procedures and the lack of consensus on best practices. There is a dearth of research around current practice, recommended standards or best practices in the collection of samples from the accused or suspects of sexual offenses. In addition, there has been little focus on inequities of examinations of potential suspects of sexual violence. Several authors have commented on the ad hoc component of the forensic medical examinations for suspects, when they do occur, regardless of who collects samples or the location of collection (Newton, 2013). Due to this lack of reliable data, the International Association of Forensic Nurses (IAFN) created a Suspect Exam taskforce charged with writing a whitepaper and exploring best practices for “suspect examinations” (Personal Communication, S. Botello, 2015). A goal of this taskforce is for members and/or the IAFN as the primary professional organization representing forensic nurses, to take an active lead in conducting research in this area. A Personal Journey Despite the clear need for standards related to forensic medical examinations for persons identified as suspects, or those accused of a sexual offense, my motivation for writing this paper is more personal. Over 15 years of practice as a forensic nursing expert, I frequently have heard statements from law enforcement officers and other forensic nurses that illustrated the ethical tensions they navigated as they interacted with those suspected or accused of sexual offenses. 34 For example: · “There’s no evidence if the victim refuses the exam.” · “Suspects are not patients.” · “Our role is to collect evidence from victims.” · “We’ve done all of these exams for years, not the nurses.” · “The nurse who does the victim exam can’t do the suspect exam.” · “We don’t need consent; we have a search warrant.” · “We’ve never done a kit on a suspect.” · “We use our victim kits if we get a suspect.” · “What’s a suspect exam? I’ve never heard of that.” Language Matters The language used to describe the persons who are central to the subject of this paper, suspects and the accused, and the examination they receive deserves attention. Legal and lay terms carry recognized connotations and lend themselves to accusations of provider bias when used in the clinical setting. The first use of language to be examined is who is labelled a patient. The victim of a sexual assault will be viewed as a patient, and treated with the respect, caring, professionalism and consideration that the term carries with it. This is of course appropriate and the purpose of this paper is not to challenge that label. However, viewed differently, referring to a patient as “the victim” may infer that the clinician believes this person to, in fact, be a victim, with or without supporting factual evidence. Rather than responding to the person as a patient who may have been harmed, the provider is referring to the patient as a victim – these words hold very different meanings in the legal and lay settings. It may also present the clinician as committed to collecting items to support the victim’s account of events as the primary focus of 35 the encounter rather than serving as an objective forensic clinician providing specialized services for patients affected by violence – whether the patient is legally identified as a victim, potential victim, suspect or the accused. In contrast, is the person accused of the violent act also a patient? Phrases such as “perp”, “offender”, “perp exam”, and “assailant” may be problematic in that these terms infer guilt of an offense. Unfortunately, these terms are sometimes used in documenting the “victim’s” history of events. For example, “Victim stated the assailant Richard Davis “tore off my shirt and…”. The nurse could have objectively documented this same history as, “Patient stated “he tore off my shirt and…” (Patient clarified “he” as Richard Davis)”. In situations where the person committing the crime is not known, we often find forensic nurses documenting “the perpetrator” or “the assailant” or even “the suspect” rather than “an unknown man” or “a man not known to the patient” or in other cases, “an unknown woman” or “a group of 5 unknown persons”. Although the person reporting an assault is commonly referred to as “victim”, there are several terms used to describe the person accused of committing the offense. These terms have very different meanings, both legally and literally, yet they are often used interchangeably and inappropriately by forensic nurses. For example: suspect, offender, perpetrator, assailant, rapist, and the accused. The term, “the accused” is interesting in that we do not refer to the person reporting an assault as “the accuser” – he or she is generally referred to as the victim. Yet whether a person is identified by the legal system as a victim or a suspect, the relevant question while the person is receiving services from a licensed healthcare professional (e.g., nurse) is whether they are a patient. Do some persons receive clinical forensic health care services, such as a forensic medical examination, and not carry the status of patient? While others who receive clinical forensic health care services, including a forensic medical examination, and possibly 36 other healthcare from a licensed health care provider do carry the status of being a patient? Health care clinicians, in addition to other care they may be providing, also conduct a