Rape-Sexual Assault - Violence, Rev

BIOETHICS IN
OB-GYN
Rowena M. Auxillos, MD, FPOGS, MBA-H
1
4 Basic Principles
• Clinicians and others often make
decisions without appealing to ethical
principles for guidance or justification.
• But when they experience unclear
situations, uncertainties, or conflicts,
principles often can be helpful.
• The major principles that are
commonly invoked as guides to
professional action and for resolving
conflicting obligations 2
A 28-y/o , G1P0, 25 weeks AOG, twin
pregnancy, previously diagnosed in another
hospital as Intrauterine Fetal Demise for both
babies. You give her treatment options and
she chose induction of labor. 7 days passed
and the babies are still undelivered. She was
given only a month by her employer , based
in Singapore, to go on maternity leave. The
patient and her husband withdrew informed
consent for induction of labor and opted for
hysterotomy. If the OB acceded to this
request, which bioethical principle is she in
conformity with?
3
A.Beneficence
B.Nonmaleficence
C.Autonomy
D.Justice
E.Double effect
4
KEY PRINCIPLES
• Obligation to do good
• includes the obligation
BENEFICENCE to produce a net
balance of benefits over
harm.
Obligation not to harm
others, including not killing
NON-MALEFICENCE
them or treating them
cruelly.
5
KEY PRINCIPLES
AUTONOMY Obligation to respect the choices of
competent persons
JUSTICE Obligation to distribute benefits and

harms fairly
In case where a contemplated

action has both good effects and
DOUBLE
bad effects, the action is
EFFECT
permissible only if it is not wrong in
DOCTRINE
itself and if it does not require that
one directly intends the evil result6
• a cure • comfort
• medication • professionalism and
• YOU to listen respect
• sympathy • the “answer”
• advice • a two-way
conversation
• to be understood
• to be told what to do
• to get what they want
• to feel better
(agenda)
• the truth
7
GOAL AS A PHYSICIAN
• Highest quality care
• Reducing patient harm
• Patient safety thinking
• Best possible clinical outcome
• Most effective care
• Preventive care
• Cut costs and reduce patient
utilization while mainting quality and
safety 8
Physician-‐patient relationship
Physician
Physician
Control
Control
Low
High
Patient Control Paternalistic

Default
Low
Patient Control
Consumerist Mutuality
High
9
MUTUALITY
Optimal relationship
Both physician and patient

contribute strength and resources
Based on communication

10
PATIENT CENTERED CARE
11
Obligation
Mother
BENEFICENCE AUTONOMY
Physician
BENEFICENCE
Fetus
BENEFICENCE
12
A G1P0, 24-25 weeks AOG, in preterm
labor. The OB advised admission for
tocolysis but the patient refused .
Which is the next best thing that a
clinician should do?
A.The clinician should prescribe tocolytics as
home meds
B.Focus on fetal well-being rather than
maternal well-being
C.Control the pregnant woman's options and
decisions in this situation
D.Ask the patient to sign a HAMA form
13
GENERAL ISSUES IN
WOMEN’S HEALTH
AND ADVOCACY
14
ISSUES
THE ROLE OF THE OB-‐GYN AS

Have an ethical duty to be advocates
ADVOCATES FOR WOMEN’S
for women’s health care
HEALTH
Violence against women is
condemned, whether it occurs in a
VIOLENCE AGAINST WOMEN societal setting or a domestic
setting. It is not a private or family
matter
THE ETHICAL ASPECTS OF
SEXUAL AND REPRODUCTIVE A right to the highest available
RIGHTS standard of health care
Sex selection in any form, method or

SEX SELECTION FOR NON-‐
technique is not ethical because it is
MEDICAL PURPOSES
discrimination 15
You are attending to an 18-‐y/o autistic
patient. One of the most important elements
of informed consent is the patient's capacity
to understand the nature of her condition
and the benefits and risks of the treatment
that is recommended as well as those of the
alternative treatments. The patient,
therefore, should be
A.at least 21 years old
B.a high school graduate
C.able to speak fluent English
D.assisted by a legal guardian 16
ISSUES
• Informed consent
• Confidentiality, privacy
ETHICAL ISSUES IN THE and security of patients’
DOCTOR-‐PATIENT health care information
RELATIONSHIP • Referrals to other
physicians
PATIENT’S RIGHTS AND

OBLIGATIONS
OB-‐GYN’S
PROFESSIONAL
OBLIGATIONS 17
ISSUES
ADOLESCENT AND Recognize that
YOUTH adolescents and youths
REPRODUCTIVE can possess capacity to
HEALTH CARE AND make substantial life
CONFIDENTIALITY choices for themselves
Obligation to advocate for
HPV VACCINATION
vaccination and
AND SCREENING TO
screening and to assist in
ELIMINATE
the creation of coalitions
CERVICAL CANCER
to address prevention of
cervical cancer. 18
ISSUES
Dying women who are
ETHICAL GUIDELINES pregnant may face choices
IN REGARD TO between achieving maximal
TERMINALLY ILL palliative care for their
WOMEN condition or achieving
maximal fetal welfare.
Participation in clinical trials
for women of reproductive
JUST INCLUSION OF age requires the capability for
WOMEN OF women to make their own
REPRODUCTIVE AGE IN health choices, free of
RESEARCH coercion, about healthcare as
well as access to family
planning 19
ISSUES
All obstetrician-
gynecologists (OB-GYNs)
be aware of Republic Act
8504, also known as the
Acquired Immunodeficiency
THE OB-GYN AND
Syndrome (AIDS)
THE HIV-POSITIVE
Prevention and Control Act
PATIENTS
of 1988, in order to avoid
ethical and legal violations of
the rights of HIV-positive
patients
20
ISSUES
It is essential to offer
appropriate advice to
women with HIV or
ETHICAL ASPECTS
whose partners are
OF HIV INFECTION
HIV positive who wish
AND
to reproduce, so that
REPRODUCTION
their health, the health
of their partner, and
that of any future child
is protected
21
ISSUES
Treatments of seropositive couples
by assisted reproductive means,
which reduce the chance of
HIV AND FERTILITY exposure to the woman and her
TREATMENT offspring, are of proven efficiency,
and it is therefore ethical to offer
such techniques in appropriate
cases
Although the risk of clinician-‐to-‐
patient transmission is extremely
PRACTITIONERS low, all infected OB-‐GYNs must
INFECTED WITH HIV make a decision as to which
procedures they can continue to
perform safely. 22
ISSUES IN GENETICS, PRE-‐EMBRYO RESEARCH
Both reproductive and
HUMAN CLONING
therapeutic cloning are
(Somatic Cell Nuclear
unethical because they
Transfer )
violate human dignity.
Permitting human genes
or fragments of the
PATENTING HUMAN human genome to be
GENES patented disrupts the
intimate genetic identity
of each person 23
Only embryos resulting
from spontaneous
EMBRYO RESEARCH
abortion may be used for
research.
The obtaining of stem

cells from a living human
embryo invariably causes
STEM CELL THERAPY
the death of the embryo
and is consequently
gravely illicit 24
Nontherapeutic genetic alteration
(genetic enhancement
procedures) involves the attempt
GENE to enhance or improve an already
THERAPY healthy genetic make-‐up by
inserting a gene for improvement.
Such manipulation would promote
a eugenic mentality which violates
the basic equality of each person
25
DONATION The donation of genetic material
OF GENETIC whether sperm, oocyte or pre-‐
MATERIAL implantation embryo, in order to
FOR HUMAN create a child raises serious issues.
REPRODUCT Its effect on the marriage and
ION family of the couple involved, on
the identity of the child, dignity of
the donor, paternity issues and the
possibility of unrecognized
“incest” with multiple donations
(common good): 26
An OB-‐GYN researcher who
proposes to perform genetic tests
of known clinical or predictive
TESTING FOR value on biological samples (e.g.
GENETIC amniotic fluid, chorionic or
PREDISPOSITION placental tissues, cord blood,
TO ADULT ONSET embryonic or fetal tissues, etc) that
DISEASE can be linked to an identifiable
individual must obtain the
informed consent of the individual
or the permission of a legally
authorized representative. 27
ISSUES IN CONCEPTION AND REPRODUCTION
MULTIPLE
Multiple pregnancy should be
PREGNANCY IN considered a complication of
CONTROLLED infertility treatment, rather than a
OVARIAN success. Couples undergoing infertility
HYPERSTIMULATIO treatment should be counseled and
N (COH) AND informed, both verbally and in
ARTIFICIAL writing, of the all the possible
consequences of treatment, including
REPRODUCTIVE
multiple pregnancy
TECHNIQUES (ART)
ETHICAL ASPECTS Confidentiality is not only determined
OF GAMETE by legal rules and professional ethical
DONATION standards but also by the relationship
28
of the involved parties.
These issues include the risks of
pregnancy to the surrogate mother
and the child; protection of interest
of the surrogate mother, the
commissioning couple and the
child; issues of possible
SURROGACY abandonment of the child;
anonymity versus disclosure;
clarification of the legal standing of
the surrogate mother;
compensation of expenses directly
related to pregnancy; and familial
29
coercion
ETHICAL
CONSIDERATIONS
The most available, standardized and
WITH
effective technique should primarily be
OOCYTE AND
offered such as IVF or embryonic
OVARIAN
freezing
CRYPORESERVATION
IN WOMEN
Iatrogenic infertility may, in some
circumstances, be unavoidable and
ETHICAL GUIDELINES
occurs as a side effect of necessary
ON IATROGENIC AND
surgical or medical procedures. It is the
SELF INDUCED
duty of the OB-‐GYNs to take all
INFERTILITY
necessary measures to reduce the
incidence of iatrogenic infertility in 30such
cases.
Decisions about treating or
FERTILITY
refusing to treat patients should
CENTERS AND
reflect the balance between
WHO THEY
patient’s autonomy, and the clinical
SHOULD TREAT
team and patients’ responsibility to
the future child.
ISSUES REGARDING PREGNANCY & MATERNAL/FETAL
ISSUES
ETHICAL GUIDELINES Once a pregnant woman has been
REGARDING declared dead because of brain death, or
MANAGEMENT OF death is imminent due to lack of
PREGNANCY circulatory and respiratory functions, the
RELATED TO SUDDEN life and well-being of her fetus become a
UNEXPECTED matter of urgent consideration.
MATERNAL DEATH 31
A 30 –year old, G2P1(1001), full term,
asks her AP to deliver her baby via CS.
Her last pregnancy was 2 years ago
delivered spontaneously without any
complications. She states that her
husband is coming home from abroad for
only a week, just to see her delivery their
baby. The AP’s next move should be to
32
A.do outright CS as requested
B.counsel the patient on the benefits of
an epidural anesthesia
C.refer to another obstetrician who is
willing to do the CS
D.do the CS after explaining to the
patient the risks involved and getting
a well informed written consent
33
ISSUES REGARDING PREGNANCY AND
MATERNAL/FETAL ISSUES
When a woman requests elective delivery by
cesarean section in the absence of medical
indication, the OB-GYN should acknowledge the
legitimacy of the request and explore the reasons
ETHICAL
underlying it. If after full discussion the patient
ASPECTS
persists with a request for delivery by cesarean
REGARDING
section, the OB-GYN has the following options:
CESAREAN
1. Agree to perform the cesarean section,
DELIVERY ON
providing the patient is able to demonstrate an
MATERNAL
understanding of the risks and benefits of the
REQUEST
course of action she has chosen. In this case,
a well-written informed consent approved by
the Institutional Ethical Review Board (ERB)
should be signed by the patient prior to the
conduct of the elective cesarean section. 34
2. Decline to perform the cesarean
section in circumstances where the
ETHICAL OB-GYN believes there are
ASPECTS significant health concerns for
REGARDING mother or baby if this course of
CESAREAN action is pursued, or the patient
DELIVERY ON appears to not have an
MATERNAL understanding sufficient to enable
REQUEST informed consent to the procedure.
3. Advise the patient to seek the advice
of another OB-GYN for a second
opinion.
35
A clinician finds difficulty in doing
salpingostomy in an unruptured ectopic
pregnancy with a live embryo in a 23-
year old primipara. She believes that it
is directly killing the embryo once the
procedure is done. Which of the
following principles should be upheld?
A.Beneficence
B.Maleficense
C.Autonomy
D.Double effect
36
No woman should be
ETHICAL
forced to undergo an
GUIDELINES
unwished-for medical or
REGARDING
surgical procedure in order
INTERVENTIO
to preserve the life or
NS FOR
health of her fetus, as this
FETAL WELL
would be a violation of her
BEING
autonomy and
fundamental human rights.
37
ETHICAL Maternal-fetal conflict occurs
ASPECTS IN when interventions to save
THE the life of the mother
MANAGEMENT inadvertently result in death
OF AN of the fetus.
ECTOPIC
PREGNANCY In managing cases of ectopic
WITH A LIVE pregnancy where the fetus is
FETUS alive, the principle of double-
effect is upheld
38
A 75 -year-old woman with stage IV
ovarian cancer refuses chemotherapy.
She wants to "go home to die." The
next step in evaluating this patient is to
A.determine insurance coverage for this
action
B.call the family for a conference
C.accept the patient's wishes and
discharge her from the hospital
D.assess the patient's comprehension
and look for evidence of impaired
decision making 39
Chemotherapy and Radiation in
Pregnancy
ETHICAL 1. Radiation therapy, if
ASPECTS ON THE indicated, is preferably
MANAGEMENT OF withheld until after delivery,
since it may be harmful to the
PREGNANCIES fetus at any stage of
WITH development.
GYNECOLOGICAL 2. Chemotherapy, if needed, is
CANCERS given after the period of
embryogenesis, preferably
after 14 weeks gestation.
40
A 28-year old primi discovered that she
is carrying an anencephalic baby after
an ultrasound was done on her 24th
week of pregnancy. After learning from
her obstetrician that such condition is
not compatible with life, she wants her
OB to terminate the pregnancy ASAP.
Should the OB agree to this?
A.Yes
B.No
41
ISSUES REGARDING FETUS /
NEONATES
ETHICAL
ISSUES
Termination of pregnancy
CONCERNING
is not an option in prenatal
PRENATAL
diagnosis of congenital
DIAGNOSIS
anomaly.
OF DISEASE
IN THE
CONCEPTUS
42
ISSUES REGARDING FETUS / NEONATES
The severely malformed
fetus/neonate is entitled to the
same respect of human rights, in-
utero and after birth, as provided
ETHICAL
for legally (See Appendix: 1987
ASPECTS IN THE
Philippine Constitution Article II,
MANAGEMENT OF
Section 12)2 and morally.
THE SEVERELY
POGS advocates respect for
MALFORMED
human life starting from
FETUS/NEONATE
conception and consider it
unethical to terminate a pregnancy
because of fetal defects that have
been detected on ultrasound or
invasive fetal testing. 43
32-year-old patient has delivered at 23 weeks
of gestation, 3 days after premature rupture of
the membranes. She requests that no
attempts at resuscitation should be made. At
delivery breathing movements were noted.
The pediatrician decides that intubation be
done. In this case, the individual with the
clearest primary responsibility for this decision
is the
A.obstetrician
B. pediatrician
C. mother
D. hospital attorney
44
ISSUES IN POGS upholds that
CONTRACEPTION human life begins at
AND ABORTION fertilization.
While POGS respects that
an OB-GYN may refuse to
render emergency
GUIDELINES IN contraception because of
EMERGENCY personal beliefs and
CONTRACEPTION convictions, it must also
uphold the patient’s right
to information and access
to this
45
POGS upholds that any
abortion procedure
purposely done is not
only illegal but also
ETHICAL
immoral. Abortion
ASPECTS OF
through any means
INDUCED
done for the purpose of
ABORTION
contraception has never
been and will never be
condoned by any
member of POGS.
46
LESBIAN, GAY, BISEXUAL,
AND TRANSGENDER
HEALTH CARE
47
LESBIAN, GAY, BISEXUAL, AND
TRANSGENDER HEALTH CARE
• Increased rate of
• Depression
• Anxiety disorder
• Substance abuse
• High risk for suicide attempt
• High rate of alcohol and drug
dependence
King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self-harm in
lesbian, gay, and bisexual people. BMC Psychiatry. 2008;8:70.
48
Healthcare risks
• Cardiovascular
• Obesity
• Smoking
• Lower rates of physical exams and paps
• Preference for alternative healthcare providers
King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self-harm in
lesbian, gay, and bisexual people. BMC Psychiatry. 2008;8:70.
49
Disclosure of sexual
orientation
• Artificial insemination
• Adoption
Obstetriciang-ynecologists need to be comfortable treating and advising
LGBT women and couples, not just for pregnancy but also for general
health issues, or should refer them to an appropriate provider
50
51
RAPE, SEXUAL ASSAULT, AND
INTIMATE PARTNER VIOLENCE
52
RAPE, SEXUAL ASSAULT, AND
INTIMATE PARTNER VIOLENCE
• Sexual assault encompasses many acts
including
• Rape
• Unwanted genital touching
• Rape is a legal term and refers to any
penetration of a body orifice with threat of
force or actual force and non consent.
• Sexual violence : any sexual act performed
by one person on another without that
person’s consent. 53
Republic Act 9262Anti-Violence Against Women and Their Children Act of 2004
Physical
Violence
bodily or physical harm;
rape
acts of lasciviousness
Sexual
violence
sex trafficking
"Violence against women prostitution
and their children
intimidation
Psychological
violence
harassment
stalking
withdrawal of financial support
"Economic
abuse
deprivation pf financial support
54
RAPE
and
SEXUAL ASSAULT
55
Sexual Violence
•One in twenty five women age 15-49 who have ever had sex ever experienced forced first sexual
intercourse
•One in ten women age 15-49 ever experienced sexual violence
Statistics on violence against Filipino women 2014-05-13 15:07
56
Statistics on violence against Filipino women 2014-05-13 15:07
57
Sexual
Violence
Unwanted
Taking nude touching
photos
without Rape
consent Sexual
Violence
Sexual
Peeping harassment
Threats
58
Sexual Assault: Susceptible
Persons
• Homeless
• Mentally ill
• Very young
• Very old
• Physically handicapped
Happens to people of all ages, races,

societal levels 59
Variants of Sexual Assault
Marital Rape Date Rape Statutory Rape
• Forced coitus or • Woman may • Consent is

related acts voluntarily irrelevant
without consent participate in because the
but within the sexual play, but female is defined
marital coitus is by statute as
relationship performed, often being incapable
forcibly, without of consenting
her consent • Age of statute by
• Often not Philippine law:
reported <12 years old
60
61
Essential
components
of Rape
62
63
You were called to the ER for a 13-‐y/o claiming
to have been assaulted by her uncle. Upon
inspection of the genital area, you noted
bruising on the inner aspect of the thigh. The
hymen appeared not to be intact.
64
What laboratory tests can you do to identify
possible transmission of STDs to this
patient?
65
While awaiting for the laboratory test
results, what is the shortest antibiotic course
could you possibly give to prevent STD
transmission?
The CDC recommends the woman can be given
a
• single dose of ceftriaxone 250 mg
intramuscularly, for gonorrhea prophylaxis
plus single dose azithromycin, 1 g PO for
chlamydia prophylaxis plus metronidazole 2
grams orally in a single dose or tinidazole 2
grams PO in a single dose for trichomonas. 66
The family is concerned about possible
pregnancy. What contraceptive methods
should you advice?
There are two emergency contraceptive pill
regimens that can be used:
1.THE LEVONORGESTREL-‐ONLY REGIMEN: 1.5
mg of levonorgestrel in a single dose (this is
the recommended regimen; it is more
effective and has fewer side-‐effects)
2.THE COMBINED ESTROGEN-‐PROGESTOGEN
REGIMEN : two doses of 100 micrograms
ethinyl estradiol plus 0.5 mg of levonorgestrel
taken 12 hours apart 67
The family is concerned about possible
pregnancy. What contraceptive methods
should you advice?
If the survivor presents within 5 days after

the rape (and if there was no earlier
unprotected sexual act in this menstrual
cycle), insertion of a COPPER-BEARING
IUD is an effective method of emergency
contraception. It will prevent more than
99% of expected subsequent
pregnancies.
68
69
70
71
The patient would like to file Rape charges
against the perpetrator. You have no training
in gathering forensic evidence. What
government agencies should you refer this
patient to for this purpose?
Forensic evidence
documentation
•PC Crime Lab-Camp Crame
•Women and Children Protection
Unit-UP-PGH
72
VAWC Units in Different Government Agencies
• DSWD – Crisis Intervention Units, Temporary Shelters

• Police Women’s Desks - PNP
• Women and Children Protection Units in hospitals
• Women and Children Desks in other Agencies
• LGU’s – Social Service and Development Desks, Barangay
Council for the Protection of Children – Brgy. Women’s Desks
73
TRIAGE
ACUTE CASE WTHIN 72
HOURS
NON-ACUTE CASE
TREAT ACUTE/MEDICAL URGENT

PROBLEMS AND STABILIZE
PATIENT
IMMEDIATE ANOGENITAL GENERAL OUT-

ADMIT EXMINATION PATIENT
TREAT OTHER RELATED PROBLEMS

WOMEN AND CHILD SCHEDULE FOR CPU APPOINTMENT
PROTECTION UNIT
SOCIAL SERVICES- MANDATORY REPORTING

• HISTORY, PE • DSWD
CPU SW • MEDICO –LEGAL • LGU
• FAMILY COUNSELLING • PNP
• CASE CONFERENCE
• NBI
• OTHER ISSUES
EMERGNCY PLACEMENT • DOJ
PROTECTIVE CUSTODY
HOME VISITS
FAMILY COUNSELLING
OTHER SERVICES MEDICAL
PSYCHIATRIST, PEDIA GYNECOLOGIST,, ADOLESCENT MEDICINE, PERINATOLOGIST
74
ABUSE
INTIMATE PARTNER
VIOLENCE
75
Intimate Partner
Violence
>age 16 with evidence of
Partner abuse physical abuse on at least
Domestic one occasion
violence
Battered woman
symptom
complex in a
Spouse abuse Battered Wife woman
Syndrome resulting from
violence
inflicted
76
Range of Abuse
Verbal
abuse, Throwing
objects Pushing Slapping
threats
Threatening
Kicking Hitting Beating or use of a
weapon
Mental
abuse Intimidation
77
78
Common sites of Injury
Abdome Upper
Head Neck Chest Breast extremitie
n s
79
Red Flags Of Abuse Behavoral
Presentation
☞Appear afraid of her partner
Minimize injuries
Turn to her partner for answers
Ask her partner’s permission to speak
Are unable to make eye contact when explaining her

injuries VAW-ACOG Fact sheet, 2007
80
Red Flags Of Abuse Behavoral
Presentation
Eating
disorders,
sleep
disturbances
Early
initiation of Alcohol,
sexual
activity,
drug, and
compulsive tobacco
sexual abuse
behaviors
Self-
Aggression neglect,
towards self malnutritio VAW-ACOG Fact sheet, 2007
and others n, failure to
thrive
81
Red Flags Of Abuse Obstetrical Presentation
Unintended pregnancy
Late registration for prenatal care, no prenatal

care, missed appointments
Fetal or maternal injury (violence is often
directed toward the woman's abdomen during
pregnancy)
Spontaneous abortion or stillbirth
Vaginal bleeding in the 2nd or 3rd trimester
Warshaw C., Improving Health Care Response to Violence: A Trainer’s Manual For Health Care Providers,
Family Violence Prevention Fund 1998
82
RED FLAGS
OF ABUSE
OBSTETRICAL GYNECOLOGIC
PRESENTATION PRESENTATION
• Preterm labor • Chronic pelvic pain,
• Infection Abdominal complaints
• Anemia • Severe premenstrual
• Poor weight gain syndrome
• Low-birth-weight infants • Multiple or recurrent STDs
or recurrent vaginitis
Warshaw C., Improving Health Care Response to Violence: A Trainer’s Manual For Health Care
Providers, Family Violence Prevention Fund 1998
83
Somatic
Complaints
in Abused
Women
84
How do we manage
cases of violence if
the patient answers
YES to abuse ?
85
Encourage her to Listen non- Validate her
talk about it. judgmentally experience
• You are not alone”.
• “No one has to live
with violence”.
• “You do not deserve
to be treated this
way”.
• “You are not to
blame”.
• “What happened to
you is a crime”.
• “Help is available to
you”.
86
Essential elements in the provision of appropriate
intervention for GBV cases
• Routinely screen patients about violence

• Assess the health impact of victimization
• Document the occurrence of violence.
• Conduct intervention by:
• Giving validating messages
• Providing information about violence
• Assisting in safety planning
• Referring to appropriate support and
advocacy services
• Conducting a follow up session
87
88
Essential elements in the provision of
appropriate intervention for GBV cases
• Routinely screen patients about violence

• Assess the health impact of victimization
• Document the occurrence of violence
advocacy services
89
Essential Components of Documentation
Name;; age;; sex;; address;; civil status;; occupation;;
Demographic information accompanying person;; and place, time, and date of
examination
Informed consent
Results of the laboratory and other diagnostic procedures
Treatment plan Record all medications given or prescribed
document the advice and counseling given to the patient
Assess and record information regarding the patient’s
Safety assessment
suicidal or homicidal risks, and potential for serious harm or
injury
Police report Name of the investigating officer and the actions taken
Options discussed and referrals
Only enter in the records that the patient was given referrals
offered
for emergency shelter and counseling.
Arrangements for follow-up or discharge information

One full body shot (to link injuries with patient) /One mid-
Take photographs of the injuries,
range to show torso injuries/Close-up shot of all wounds and
including:
bruises
90
Essential elements in the provision
of appropriate intervention for
GBV cases
• Routinely screen patients about

violence
• Assess the health impact of
victimization
• Document the occurrence of
violence
91
Essential elements in the provision
of appropriate intervention for
GBV cases
advocacy services
92
Approaches to Intervention :
collaborative
SUPPORT
PHYSICIAN NURSING COMMUNITY
SERVICE
REPRESENTA REPRESENTA REPRESENTA
REPRESENTA
TIVES TIVES TIVES
TIVES
• internists, • social • shelter
family services, counselors/
physicians, alcohol and directors,
OB-Gyns, drug abuse legal
emergency services, services for
physicians, employee battered
general assistance women,
surgeons, personnel, clergy,
ENT, clergy, and police,
ophthalmolo security district
gists, attorneys,
maxillofacial victims/survi
93
and plastic vors
surgeons,
collaborative
• Physician representatives
• internists, family physicians, OB-
Gyns, emergency physicians,
general surgeons, ENT,
ophthalmologists, maxillofacial
and plastic surgeons, orthopedic
surgeons, pediatricians, and
psychiatrists
94
collaborative
• Nursing representatives
• Support service representatives
• social services, alcohol and drug
abuse services, employee
assistance personnel, clergy, and
security
95
collaborative
• Community representatives
• shelter counselors/directors, legal
services for battered women,
clergy, police, district attorneys,
victims/survivors
96
Where to go
Asks neighbors to call police
The Exit Plan Remove weapons
Teach kids to call for help
Available financial records
97
What referral
options can we
offer the
victims of
violence?
98
Referral options
☞Health professionals should be aware of the
resources in their area or be able to refer the
woman to someone who does.
Individual communities
• Women’s shelters
• Crisis Centers
• Rape Crisis Centers
• Legal Services
• Program for Partners who Batter
• Support Group 99
• Individual Counseling
Referral options
• Health professionals should be aware of the
resources in their area or be able to refer the
woman to someone who does
• Individual communities
• Women’s shelters
• Crisis Centers
• Rape Crisis Centers
• Legal Services
• Program for Partners who Batter
• Support Group
• Individual Counseling 100
Thank You
101

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BIOETHICS IN

JUSTICE Obligation to distribute benefits and

In case where a contemplated

Patient Control Paternalistic

Both physician and patient

Based on communication

THE ROLE OF THE OB-­‐GYN AS

Sex selection in any form, method or

PATIENT’S RIGHTS AND

The obtaining of stem

Statistics on violence against Filipino women 2014-05-13 15:07

Happens to people of all ages, races,

Marital Rape Date Rape Statutory Rape

• Forced coitus or • Woman may • Consent is

If the survivor presents within 5 days after

• DSWD – Crisis Intervention Units, Temporary Shelters

TREAT ACUTE/MEDICAL URGENT

IMMEDIATE ANOGENITAL GENERAL OUT-

TREAT OTHER RELATED PROBLEMS

SOCIAL SERVICES- MANDATORY REPORTING

PSYCHIATRIST, PEDIA GYNECOLOGIST,, ADOLESCENT MEDICINE, PERINATOLOGIST

☞Appear afraid of her partner

Turn to her partner for answers

Ask her partner’s permission to speak

Are unable to make eye contact when explaining her

Late registration for prenatal care, no prenatal

Vaginal bleeding in the 2nd or 3rd trimester

• Routinely screen patients about violence

• Routinely screen patients about violence

Arrangements for follow-­up or discharge information

• Routinely screen patients about

Asks neighbors to call police

The Exit Plan Remove weapons

Teach kids to call for help

Available financial records

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THE ROLE OF THE OB-‐GYN AS

Arrangements for follow-up or discharge information