Doctors must avoid the word even in court depositions

The Health Ministry has advised doctors not to use the word ‘rape’ in medical reports on sexual assault victims, and even in court depositions.

“Rape is not a medical diagnosis, it is a legal definition, hence the word should not be used while forwarding opinion,” says the latest Instruction Manual for Forensic Medical Examination Report of Sexual Assault (Victim) brought out by the Indian Council of Medical Research under the Department of Health Research (DHR). The victim must not be refused treatment and examination for want of police papers.

The recommendations, which also carry a draft of a ToolKit for Psychological Support for Women Survivors of Sexual Assault, are open to public opinion.

Importantly, the manual suggests that doctors should not identify a victim as ‘habituated to sexual intercourse’ on the basis of a ‘finger test.’ Such identification is an unlawful interference with her privacy and an unlawful attack on her honour and reputation and is violation of her human rights. “In a prosecution of sexual assault, where the question of consent is at issue, evidence of the character of the victim or of her previous sexual experience with any person is not relevant to the issue of consent or quality of consent.”

As normal examination findings neither refute nor confirm forcible sexual intercourse, circumstantial and other evidence may be taken into consideration.

The manual says forcible sexual intercourse is possible without leaving any medical evidence. Submission of the victim may be achieved by emotional manipulation, fear of violence or death or by verbal threats; the force used, or resistance offered, is insufficient to produce injury; bruises may not become apparent for 48 hours following an assault; a delay in reporting the incident will allow minor injuries to fade or heal, and the survivor becoming unconscious, under the effect of alcohol/drugs are some of the reasons cited for absence of injury.

Such cases shall be registered in hospital as a medico-legal case (MLC), whether the patient comes on her own or is brought by the police. If the patient comes on her own, the decision to inform the police shall be taken after obtaining due consent from her or her guardian. The doctor should examine such cases if the survivor reports to the hospital first without a First Information Report.

A victim may come to the hospital only for treatment of the effects of the assault. Under Section 39 of the Cr.PC, the doctor is not bound to inform the police of such cases.

Informed refusal to inform the police should be documented. Neither the court nor the police can force the victim to undergo medical examination. It has to be done with her/parents/guardian’s informed consent (depending on age). The consent form will be signed by the person herself if she is above 12, the manual recommends.

An important need identified by the DHR is making guidelines available to healthcare providers who work with victims of sexual violence. The manuals are meant, not to replace the standard textbooks, but to supplement them in such a way that these guidelines can be adapted easily to most healthcare provider situations in the country.

Most countries which have well-developed services for women subjected to sexual assault have realised the need for psychological support and the need for a survivor support worker who will help the woman through all stages — from the initial contact at the police station or health facility, helping her handle medical examination, discussing an emergency contraception and STD/HIV prophylaxis and subsequently helping her with court proceedings and to normalise her life.

The toolkit is meant to help nurses, doctors and counsellors give psychosocial support to survivors of rape, help them with the consequences of the experience and through recovery from trauma.

Describing rape and sexual assault as severely traumatic experiences often associated with immediate psychological reactions such as shock, shame, guilt, anger, numbing and psychological distress, the toolkit says women and young girls may not be able to discuss everything or reveal all details at the first contact at a police station or hospital. The clinical environment of a hospital or the alien atmosphere in a police station may add to the distress and often result in the survivor not revealing important information.

‘You are not to blame’ is the key message the survivor wants to hear. She should not be quizzed by too many professionals. ‘I believe you’ and ‘I understand your distress’ are two critical messages that will help a survivor in talking about her problem. The partner needs to be educated on the normal reactions to healing after sexual assault: how anger sometimes serves a function and how the partner may also need to talk about his own emotions with the counsellor.

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