"Sexual violence shakes the whole system"

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Mathias Wirth, a medical ethicist, advocates for a code of conduct at the Saarland University Hospital.

Mathias Wirth, born in 1984, is a young professor and directs the Department of Ethics of the Faculty of Theology of the University of Bern. His research focuses on medical ethics. Wirth has published several studies on sexualized violence, including in ecclesiastical contexts.

Professor Wirth, if children and adolescents, in all contexts characterized by a division of power, are victims of sexual abuse, can it be surprising that this also happens in the hospital, as in the case that we know today at the University Hospital of Saarland?

No, only the hospital or medical environment has been barely visible to the public, despite the fact that it offers a specific, highly physical setting in which sexual violence becomes possible.

Which frame?

In the clinical setting, certain behaviors are considered medically normal or even necessary, which would create distrust elsewhere: touching the genitals or invading the anogenital openings. A suppository, an ointment, a thermometer, the fingers can of course be used medically. But you can also be part of a rape. And if this happens in the medical context, the violence is particularly massive, but often goes unnoticed. In addition, paternalism, common in medicine, promotes sexual violence.

Paternalism?

All benevolent relationships are paternalistic. This means that someone acts for another person or for him "for his own good" because the person concerned – so the hypothesis – can not do it himself or knows better. The doctor-patient relationship is classic for this. In addition, medical staff have the impression of increased authority, not only technically, but also morally: physicians, like nurses, act well and out of compassion. This makes it all the more difficult to cast doubt on the legitimacy or otherwise of a particular act.

What do you mean?

In my opinion, among the few well-documented cases, we find a particularly disturbing conclusion: 90% of perpetrators were able to engage in sexual violence, even in the presence of third parties. It started, for example, with the suppository, the attribution was not indicated. Or medical devices have been introduced into the vagina or anus, although this would not have been medically necessary. Finger exams also took place under the eyes of parents or medical staff. This was initially considered normal. Colleagues and colleagues suspected that this was increasing. In another ongoing case, discussed by my colleague Heinz-Peter Schmiedebach in our study, it was the grandmother of a boy who was wondering why his grandson was manipulating his genitals under the practitioner's eyes. This shows that while the risk of such forms of sexual violence exists in the clinical setting, no one is expecting it.

Medical Ethicist Mathias Wirth.

© DR

Less children and adolescents?

Children who go to the doctor or the hospital are used to physical exams and, if in doubt, they even expect their will to be passed in case of doubt. medical staff do things that are uncomfortable or repugnant to them. This type of addiction to violence leads to the fact that sexualized violence can be practiced without being easily recognized as such. It is therefore all the more important to exclude cases known as marginal alien phenomena. They are not. I remember the last big deal in Germany 2015 in Augsburg. The British Medical Journal lists a whole series of events each year. Of course, these are just the cases that have been brought to the screen and given to medical associations. The number of unreported cases, especially in the medical context, is likely to be enormous, especially as the perpetrators are doing everything in their power to irritate the perception of those affected and those around them by ambivalent actions. , so that they then remain silent.

What counter-strategies do you recommend?

In general, what we learned from other contexts of learning experience, it is that we must first of all consider sexual violence as possible; You should know that this also happens in places that we generally consider safe or detained: schools, churches and even hospitals. More specifically, in relation to situations such as the one currently known at Saarland University Hospital: a very clear and precise code of conduct for medical institutions for children and adolescents is needed.

What should such a code of conduct contain?

The way in which patients can be examined must be precisely regulated: when and how are anogenital examinations conducted? What precise and narrow indications exist for such interventions on the genitals or on the anus? An explanation of why and how does it occur? Who is involved in the investigation? Was the child's or adolescent's determination determined? It is important to determine this, so that nothing is done quickly in the genital area of ​​children and adolescents "at the height of the heat", which means that reasonable measures, medically indicated, do not turn into twilight.

A code of conduct is addressed to health professionals. For example, what should parents do with it?

Of course, parents who accompany their children to the doctor should not have to read the rules or even have them in mind. But with regard to children and prevention, an anogenital examination should not be considered a trivial matter. An illumination should go without saying. It must be transparent to everyone involved, what is happening and why. The American Pediatric Society has long since published corresponding rules. Incidentally, the list is not so long or complicated that lay people could not understand it.

What is on this list?

No private data exchange between doctor and patient, for example. Or exclusion from routine intravaginal examinations in patients under 21 years of age. The duty of the glove in all intimate exams. Each hospital would send a significant positive signal indoors and outdoors if it possessed and communicated it. Clear rules serve the well-being of everyone involved, including the protection of medical personnel. In Germany, they are so far away but hardly. And here the circle closes. Every case of sexual violence in the medical context is not just horrible, in many cases traumatic and constitutes a serious breach of trust, but also a total shake-up of the system based on trust and the highest normative requirements.

Interview: Joachim Frank

The scandal

At the University Hospital of Saarland (UKS), a medical assistant now deceased would have sexually abused children for years. Eight years after a first suspicion of abuse committed against the child psychiatry physician in Homburg, potential victims and their parents need to be informed, UKS said. About the scandal had first reported the magazine ARD "Monitor". According to this information, the resident physician who died in 2016 reportedly carried out unnecessary medical treatment in the intimate area of ​​children aged 4 to 12 between 2010 and 2014 in at least 30 cases.

The UKS filed a criminal complaint in late 2014 and dismissed the doctor without notice. Since his death in 2016, the prosecutor's investigations had to be interrupted. UKS and the prosecution then decided not to inform potentially affected patients of suspicion. The Homburger Klinikum had not informed the State Chancellery of Saarbrücken as a supervisory board. According to media reports, the Ministry of Justice has been informed by the prosecutor. The Judiciary Committee of the Saarland Parliament wanted the facts to be reported on Thursday.

After further evidence, the UKS extends the investigation period: "The defendant studied human medicine at the University of Saarland in Homburg from 2003, the clinical part of his studies began at the end of 2005. " In addition, Medical Director Wolfgang Reith had set up a task force to evaluate and optimize the concepts of child protection at the hospital. An external evaluator will be mandated and involved. (EPD)