domingo, 4 de março de 2018



CRIMES SEXUAIS

Na actualidade, somos confrontados, diariamente, através dos meios de comunicação social, com notícias sobre a ocorrência de crimes de natureza sexual. Não significa que a violência esteja a aumentar, as pessoas estão é mais informadas e atentas a este tipo de crime, e surgem mais denuncias. Os termos violação, agressão sexual, abuso sexual e violência sexual, muitas vezes são utilizados como sinónimos. As definições legais diferem entre si, e podem variar de pais para país, e por isso irão interferir nos dados estatísticos. A abordagem da vítima difere de acordo com a idade, sexo, tipo de prática, número e o momento da intervenção técnica.  Intervenção nestes casos revela-se particularmente complexa, uma vez que a vitima por vezes oculta as informações (por medo, vergonha, sensação de culpa).

Enquadramento legal dos crimes sexuais em Portugal –

Os crimes de natureza sexual de acordo com o CP (código penal), encontram-se divididos em dois grupo: crimes contra a liberdade sexual (art. 163º) e crimes contra a autodeterminação sexual (art. 171º a 176º). Nos crimes contra a liberdade sexual pretende-se proteger a liberdade sexual através da incriminação de diversas condutas de natureza sexual. Considera-se a coacção sexual (art. 163º), relativa a actos sexuais de relevo por meio de violência, ameaça grave ou depois de ter tornado a vítima inconsciente ou a ter posto na impossibilidade de resistir ou por abuso de autoridade. A violação (art. 164) é relativa à prática de cópula, coito anal, oral ou introdução vaginal ou anal de partes do corpo ou objectos, nas mesmas condições do artigo 163º. 
Relativamente aos crimes contra a autodeterminação sexual, o art.171º (abuso sexual de crianças), visa proteger as crianças menores de 14 anos contra a prática de cópula, coito anal ou oral, de outros actos sexuais de relevo, de condutas censuráveis, obscenas ou pornográficas e da exposição e cedência de fotografias, filmes ou gravações pornográficas, com ou sem intenção lucrativa, em que estes sejam usados.
Um crime é semi-público quando depende de apresentação de uma queixa, sendo que há uma expressa manifestação de vontade de perseguição criminal do agente do crime. Será público quando o procedimento criminal não depende de apresentação de queixa, bastando a notícia, para que o Ministério Publico, exerça acção penal, independentemente de qualquer manifestação de vontade por parte do ofendido.

No caso dos crimes sexuais, são de natureza pública os abusos contra menores de 14 anos e certos abusos entre os 14 e os 18 anos, dependendo estes últimos do consentimento e da capacidade da vitima para o prestar.

A Clinical Role in Crime Scene Investigation

Considering that death is first a medical issue and secondly a legal issue, intuitive intellect indicates a need for individuals with a stronger background in the biomedical sciences, such as pharmacology, anatomy and physiology, medical terminology, and psychology among other related issues to pronounce death and recover medical/forensic evidence. The criminal investigator’s responsibility is to determine if a crime was committed, if so, who committed the crime. Medical investigators are charged with the determination of death, if so, what caused the death based on medical evidence.
The role of a forensically skilled nurse serving as a medical/forensic death scene investigator provides one solution to problems faced by the forensic pathologist, police and community at large. Medical death investigation must include preparation in medical science to help determine the precise precipitating factors and causes of death. This forensic clinician not only benefits the crime scene investigators, but also serves the public’s general welfare by ensuring that natural, accidental and crime-related trauma is systematically identified and investigated regarding cause, manner and mechanism of injury or death. The FNE is not a criminal investigator, but rather a clinical investigator with separate but integrated responsibilities to assist in the recovery of medical evidence and documentation of injury in circumstances not generally addressed in law enforcement education and training. Such is this partnership in Health and Justice.
Regardless of the circumstances of death, the family and/or significant others typically experience an acute emotional reaction of shock and grief. Events that surround the process of death cannot be viewed apart from the consideration of civil and criminal laws and collective justice principles that govern human existence from a social, moral and religious perspective. Intervention in grief benefits the family’s ability not only to recover from unresolved emotional trauma, but increases cooperation between the bereaved and the investigative agencies. Further, it increases confidence and respect in the medicolegal systems. The ability to review health histories and medical records, understand medical terminology, interpret medical abbreviations, communicate with physicians and paramedical personnel is essential. Evaluation of the surgical or chemical interventions prescribed and performed prior to death relating to the social, financial and interpersonal relationship factors of the psychological autopsy must also be included in the armamentarium of the investigator of medical/forensic deaths. These skills are unique to nursing.
Essential knowledge regarding sudden and unexpected deaths or the clarification of suspicious and/or natural deaths across the life span must begin with an incisive understanding of the phenomenon of death. An elucidation of these issues may become a point of contention in a court of law. Recent advances in the medical and legal sciences require an understanding of the disease mechanisms and biomechanical factors associated with death for the benefit of public health and the administration of justice. Thus, a new generation of medical death investigators, blending bio-psycho-social and medical training with the scientific investigation of death indicates a new trend in the 21st century forensic sciences.
Role of CSI in crime prevention measures
            This century has brought positive change to global endeavors in the reduction and prevention of violence.  Enlightened countries have recognized the need to support the development of a new forensic specialist that serves to assist the forensic medical community, law enforcement and public health.  This new specialist is known as the Forensic Nurse Examiner (FNE) who provides forensic services under the direction of the forensic pathologist or clinical forensic physician.  It is well known that the practice of forensic medicine is the second smallest specialty in medicine and has long deserved a clinical associate to evaluate trauma and questioned death. The FNE does not assume any criminal investigative responsibilities, but rather serves to augment forensic services that may require an immediate response to victims, families, police, and emergency services where the physician is absent or not readily available. Preventive factors evolve in the immediate provision of forensic services in the emergency room, or at the crime scene that may avoid the transfer of a survivor to another medical facility or distant location.
Reduction and prevention of violence is a major responsibility of the FNE.  U.S. research indicates that victims of interpersonal violence (battered and vulnerable persons) are admitted 7-9 times before being identified as crime victims by hospital personnel due to the lack of forensic training for nurses and clinical physicians. These categories of victims are often afraid or ashamed to admit that they were assaulted by a spouse or parent. Such cases are required to be reported to police who are not trained in the recognition of trauma or psychological intervention. If these victims are not identified upon admission by nurses or physicians, they are subsequently readmitted time and again. The perpetrator often goes unpunished and the cycle of violence continues until the same victim becomes a homicide case. Thus, prevention results when crime is detected and reported with the cooperation of law enforcement and the courts. The FNE, as a forensic educator provides individual, family and community education in public health and safety. The FNE educator also provides medical/forensic education to police and the judicial system on the clinical aspects of crime scene investigation when the body becomes the scene of crime. This approach helps to alleviate the wrongful interpretation of medical evidence, injury or death that may convict an innocent person. Further prevention is achieved with the skilled recovery of trace and biological and medical evidence on the body/scene unique to those with biomedical training that may not be recognized by non-medical/forensicinvestigators.

CSI in sex related crimes and domestic violence
The FNE is highly skilled in performing evaluation of sexual trauma, recovery of biological and physical evidence, and documentation of genital and non-genital injury. Magnification of microscopic body surface injuries such as abrasions, lacerations, contusions, or human bite marks with colposcopic enhancement and the application of a chemical marker (for observation only) are simultaneously photo-documented with an attached digital camera for evidentiary purposes. In numerous countries the FNE is recognized as a specialist and gives both expert and fact testimony. Board Certification in sexual assault examination is provided by the International Association of Forensic Nurses. The field of forensic nursing science was first recognized by the American Academy of Forensic Sciences in 1991. Police and homicide detectives in the U.S. frequently request the FNE sexual assault expert to respond to the scene of a suspected rape homicide. Forensic pathologists often request the FNE to provide the rape examination prior to autopsy. Police who bring rape victims to the hospital find this service is preferred as compared to the frequently long wait (7-8 hours) for a physician to arrive or to take emergency physicians away from patients that require life-saving interventions. Nurses are also known for their ability to appropriately intervene with emotionally traumatized patients, which may enable the victim to provide better information and become a better witness. Because victims of domestic violence are also commonly victims of rape/sexual abuse, it is important for the forensic examiner to have an acute awareness and understanding of the association between physical, psychological, and sexual trauma. The ability of the FNE to identify patterned injuries, photodocument evidence of violence and skillfully interview victims of interpersonal crime is essential for the patient to respond truthfully regarding how the injuries occurred. Privacy, patience and resource support also entail the need for a dedicated professional who sincerely cares about their patience. The reduction and prevention of cyclical violence must include the support of laws and law enforcement agents and the courts to act in the best interest of these victims. Forensic Nurse Examiners cannot change a society’s state of mind alone.
 CSI in violent deaths
The FNE is well educated and highly trained to perform a thorough medical investigation of natural and unnatural deaths, recovery of medical evidence pertaining to the cause of death, communicate delicate information to the grieving family and provide the forensic pathologists with a detailed medical report along with photographs of the body at the scene. This new role, as an associate to the forensic pathologist is authorized by the physician who has jurisdiction of the body and medical evidence. The FNE works in partnership with the police who maintain jurisdiction of the criminal investigation, criminal evidence and the crime scene. This objective incorporates all skills and knowledge identified in previous objectives.

CSI in mass disasters
Forensic Nurse Examiners trained in mass disaster evidence and body recovery respond to the scene along with the forensic pathologists, fire fighters, paramedical personnel, and law enforcement officers.  Such specialist are assigned responsibilities in a variety of areas including overseeing the proper recovery and removal of bodies without loss of evidence essential to personal identification, determination of cause and manner of death and notification of death among other tasks requiring medical/forensic supervision or skills. Much has been learned from major disaster scenes where insufficient medical/forensic personnel resulted in serious misinformation, loss of evidence, incorrect notification of kin, and lack of coordination/cooperation among the various teams of forensic investigators.

Interactions among different components of CSI teams
As an associate to the medical examiner, the FNE works within a team of forensic and legal experts. This forensic specialist is one member of the CSI team that assists law enforcement officers and serves as a liaison to the medical/forensic community. Some FNEs are employed by police departments (as a civilian), prosecution, defense, insurance agencies, government agencies, military services, and  Office of the Attorney General as consultants, educators, direct service providers, and risk assessment research. One unique role as a hostage negotiator involved a forensic psychiatric nurse who worked with the police department after completing an FBI training program.

Advanced techniques and modern technology in CSI
Considering that the body is the crime scene, one important aspect of advanced techniques applied by the FNE in pediatric sexual assault examination requiring expert skills is the ability to minimize emotional trauma while maximizing collection and documentation of forensic evidence. Such methods and techniques include a 3 step approach known as inspection, separation and traction. This method refers to inspection of external female genitalia, separation of the labia majora and minora, and traction of the labia majora to provide a gentle tunneling of the labial tissue for visualization and evaluation of the hymenal rim. This technique must be used by a skilled clinician with intricate knowledge to prevent further injury

With advanced education in the forensic nursing sciences, these specialists are experts in the use of alternate light sources, the binocular magnifying colposcope, digital and other categories of forensic photography. Some FNEs are forensic laboratory scientists trained in ‘touch’ DNA and other types of biological evidence who are employed in crime laboratories. With the current method of digital documentation in healthcare, informatics has become an essential tool for nurses and physicians. Medical errors, malpractice, neglect or intentional actions causing injury or death and has become an area of investigation requiring attention by the forensic nurse known as a Legal Nurse Consultant. This forensic nurse may be employed by the prosecution or defense. Numerous other technological skills and methods are also provided by the FNE.

domingo, 6 de agosto de 2017

"Os achados físicos são a melhor evidência, dai a importância que os registos apresentam. As lesões genitais também podem ocorrer numa relação sexual consensual e neste caso não são indicadores de abuso sexual. No hímen os achados podem ser variados e podem levar a uma conclusão da seguinte forma:
- perante um homem íntegro não elástico pode-se concluir que não houve desfloração embora também deve agregar-se que os sinais negativos ao exame não descartam manobras sexuais.
- perante um homem íntegro elástico pode-se concluir que pode permitir a penetração sem trauma, da mesma forma que achados negativos não permitem descartar manobras sexuais.
- perante um himen não íntegro com uma rotura recente pode-se concluir que se trata de uma desfloração ou rotura recente.
- perante um himen não íntegro com rotura antiga pode-se concluir que se trata de um himen com rotura antiga e que os achados não permitem descartar manobras sexuais.
- perante um himen não íntegro reduzido a carunculos mirtiformes pode-se concluir que é um achado consistente com um parto prévio por via vaginal. 

quarta-feira, 5 de julho de 2017

Artigo publicado na revista nursing


quinta-feira, 16 de março de 2017

A mãe da enfermagem forense chama-se Virginia Lynch, não adianta determinadas pessoas que não fazem parte da história da enfermagem forense, querer alterar esse facto. Ponto final