Skip to main content
2025 ASBH Annual Conference Main banner
OSU Master of Arts in Bioethics Ad
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.

Paper Presentation

Clinical Ethics

Session: Decision Making Capacity Assessments

Ethical Considerations Around Substitute Consent for Sexual Assault Evidence Kits for Incapable Persons

Friday, October 24, 2025
3:45 PM - 4:45 PM Pacific Time
Location: A103-104
Bijal Desai – Medical Student, The University of Toronto; Eoin Connolly – Bioethicist, Sinai Health; Nikolija Lukich – Bioethicist, Sinai Health; Rosanna Macri – Bioethicist, Sinai Health
Abstract: The decision to collect forensic evidence using a Sexual Assault Evidence Kit (SAEK) from an incapable person who is believed to have recently experienced sexual assault is fraught with ethical complexity. SAEKs are not considered treatment under the Health Care Consent Act, and therefore the standard hierarchy for substitute decision-making does not statutorily apply. However, individuals who have experienced sexual assault often present to emergency departments and sexual assault clinics where one of the supports that is offered is a SAEK administered by a healthcare practitioner. If the individual is unconscious or incapable, this gives rise to challenges in identifying an appropriate proxy decision-maker to provide consent for a SAEK, if substitute consent is appropriate at all. Without clear policy and or legislative guidance, hospitals are faced with inconsistent practices and feelings of moral distress amongst healthcare workers. In determining whether or not consent should be sought and from whom, organizations rely on ad hoc decision making consisting of institutional values and varying individual opinions. In order to support those involved in non-treatment related decisions, such as this one, hospitals must engage in ethical analysis to address a lack of procedural support. With little legal and clinical guidance on how to proceed, an ethical analysis of substitute consent for SAEKs should be informed by the principles of trauma-informed care. This analysis should attempt to minimize the risk for further re-traumatization or harm but also respect the person’s autonomy to the greatest extent possible and serve their overall best interests.

Keywords: Clinical Ethics, Substitute Consent for Incapable Persons, Reproductive and Sexual Health

Learning Objectives:

After participating in this conference, attendees should be able to:
  • explore the potential role of the “Substitute Decision Maker (SDM)” in cases involving the use of Sexual Assault Evidence Kits (SAEKs) for incapable persons.
  • propose considerations healthcare professionals should reflect on when determining from whom to seek consent.
  • suggest considerations an SDM should weigh in determining whether or not to consent to the use of a SAEK.