Medico-Legal Evidence: Survivor Relational Autonomy and Informed Consent in Sexual Assault Examinations

Abstract Survivors of sexual violence often consent to forensic medical examinations for medical and legal purposes, including healthcare treatment, trace evidence collection, and documentation of injuries. Internal vaginal examinations, necessary in cases of penetrative vaginal rape, can be invasive and cause trauma. Recent efforts aim to minimise harm through victim- and trauma-centred approaches. Despite this, there are instances where forensic samples lack evidentiary value due to issues like degradation, contamination, tampering, sample backlog, or collection of forensic evidence that is not necessary (for example, in cases of consent and where identification of the perpetrator is not required). However, internal vaginal examinations are still taking place, turning the collection into a potentially harmful, performative process for the survivor. Limited healthcare resources and structural constraints can contribute to these challenges worldwide. This paper examines the British civil law context because of the contemporary global debate around patient autonomy and understanding of informed consent. It considers that much can be learnt from the British approach when ensuring survivors of sexual violence undergoing forensic medical examination are adequately informed.