Respect their patients as well as avoiding causing

Respect for
autonomy, benevolence, non-maleficence, and justice. The four principal tenets
of medical ethics that every physician is sworn to uphold. The principles of benevolence
and non-maleficence are the forerunners in the context of physicians dealing
with cases of suspected child abuse. The principle of benevolence in this context
refers to the physician acting in the best interest of their patient (the
child) and non-maleficence refers to physicians avoiding causing harm to their patients.
While it seems simple, the legal and ethical obligations held by physicians with
regards to child abuse is rather difficult and perplexed. In order to
understand the challenges faced by many physicians with regards to reporting
child abuse, abuse must first be identified.

            Child abuse can be defined into four
different categories, namely, emotional, sexual, physical abuse and neglect (Health
Service Executive, 2011). Emotional abuse revolves around the relationship between
child and carer and occurs when a child’s developmental needs are not met
(Health Service Executive, 2011). Sexual abuse includes a sexual offence
against a child, voluntary exposure of the child to pornography, or voluntary
sexual activity while the child is present (Children First Act, 2015). Physical
abuse can be defined as acts of a caregiver that cause actual physical harm or
have the potential of harm (World Health Organization, 2002). Neglect is
indicated by the failure of a parent with adequate resources to provide for the
development of a child  (World Health
Organization, 2002).

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            As aforementioned, it is a physician’s
duty to act in the best interest of their patients as well as avoiding causing
them harm. In relation to children and according to law, if a physician “believes
or has reasonable grounds for suspecting that a child is being harmed, has been
harmed, or is at risk of harm through sexual, physical emotional abuse or
neglect…” the physician must report this to the proper authorities without pause,
as the welfare of the child is of utmost significance (Medical Council of
Ireland, 2016). In these cases, the parents/guardians of the child in question should
be informed of the physician’s request to report their worries, unless doing so
may further endanger the child (Medical Council of Ireland, 2016). Though
reporting their findings would be a breach in confidentiality of their patient,
protection of the child is justifiable in the eyes of the law as long as there
are reasonable grounds that acts of abuse have been committed against a child
(Medical Council of Ireland, 2016). Similarly, physicians who report cases of
child abuse who believe what they suspect is true and are acting in the best
interest of the child cannot be prosecuted for making false reports (Protection
For Persons Reporting Child Abuse Act, 1998).

            Upon reflection, I believe this law
to fall within a very grey area. While physicians must practice within the full
extent of the law, there is no doubt in my mind that if a physician suspects probable
cause beyond a reasonable doubt that a child may be a victim or become a victim
of abuse, they must report their findings to the Health Services Executive.
However, where is the line drawn of what constitutes “reasonable grounds?”
Moreover, a physician reporting a case of child abuse to the authorities is
indeed following their moral compass and acting on their principle of benevolence,
but at the same time may be impinging on non-maleficence. If there was an
inquisition of child abuse with probable cause that ended up to be false, they
may be protected from litigation, but may have breached their ethical duty of
non-maleficence, where harm and embarrassment are brought to the family
dynamic. I believe the law is written specifically to avoid turning a blind eye
towards child abuse as this may lead to criminal prosecution, where physicians
who do suspect abuse are protected even though their qualms may be false.


            Apart from the legal and ethical
aspects physicians must be wary of, there are several other challenges that
physicians face when dealing with child abuse cases. Many physicians feel as
though their knowledge on the subject of child abuse is insufficient and this
may impact the timeframe of reporting abuse. Many feel as though more convincing
evidence is required before a report is filed, but if a child is indeed being
abused, this will allow it to perpetuate causing more violence (Bannwart &
de Faria Brino, 2011). This in turn with possibly inadequate training on how to
deal with victims of abuse may contribute to physicians deciding on whether to
report child abuse. Physicians fear that reporting potential child abuse may
lead to damaging a family’s dynamics, but more so their involvement in legal
matters or receiving backlash from the family (Bannwart & de Faria Bruno,
2011). Similarly, some physicians may find it difficult to recognize emotional
abuse and neglect, unlike physical abuse which leaves visible damage (Bannwart
& de Faria Brino, 2011).

            I believe that in order to minimize
the challenges that physicians face regarding victims of child abuse,
physicians should be better educated about abuse and given the tools necessary
for early recognition and reporting their findings. Early reporting of abuse is vital as it is a means
to fight violence since it promotes the employment of intervention strategies
at different levels. These tools will allow physicians to develop the
skills and capacities necessary to identify situations of abuse, diminish their
fear of reporting abuse, and protecting the affected child/adolescent. These strategies
coincided with the law, will allow the physician to act in the best interest of
their as the safety of their patients is their greatest importance. 



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