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Ethical Decisionmaking

Because the role of the SANE intersects both the health care system and the criminal justice system, conflicts do arise between the needs of the patient and the needs of the criminal justice system. When faced with an ethical conflict, nurses should start with the Nurse Practice Act. Does the Nurse Practice Act speak to the nurse's duty to give care in a specific situation? SANEs can also use the American Nurses Association Code of Ethics as a framework for ethical decisionmaking. In 2008, IAFN published Vision of Ethical Practice. The Vision of Ethical Practice provides a guide for looking at ethical issues within forensic nursing. It is designed to be a document used for encouraging, instead of enforcing, a standard of practice.

Having clear policies and procedures about informed consent, providing examinations for unconscious patients, and collecting evidence from nonconsenting suspects allows nurses to provide ethical care in many situations. It is impossible to predict all of the possible scenarios that a SANE nurse might face in advance. Programs should have protocols in place for seeking legal and ethical advice. Most hospitals have risk managers and ethics committees, and SANEs should be aware of how they function and when to contact them with a concern. It is not sufficient for nurses to make a decision based on what they think is right. Ethical decisionmaking requires a broader look at what is legal under the circumstances, and what patients would decide for themselves if they were able. Hospital ethics committees provide valuable assistance in ethical decisionmaking because they are composed of members who represent both the hospital and the community. Chapter 7 provides more guidance on creating specific policies for ethical issues such as collecting evidence from an unconscious patient.

For SANEs involved in either clinical or practice research, Institutional Review Boards (IRB) provide a required evaluation of the ethical implications of the research. Seeking IRB approval helps to ensure that the safety, privacy, and confidentiality of a patient or other subjects, such as nurses, are considered before any research is conducted. HIPAA also requires IRB approval for any research involving patients, including chart reviews.66 Hospital-based SANE programs may have access to an IRB through their facility. Other programs may wish to partner with a local college or university. Some tribes may also have their own IRB. It is important for SANEs to realize that any data collection from patients regarding their experiences with interpersonal violence can potentially trigger a trauma response from the patient, and nurses need to be prepared to provide support to patients dealing with a trauma response if it occurs. 


It is critical to understand the legal and ethical aspects of SANE practice. SANE programs must be aware of any state, tribal, or federal laws that impact the nurses in their practice. SANEs must also create policies and procedures that comply with the laws of the state and, if practicing in Indian Country, the laws of the tribe and the Federal Government. Appropriate legal counsel should be consulted throughout the process of SANE program development.