Respect forautonomy, benevolence, non-maleficence, and justice. The four principal tenetsof medical ethics that every physician is sworn to uphold.
The principles of benevolenceand non-maleficence are the forerunners in the context of physicians dealingwith cases of suspected child abuse. The principle of benevolence in this contextrefers to the physician acting in the best interest of their patient (thechild) and non-maleficence refers to physicians avoiding causing harm to their patients.While it seems simple, the legal and ethical obligations held by physicians withregards to child abuse is rather difficult and perplexed. In order tounderstand the challenges faced by many physicians with regards to reportingchild abuse, abuse must first be identified. Child abuse can be defined into fourdifferent categories, namely, emotional, sexual, physical abuse and neglect (HealthService Executive, 2011). Emotional abuse revolves around the relationship betweenchild and carer and occurs when a child’s developmental needs are not met(Health Service Executive, 2011). Sexual abuse includes a sexual offenceagainst a child, voluntary exposure of the child to pornography, or voluntarysexual activity while the child is present (Children First Act, 2015). Physicalabuse can be defined as acts of a caregiver that cause actual physical harm orhave the potential of harm (World Health Organization, 2002).
Neglect isindicated by the failure of a parent with adequate resources to provide for thedevelopment of a child (World HealthOrganization, 2002). As aforementioned, it is a physician’sduty to act in the best interest of their patients as well as avoiding causingthem harm. In relation to children and according to law, if a physician “believesor has reasonable grounds for suspecting that a child is being harmed, has beenharmed, or is at risk of harm through sexual, physical emotional abuse orneglect…” the physician must report this to the proper authorities without pause,as the welfare of the child is of utmost significance (Medical Council ofIreland, 2016). In these cases, the parents/guardians of the child in question shouldbe informed of the physician’s request to report their worries, unless doing somay further endanger the child (Medical Council of Ireland, 2016). Thoughreporting 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 thereare reasonable grounds that acts of abuse have been committed against a child(Medical Council of Ireland, 2016). Similarly, physicians who report cases ofchild abuse who believe what they suspect is true and are acting in the bestinterest of the child cannot be prosecuted for making false reports (ProtectionFor Persons Reporting Child Abuse Act, 1998). Upon reflection, I believe this lawto fall within a very grey area.
While physicians must practice within the fullextent of the law, there is no doubt in my mind that if a physician suspects probablecause beyond a reasonable doubt that a child may be a victim or become a victimof 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 isindeed 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 aninquisition of child abuse with probable cause that ended up to be false, theymay be protected from litigation, but may have breached their ethical duty ofnon-maleficence, where harm and embarrassment are brought to the familydynamic. I believe the law is written specifically to avoid turning a blind eyetowards child abuse as this may lead to criminal prosecution, where physicianswho do suspect abuse are protected even though their qualms may be false. Apart from the legal and ethicalaspects physicians must be wary of, there are several other challenges thatphysicians face when dealing with child abuse cases. Many physicians feel asthough their knowledge on the subject of child abuse is insufficient and thismay impact the timeframe of reporting abuse. Many feel as though more convincingevidence is required before a report is filed, but if a child is indeed beingabused, this will allow it to perpetuate causing more violence (Bannwart Faria Brino, 2011).
This in turn with possibly inadequate training on how todeal with victims of abuse may contribute to physicians deciding on whether toreport child abuse. Physicians fear that reporting potential child abuse maylead to damaging a family’s dynamics, but more so their involvement in legalmatters or receiving backlash from the family (Bannwart & de Faria Bruno,2011). Similarly, some physicians may find it difficult to recognize emotionalabuse and neglect, unlike physical abuse which leaves visible damage (Bannwart& de Faria Brino, 2011). I believe that in order to minimizethe challenges that physicians face regarding victims of child abuse,physicians should be better educated about abuse and given the tools necessaryfor early recognition and reporting their findings.
Early reporting of abuse is vital as it is a meansto fight violence since it promotes the employment of intervention strategiesat different levels. These tools will allow physicians to develop theskills and capacities necessary to identify situations of abuse, diminish theirfear of reporting abuse, and protecting the affected child/adolescent. These strategiescoincided with the law, will allow the physician to act in the best interest oftheir as the safety of their patients is their greatest importance.