Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.
BMJ Open. 2023 Mar 27;13(3):e072077. doi: 10.1136/bmjopen-2023-072077.
Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or no externally visible injuries making prosecution challenging. This review aimed to provide an overview of how health professionals can support the prosecution of criminal charges of NFS as part of regular practice, particularly when externally visible injuries are absent.
Eleven databases were searched with terms related to NFS and medical evidence in health sciences and legal databases. Eligible articles were English language and peer reviewed, published before 30 June 2021; sample over 18 years that had primarily survived a strangulation attempt and included medical investigations of NFS injuries, clinical documentation of NFS or medical evidence related to NFS prosecution.
Searches found 25 articles that were included for review. Alternate light sources appeared to be the most effective tool for finding evidence of intradermal injury among NFS survivors that were not otherwise visible. However, there was only one article that examined the utility of this tool. Other common diagnostic imaging was less effective at detection, but were sought after by prosecutors, particularly MRIs of the head and neck. Recording injuries and other aspects of the assault using standardised tools specific for NFS were suggested for documenting evidence. Other documentation included writing verbatim quotes of the experience of the assault and taking good quality photographs that could assist with corroborating a survivor's story and proving intent, if relevant for the jurisdiction.
Clinical responses to NFS should include investigation and standardised documentation of internal and external injuries, subjective complaints and the experience of the assault. These records can assist in providing corroborating evidence of the assault, reducing the need for survivor testimony in court proceedings and increasing the likelihood of a guilty plea.
非致命性勒颈（NFS）是一种严重的性别暴力形式，在世界上许多司法管辖区，它正迅速成为一种犯罪。然而，它通常不会留下任何或几乎没有外部可见的损伤，这使得起诉变得具有挑战性。本综述旨在概述医疗专业人员如何在常规实践中支持对 NFS 的刑事指控，特别是在没有外部可见损伤的情况下。
在健康科学和法律数据库中，使用与 NFS 和医疗证据相关的术语搜索了 11 个数据库。合格的文章为英文同行评审，发表于 2021 年 6 月 30 日之前；样本超过 18 岁，主要是从勒颈企图中幸存下来，并包括对 NFS 损伤的医学调查、NFS 的临床记录或与 NFS 起诉相关的医学证据。
搜索发现了 25 篇符合审查条件的文章。在其他方面不可见的 NFS 幸存者中，似乎交替光源是发现真皮内损伤证据的最有效工具。然而，只有一篇文章研究了该工具的实用性。其他常见的诊断成像在检测方面效果较差，但被检察官所追求，特别是头颈部的 MRI。建议使用专门针对 NFS 的标准化工具记录损伤和攻击的其他方面，以记录证据。其他记录包括逐字记录对攻击的经历的描述和拍摄高质量的照片，以协助证实幸存者的说法，并在相关司法管辖区证明意图。
对 NFS 的临床反应应包括对内部和外部损伤、主观投诉以及攻击经历进行调查和标准化记录。这些记录可以协助提供攻击的佐证证据，减少幸存者在法庭程序中作证的需要，并增加认罪的可能性。
