persons identified as victims or potential victims and persons identified as suspects or the accused vary significantly. Arguably, those who are accused or suspected of sexual crimes receive lower quality of care. Is this difference a result of tensions between distributive and retributive justice perspectives? Reasons for disparate care include: 1) forensic medical exams may not be done with the same attention to establishing innocence as guilt, 2) gender assumptions may disproportionately affect suspects of sexual offenses, and, 3) many suspect specific sample collection kits are designed for limited sample collection. These disparities beg the question of whether victims, or potential victims, the accused, and suspects of sexual offenses are viewed as having equal worth. An obvious answer is “No” when eligibility for services available to those who are identified as victims is considered (e.g., access to Victim’s Compensation funds, advocacy services, and prophylactic medications). Some of these services might be viewed as society’s compassion towards victims of violence or leaning towards restorative justice. Others, such as free prophylactic medications, might be seen as fair in broader terms however. Those convicted of crimes enter a special class, prisoners, who have 45 special rights to healthcare. Hence, one might claim that by offering victims healthcare, fairness is increased. A question that remains however, and is the focus of this paper, relates specifically to forensic nursing care. If forensic nurses truly are objective, impartial, forensic healthcare providers, a legal difference in a patient’s status ought not to justify providing different levels of care for the same procedure, in this case, clinical forensic interventions. All parties to a sexual crime, regardless of legal labels, are in need of a competent forensic medical examination. Autonomy: “We don’t need consent; we have a search warrant.” A strong value in the United States and many other Western countries is respect for personal autonomy. Respect for autonomy includes acknowledging a person’s right to have individual views, make choices, and to act on his/her values and beliefs (Beauchamp & Childress, 2013). In healthcare, this is embodied in the practice of obtaining informed consent prior to all healthcare procedures and treatments. Generally speaking, informed consent involves assisting patients to make decisions for themselves that are consistent with their values and their view of themselves. For forensic medical examinations and forensic nurses, if both the accused and the victim are considered patients, then both are therefore deserving of respect for their autonomy. But this core practice of healthcare is challenged in forensic nursing practice. For example, as supported by legislation in one State, force can be used to collect samples for forensic analysis from a suspect – consent and or cooperation is not legally required even when collection occurs by a forensic nurse. In other jurisdictions, search warrants and court orders are issued to collect forensic samples. While the presence of a search warrant or court order does not automatically exclude a clinician’s ability to obtain informed consent, in actuality, it may hinder informed consent in that is raises questions about legal coercion or coercive settings. 46 Both victims and suspects may experience coercive settings. There may be expectations of victims, similar to that of being a good patient, to cooperate and be a “good victim”. For patients identified as victims, the examination environment may create a coercive setting in particular when it is a hospital emergency department with hospital staff, a forensic nurse who has been called in just for their examination, victim advocates, and law enforcement officers. Suspects or the accused may experience coercion secondary to a search warrant or court order. The exam setting for patients identified as suspects may be a uniquely coercive setting such as a police station with several uniformed law enforcement officers or plain clothed detectives present. An additional coercive factor for suspects or the accused involves being detained, cuffed, or otherwise restrained. Both groups may experience a loss of autonomy when objectification occurs and they are treated more as a crime scene than as people who may have been present at a crime scene. Search warrants and court orders have been construed to remove the need for respecting the autonomy of patients around informed consent for forensic medical examinations and obtaining samples. Search warrants are issued to protect a person’s Fourth Amendment rights: “The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized” (U.S. Constitution, Amendment IV). Most suspects will consent to a forensic medical examination when asked and this consent should be documented in writing (Archambault, 2007). They should also be informed, just as a patient identified as a victim is informed, that they are free to pause or stop the examination at any time or refuse any part of the examination (Faugno, 2014). 47 Harms and Nonmaleficence