For many years, spanning decades and centuries, children have constantly been the subject of abuse, whether it be emotional, sexual, or physical. Child abuse has become one of the world’s most tragic health issues, resulting in millions of injuries and deaths among children, many of which are incorrectly attributed to causes other than abuse (World Health Organization 2018). For this extremely vulnerable population, the role of the health practitioner becomes paramount; their ability to identify a child that may be at risk or subject to abuse is vital in the protection of the child from any harm they may face towards their health or development. However, in cases of suspected child abuse, a doctor faces many ethical, professional, and legal challenges in their attempt to help a child escape from conditions of negligence and maltreatment.
When a doctor suspects that their patient may be subject to abuse by members at home or in their community, the primary ethical challenge they face is whether or not they should report it. Depending on the situation the doctor is faced with, their decision may not be as clear-cut, and it may be necessary to assess and justify each of the alternatives. For example, in one episode of a US television series, a case was depicted where a child, under 18, was brought to hospital with suspicious bruises and cuts on his arms and face. With the parents’ half-hearted explanations for the child’s injuries and a suspicion for the well-being of the child, the doctor though of reporting this to social services. Nevertheless, his decision was complicated, and he faced an ethical challenge when the child asserted that he got the injuries while playing. In this situation the ethical problem lay in whether the doctor should believe the child or go on to report the case assuming that the child may have been convinced to lie by the abusing body or in fear of repercussions for telling the truth. As a doctor, he has a moral obligation to protecting his patient but the fact that his patient denies any abuse and the thought of wrongly accusing the patient makes reporting his suspicions quite challenging. How could he justify that the child was telling the truth and if not, the guilt that followed for potentially leave him in an abusive trap? And how could he justify that the child was indeed lying, and again, if not, the guilt of making an accusation against the parents?
On one hand, by reporting the case to the Child and Family Agency, he may be helping his patient where on the other hand he may be aggravating the situation say if the abusive person punished the child afterwards for not being able to successfully conceal the truth or perhaps through separating him from his parents and potentially putting him in a condition that is far worse than from which he is going to be removed. The doctor’s ethical challenges can be believed to be furthered by the legal obligations that he faces. If he were in Ireland, the National Guidelines for the Protection and Welfare of Children makes it mandatory for him to report any suspected cases of abuse. He could be excused from informing the parents about his decision to report given he had concerns that informing them of so might endanger the child. At this point the legal challenge of abiding or not abiding by the law of mandatory reporting itself becomes a moral dilemma. He could be confronted with the challenge of whether he has enough evidence to be legally mandated to report the case or whether he does not have enough evidence such that he won’t be penalized for failing to report the case. Another legal challenge that transpires at this point is the concept of confidentiality. Whether it be for drafting a report or even asking for aid in his decision-making process, he must share the child’s information with various individuals and statutory bodies, permission for which must be granted by the parents. Again, if the doctor believed he has good reason to believe that the child was indeed in danger, the National Guidelines would allow for the breach of confidentiality. Further, if he feared of whether he would be taken action against by those who accuses, the Protections for Persons Reporting Child Abuse Act gives an answer for this legal concern, which states as long as he reports what he believes to be true and in good faith, he cannot be sued for making a false or malicious report.
The doctor’s ethical and legal obligations then also tie in into his professional obligations. As a doctor, his role is to aid in his patient’s well-being, through both prevention and treatment. Nevertheless, in a situation of child abuse, it would be essential that as a competent professional he be able to discern his patient’s injuries as being from abuse and not due to other causes. In addition to their professional obligation of identifying abuse in their vulnerable patient population, another obligation, as a mandated reporter, would be compiling all the necessary evidence and efficiently reporting all cases of suspected abuse to the appropriate authority. As a professional, the doctor should know of the various options available to him in effectively the handling the case in front of him. Given the inconsistency in his findings compared to the parents’ and patient’s statements, the doctor should aim to strengthen his findings with evidence as to make sure his claim of abuse is based on reasonable grounds and to limit the possibility of him wrongfully accusing someone. Even though he will not legally face any repercussions for an incorrect report or not submitting a report because of insufficient evidence, his clinical uncertainty could possibly adversely affect his professional reputation. Through discussing his findings with a more experienced medical professional, as they have more experience in the matter, or an ethics board at the hospital he may able to take the right course of action and fulfil all his professional obligations.
Day to day, doctors are faced with many ethical, legal, and professional challenges. In order to fulfil their roles as providers, they must transverse these challenges with the ultimate goal to promote and maintain the the well-being of their patients. Especially when presented with cases involving children, such as child abuse, the duty of the medical practitioner becomes ever more imperative due to the major role they play in the protection of this vulnerable population. From upholding patient autonomy and doing what’s best for the patient to abiding by law and fulfilling one’s professional roles, there are many obligations that are placed upon a clinician when dealing with cases of child abuse, all of which must be addressed and fulfilled in order to achieve a positive outcome for the young patient.