Problems of capacity, consent and confidentiality

For the clinician managing a woman who has been violated sexually, core values of compassion, understanding and concern for the woman's distress are essential. The nature of the violation itself places the woman in a uniquely dependant, anxious, vulnerable and exploitative state. Capacity, consent and confidentiality derive from the principle of autonomy. Informed consent entails a process of information sharing and decision making based on mutual respect and participation. Practitioners should have communication, listening and interpretative skills. One of the greatest challenges is the difficulty in ascertaining whether or not the woman truly understands and grasps the nature of her condition. There are many challenges to obtaining a valid consent in the real world. Information obtained from the woman could be shameful and embarrassing, but would be used in a court of law. She should be informed of the potential for breach of confidentiality. These issues are explored and examples of practical application of the relevant themes are given from the England and Wales jurisdiction.