection (2010) Emergency Nurses Association. [28] http://www.acog.org/Resources_And_Publications/Committee_Opinions/
Committee_on_Health_Care_for_Underserved_Women/Sexual_Assault [29] Macdonald, S. and Norris, P. (2007) Guidelines for the Collection of Forensic Evidence from the Person Who Is Unable to Provide Consent Provincial Coordinator for Sexual Assault & Domestic Violence Treatment Centres in Ontario. Ontario Network of Sexual Assault & Domestic Violence Treatment Centres. [30] Williams, J. and Williams, D. (2013) Disaster Forensic Nursing. In: Constantino, R.E., Crane, P.A. and Young, S.E., Eds., Forensic Nursing: Evidence-Based Principles and Practice, F. A. Davis, Philadelphia. [31] Hammer, R.M., Moynihan, B. and Pagliaro, E.M. (2013) Vulnerable Populations. Forensic Nursing: A Handbook for Practice, Jones & Bartlett, Burlington. [32] http://www.scu.edu/ethics/practicing/decision/framework.html [33] http://josephsoninstitute.org/MED/index.html