Ethical Considerations in Handling Victims of Sexual Violence: Collaborative Role of Nurses and Forensic Experts.

Abstract

Background: Sexual violence is a major public health and medicolegal concern. Sexual Assault Nurse Examiners (SANEs) collaborate with law enforcement, crime laboratory analysts, victim advocates, and prosecutors, creating ethical tensions between survivor-centered care and forensic obligations, with trauma-informed, patient-centered care as the primary clinical commitment.

Aim: To provide an ethical analysis structured around the four biomedical principles, autonomy, beneficence, non-maleficence, and justice, to guide clinical decision-making in sexual assault care.

Methods: A narrative review supplemented by hand-searching of professional guidelines, using the Beauchamp and Childress principlist framework for systematic, principle-level analysis across informed consent, evidence collection, mandatory reporting, trauma-informed care, professional boundaries, secondary victimization, and structural justice concerns.

Results: Autonomy centers on mandatory reporting as a direct tension with self-determination, alongside dynamic consent and trauma-informed practice. Beneficence addresses the asymmetry between the immediate patient burden and the indirect, societal-level benefits of evidence collection, including nonreport kits that preserve future legal options. Non-maleficence addresses avoidance of retraumatization and minimization of examination-related harm. Justice addresses structural inequities: geographic disparities in SANE access, including the growing role of telehealth in narrowing the rural-urban gap, resource gaps between Sexual Assault Response Teams (SARTs) and non-SART settings, and broader structural barriers to equitable care. Professional and system-level considerations, including interdisciplinary role conflict, competing institutional obligations, moral distress, and practice sustainability, are cross-cutting to all four principles.

Conclusions: Ethical sexual assault care is grounded in trauma-informed, survivor-centered practice; forensic documentation functions as a secondary obligation that must not supersede informed consent or patient well-being.