Domestic Violence & Human Trafficking in Medical Journals

This issue of the AMA Journal of Ethics examines the scope of physicians’ duty to support and counsel patients afflicted by any form of violence, as well as other ethical questions raised in the course of responding to victims of violence and preventing violence. The case commentaries and articles are meant to increase readers’ awareness of, and to provide guidance on, violence as an epidemic with features of ethical, clinical, and public health relevance.

This article, written by Lynn Hecht Schafran and published in the Summer 2014 issue of The Judges Journal, discusses current science on the impact that witnessing domestic violence has on children's developing brains. We are at a watershed knowledge-development point with respect to understanding the impact of domestic violence on children. This has been a subject of judicial concern and commentary for decades. Now, with the advent of magnetic resonance imaging, neuroscientists have produced scores of studies documenting on a neuronal level the profoundly negative impact of exposure to domestic violence on children, and how children can recover when exposure to the violence is eliminated and they are secure in the care of their non-abusing, primary caregiver parent.

"When a victim of non-fatal strangulation presents to the emergency department, it is critical for the medical provider to rule-out potential life-threatening injuries,” says William Smock, M.D. the Police Surgeon for the Louisville Metro Police Department and the Chair of the Institute’s Medical Advisory Board. The Board, with unanimous support from their expert physicians, released Medical Radiographic Imaging Recommendations, based on the latest medic al literature, for hospitals and medical providers across America. “The goals of the recommendations include calling for doctors to evaluate the carotid and vertebral arteries for injuries, the bony/cartilaginous and soft tissue neck structure, and the brain for anoxic injuries,” said Dr. Smock. The recommendations have already been implemented and adopted by more than 100 hospitals and academic emergency medicine programs around the world.

The Danger Assessment (DA) tool is used to estimate the risk of being killed by an intimate partner in a violent relationship. It consists of a calendar to assess the frequency and severity of incidences of abuse and 20 YES or NO questions. This article recommends that the DA be used for all emergency department patients following IP violence and that hospitals have 24-7 access to a social worker or a representative from the local IPV advocacy center to come to the emergency department, administer the assessment, and provide the patient with safety-planning options. August 2018