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Ethicolegal considerations of screening for brain injury in women who have experienced intimate partner violence Boyle, Quinn

Abstract

One in three women will experience intimate partner violence (IPV) in their lifetime, up to 92% of whom will suffer a brain injury (BI). This demonstrates an urgent need for screening of IPV-BI. Although such screening is done with the intention of accessing appropriate care and improving quality of life, the impacts of a BI outside of the health care setting for women who have experienced IPV are poorly understood. Given the history of health information being weaponized in family law, this study explores the possible impact of a BI on parenting disputes. The overarching objective is to inform future IPV-BI screening based on how the information may be used. I applied a consequentialist ethical framework and a utilitarian ethics approach to the development of a guide for the interviews. I used a contrastive vignette technique to describe hypothetical, realistic scenarios involving clientele who have experienced IPV to catalyze conversation about legal strategy and predicted outcomes. The two vignettes were identical except for the presence or absence of IPV-BI. I conducted 12 interviews with lawyers whose focus is family law. I used a constructivist grounded theory analysis to code emergent themes. Analysis began with open coding to develop a codebook of emergent themes, and then used focused coding to further explore themes specific to BI. Results reflect current legislation is focused on the best interests of the child; however, the data suggest that this is open to interpretation and manipulation based on case facts, such as IPV-BI, and is influenced by factors such as counsel’s legal responsibility, legal aid, legal precedent, and the expectations of mothers. Overall, my findings reflect that a lack of legal precedent, inadequate education surrounding IPV-BI, and the inability to causally link IPV to BI leave women legally vulnerable to opposing counsel who will attempt to undermine her credibility and minimize her capacity to parent. This weaponization of IPV-BI results in the best interests of the child being compromised. I conclude with recommendations for the ethical continuation of IPV-BI screening while also equipping women to navigate a legal system that puts them at immediate disadvantage.

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Attribution-NonCommercial-NoDerivatives 4.0 International