The Children First Act2015, which was signed into law on 19th November 2015, sets out the steps whichshould be undertaken to ensure that a child or young person is protected from harm.The Act places a number of legal obligations on specific health professionalsand organisations providing services to children with the intention of raisingawareness of child abuse and neglect and compelling the reporting of such abuse,improving child protection arrangements within organisations and promotingcooperation and communication between agencies to assist TULSA with their evaluations(Children First Act, 2015). The protection of children and young adults is theresponsibility, not just of their parents and families, but also of thecommunity and professionals in society. It is therefore important that healthprofessionals and organisations that provide services to children can recognisewhen a child or young person is being harmed and what action should be taken inorder to protect the child and contribute to their on going safety (Departmentof Children and Youth Affairs, 2017).
Child welfare andprotection is based on a legal framework provided mainly by The Children FirstAct 2015, which places a number of statutory obligations on specificprofessionals, including medical practitioners, and organisations within thecommunity to ensure the safety and wellbeing of children. Section 7 of the Actis that the best interests of the child is the principal concern and thereforeany ‘reasonable grounds for concern’ that a child has been, is being or is atrisk of being abused or neglected should always be reported to The Child andFamily Agency (TULSA), for failure to do so could result in on going harm tothe child (Children First Act, 2015). Such grounds for concern include matterswhere the child’s health, development or welfare have been, or are likely tobe, seriously affected, for example an injury or behaviour that is consistentwith physical or emotional abuse, consistent signs that a child is sufferingfrom emotional or physical neglect, admission from the child themselves thatthey have been abused or from someone who saw the abuse and any concerns aboutpossible sexual abuse. It is important to note that a doctor or healthprofessional that has been informed of abuse from the child is ‘not required tojudge the truth of the claims or the credibility of the child’ (Department ofChildren and Youth Affairs, 2017). Any report of known or suspected abuse orneglect subsequently should be reported in person, by telephone or in writingand should always be supported by evidence with as much information given aspossible so as to aid TULSA in their investigations. Exceptions from therequirement to report include Underage Consensual Sexual Activity, in which asexual relationship is taking place where one or both parties are under the ageof consent (17 years) but the age difference is not more than 2 years, wherethere is no difference in the maturity or ability to consent between bothindividuals and when the young person clearly states that they do not want theinformation to be disclosed to TULSA.
There is also no legal obligation toreport if the concerns are developed outside of professional duties. Whilefailure to report does not lead to criminal sanctions, under no circumstancesshould a child or young person be left in a situation that may expose them toharm (Children First Act, 2015). To report or not toreport is an ethical question that many medical practitioners have to answer whenfaced with concerns over suspected child abuse mainly due to the difficulty indifferentiating between symptoms of abuse and harmless manifestations ofsomething unrelated to abuse (Shanley etal., 2009). It is not the willingness to report that causes difficulty butrather the confidence around the validity of the concern that results inhesitancy, as well as the subsequent consequences that could happen if they aremistaken (Buckley, 2015). Doctors often only see a snapshot of a child’s lifeand accordingly only have a limited window of opportunity to establish thepresence of abuse and neglect.
Consequently, the reality of reporting suspected casesof child abuse is not as black and white as it may seem in theory, especiallyfor cases of emotional abuse and neglect. This is mainly due to a high level ofambiguity and the fact that these forms of abuse are subjective and subsequentlyhave the potential to be interpreted differently. When faced withsuspected cases of child abuse and neglect, there are many factors that play arole in a doctor’s decision to report. A major ethical issue is the doctor’srelationship to the family. Familiarity with a family and a positive pasthistory could result in a doctor being less likely to report suspiciousinjuries, while meeting families for the first time or having prior concerns maybe more likely to sway the doctor towards reporting. Another issue that facesdoctors in their decision to report is the chance that reporting the situationmay result in negative implications for the child and family (Shanley et al., 2009).
This is especially truewhere an injury or behaviour, or lack of adequate explanation for said injury,may be the only indicator of possible abuse and cause for concern. This poses an ethicalchallenge in that a mistaken report could have significant negativerepercussions for the child and their family, as well as damage to thedoctor/patient relationship, both within the family and the wider community,thus impacting on the level of trust that has been built up. In particular,children who have been taken from their parents even for a few hours, let alonedays or weeks may suffer the lasting effects of the distress from beingseparated from their family, while wrongly accused parents are typicallyanxious for both themselves and their child and may be exposed to considerablestigma, even when proved to be false (Barry and Redleaf, 2014). Alternatively,a doctor may be faced with the implication that the child is being subjected toabuse and that their failure to report may result in on going harm to thechild. In the case where achild or young person has disclosed that they are being abused, but are clearthat they know not want this to be divulged to anyone else, doctors are facedwith the challenge of whether or not it is ethical to break confidentiality.Confidentiality is central to the trust between the doctor and patient and thusa core element of the doctor/patient relationship.
By sharing information oftheir abuse, the child is demonstrating the level of trust they hold with thedoctor and often takes a great deal of bravery on their behalf, something whichis recognised by the doctor. Consequently breaking this child’s trust is anethical challenge that may hinder or delay many doctors. However it isimportant to note that the sharing of information in such situations isimportant for the care and safety of the patient (Medical Council, 2016).
Ultimately a doctor’s responsibility is thewellbeing and safety of their patients. However, in their duty of care manyhealthcare professionals face ethical dilemmas with regards to children who maybe victims of child abuse and neglect. Every child deserves to be safe fromabuse and with the implementation of the Child First Act 2015, the bestinterests of the child are of principal concern with mandatory reportingrequired for any doctors who come into contact with children they genuinelybelieve to be, or at risk of being, abused so that it may be fully and fairlyinvestigated.
While it is often poses ethical challenges in deciding whether toreport suspected cases of abuse, it does not negate a doctor’s professional andlegal responsibility to protect children by doing so. It is thus important thatdespite the wide range of ambiguity associated with many cases of suspectedabuse, it is essential that the doctor rely on both his/her training andinstincts in determining whether to take a closer look at the situation. It isimportant that the possible diagnosis of child abuse or neglect is approachedin the same manner and with the same diligence as any other childhood diseaseor disorder
