Indian Journal of Medical Ethics Online First Published November 25, 2016 [ 1 ] Abstract The provision of care for survivors of sexual violence is a medico- legal emergency. However, due to social issues, healthcare providers face several ethical and legal dilemmas when administering care to such survivors at hospitals. Added to these are the compulsions under mandatory reporting laws, which oblige healthcare providers to abide by the ethical commitments of care and treatment, and make it mandatory for them to report cases of sexual violence to the police, failing which they face legal sanctions. This article draws on global evidence related to mandatory reporting of violence against women and children and the lessons learnt from it. While doing so, it presents the current status of mandatory reporting by healthcare providers in India and the challenges faced by them in operationalising the survivors’ autonomy, ensuring confidentiality and overcoming obstacles that may impede treatment and care. A 17-year-old girl was brought to a public hospital by her parents for an abortion. She was 18 weeks pregnant. She and her parents disclosed that she had been sexually abused by her uncle, who had subsequently been thrown out of the house. They did not want to report the matter to the police. The doctor explained to the parents that according to the law, he had to inform the police, but also assured them that the police would not force them into anything and that the doctors were with them. However, the girl absconded. A man brought his nine-year-old son to a public hospital as he complained of pain in the anal region. The father told the doctor that his own brother had sexually assaulted his son. He had confronted his brother, informed his elder brother and sent the former back to his village. The doctor informed him that treatment would start immediately, but the police would have to be informed. The father explained that they did not want to file a case against his brother as the burden of the brother’s family would fall on him. He said they would leave the hospital if the police was contacted. Both situations pose several challenges to a health professional. Should it be mandatory for a health professional to report rape/sexual assault even if it is without the consent of the survivor and his/her family? Does this not violate the confidentiality of the doctor–patient relationship? Does abiding by the provision of mandatory reporting amount to denial of treatment, as illustrated above? Will it prevent patients from disclosing the cause of injuries and/or ill health? Will it deter survivors from seeking healthcare, thus putting them at further risk? Does mandatory reporting take into account the dynamics and circumstances surrounding rape/sexual assault? How does the law on mandatory reporting harmonise with other existing laws, especially those on seeking informed consent (Section 164A,Code of Criminal Procedure [CrPC]) (1) and on ensuring the confidentiality of the survivor, particularly in the case of medical termination of pregnancy (as per the Medical Termination of Pregnancy(MTP) Act, 1971 and MTP Regulations, 2003)(2). These are some of the vexing questions posed by the new laws against sexual violence, ie the Protection of Children from Sexual Offences Act, 2012 (POCSO) (3) and the Criminal Law Amendment Act, 2013, (CLA) (4). Both laws make it mandatory for all health professionals to report every case of sexual violence. This paper discusses the concerns arising from the “mandatory reporting of rape/sexual assault survivors to police” by health professionals and its effect on the survivors. It also raises questions pertaining to the very concept of mandatory reporting in the absence of good-quality services for protection or additional options for survivors to heal from abuse. The paper suggests that such forced reporting may, in fact, amount to a disservice to the survivors, especially those who go to a health facility in search of treatment and care. The legal provisions It is important to note that both these laws aim to punish the perpetrator. The consequences of the assault on the victim’s health are well documented and health professionals play a critical role in mitigating them. However, the new role that they are required to play (mandatory reporting) is most likely to jeopardise their therapeutic role. COMMENT Ethical concerns related to mandatory reporting of sexual violence JAGADEESH N, PADMA BHATE-DEOSTHALI, SANGEETA REGE Authors: Jagadeesh N (corresponding author - forensicjagadeesh@ gmail.com), Professor of Forensic Medicine and Toxicology, Vydehi Institute of Medical Sciences & Research Centre, Bangalore 560066, INDIA; Padma Bhate-Deosthali (padma.deosthali@ gmail.com), Coordinator, CEHAT, Aaram Society Road, Vakola, Santacruz East, Mumbai - 400 055, INDIA; Sangeeta Rege (sangeetavrege@ gmail.com), Coordinator Designate, CEHAT, Aaram Society Road, Vakola, Santacruz East, Mumbai - 400 055, INDIA. To cite: Jagadeesh N, Bhate-Deosthali P, Rege S. Ethical concerns related to mandatory reporting of sexual violence. Indian J Med Ethics. Published online on November 25, 2016. © Indian Journal of Medical Ethics 2016 Download Date : 2016-11-25 12:37:59 PM GMT +05:1800 Asia/Kolkata