Healthcare providers in emergency departments encounter victims of violence and crime daily. Such victims of violence and crime enter emergency departments in need of medical attention, and they carry forensic evidence on their bodies. Healthcare providers offer medical attention, but, in the process, they may inadvertently destroy forensic evidence this may later deny a forensic patient the right to justice. The guidance available to healthcare providers in their training is often unclear, and the legislation and policies on forensic care are somewhat ambiguous, and are left open to the interpretation of the healthcare providers. In this context, this research provides insight into how emancipatory practice development transformed forensic care in three level-one emergency departments in Gauteng, South Africa. The research approach used was action research, in a critical realist paradigm. An emancipatory practice development conceptual framework was applied. The study was conducted with the participants, using collaborative, inclusive and participatory processes. The research commenced with an exploration and explanation of the existing forensic care practised in emergency departments. Then the actual and expected forensic roles and responsibilities were explored with healthcare providers. Next, action plans were developed and implemented. Finally, the outcomes of the research were collaboratively evaluated. The findings indicated that limited forensic care was already being provided at the time of the study. The research increased awareness of forensic care in the participating departments, as healthcare providers took the initiative to preserve evidence better, making use of the knowledge and resources acquired while participating in the research. The participants pointed out that the emancipatory practice development process followed required outsider initiation, combined with sustained support and fostering of relationships. Finally, they indicated that the research process had connected the research to the practice for them. This study demonstrated that emancipatory practice development may increase awareness of forensic care, and may encourage the healthcare providers involved to take ownership. It may simultaneously contribute to changes in existing practice. Based on the findings, healthcare providers' forensic roles and responsibilities were structured into a framework to guide their practice. Furthermore, the steps taken to follow a systematic approach, as required by the emancipatory practice development conceptual framework, have been clarified this may provide some guidance to other researchers who wish to use the same process. / Thesis (PhD)--University of Pretoria, 2016. / Nursing Science / PhD / Unrestricted

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This thesis discusses ethical dilemmas faced by district surgeons in South Africa. District surgeons render clinical forensic services, which means that they deal mainly with detainees and victims of crime. The main functions of district surgeons are the collection of forensic evidence from patients and the care of detainees. So the focus is to assist in the administration of justice rather than improvement of patient wellbeing. The district surgeon may therefore find himself in a situation where patients’ interests are in conflict with those of law enforcement agencies. Being a medical practitioner in clinical forensic medicine, the district surgeon has an obligation to assist in the administration of justice, as opposed to the traditional obligation to care for patients and put patient’s interests first. This allegiance to both administration of justice as well as patient wellbeing lead to an ethical dilemma of dual loyalties. A dual obligations presents an ethical dilemma for the district surgeon, especially if they are in conflict and mutually exclusive. I discuss the detention and subsequent death of Steve Biko to illustrate how dual obligations can lead to serious human rights violations and even death. Dual obligations are however not limited to detainees and police custody settings, and I demonstrate this by discussing three other scenarios commonly encountered by district surgeons. There is a lack clear guidance for district surgeons who are faced with a conflict of obligations. I explore several ethical theories including consequentialism, deontology and virtue ethics, in search of an ethical framework suitable for resolving conflicts in clinical forensic medicine. I therefore argue that a duty based ethical framework is central to clinical forensic medicine and the resolution of loyalty conflicts. I recommend the resolution of conflicts by using an approach developed by Benjamin (2006). This approach involves weighing -up the different duties in conflict, applying philosophical reasoning and then amelioration. By adopting a structured and wellreasoned ethical framework, district surgeons will be able to deal with conflicts of obligations better. / AFRIKAANSE OPSOMMING: Hierdie tesis bespreek etiese dilemmas wat in die gesig gestaar word deur distriksgeneeshere in Suid-Afrika. Distriksgeneeshere lewer kliniese forensiese dienste, wat beteken dat hulle handel hoofsaaklik oor die gevangenes en slagoffers van misdaad. Die belangrikste funksies van distriksgeneeshere is die insameling van forensiese getuienis van pasiënte, en die sorg van gevangenes. Met hierdie benadering is die fokus om te help met die administratiewe doeleindes van geregtigheid, eerder as die verbetering van die pasiënt se welstand. Die distriksgeneesheer kan hom dus in 'n situasie vind waarby die pasiënte se belange in konflik is met dié van wetstoepassingsagentskappe. As 'n geneesheer in kliniese forensiese geneeskunde, het die distriksgeneesheer 'n verpligting om te help met die administrasie van geregtigheid, in teenstelling met die tradisionele verpligting om te sorg vir hul pasiënte, en hul welstand eerste te plaas. Hierdie getrouheid gaan gepaard met beide regspleging, sowel as die welstand van die pasiënt, wat kan lei tot 'n etiese dilemma van dubbele lojaliteit. Dubbele verpligtinge bied 'n etiese dilemma vir die distriksgeneesheer, veral as hulle in konflik en wedersyds uitsluitend is. Ek bespreek die aanhouding en die daaropvolgende dood van Steve Biko om te illustreer hoe dubbele verpligtinge kan lei tot ernstige skending van menseregte en selfs die dood. Dubbele verpligtinge is egter nie beperk tot die gevangenes en polisie-aanhouding instellings nie, en ek demonstreer dit deur die bespreking van drie ander “scenario's” wat oor die algemeen eervaar word deur distriksgeneeshere. Daar is 'n gebrek aan duidelike riglyne vir distriksgeneeshere wat 'n botsing van verpligtinge in die gesig staar. Ek verken verskeie etiese teorieë insluitende konsekwensialisme, deontologie en deugde-etiek, op soek na 'n etiese raamwerk geskik vir die oplossing van konflikte in kliniese geregtelike geneeskunde. Ek argumenteer dus dat 'n pligsgebaseerde etiese raamwerk sentraal is tot kliniese forensiese geneeskunde, en die resolusie van lojaliteit konflikte. Ek beveel die oplossing van konflikte deur die gebruik van 'n benadering wat ontwikkel is deur Benjamin (2006). Hierdie benadering behels 'n gewigsoorweging tussen die verskillende pligte in konflik, die toepassing van filosofiese redenasie en verbetering. Deur die aanneming van 'n gestruktureerde en beredeneerde etiese raamwerk, sal distriksgeneeshere dus in staat wees om konflikte van verpligtinge beter te hanteer.