The abuse of a child is a seriousissue and one that should always be acknowledged and dealt with itappropriately.
Medical doctors are in a privileged position whereby they areinvited into their patients’ lives and their family’s lives and in doing sothey may observe instances of abuse. However, there is a difficulty in theethical and legal obligations in reporting of abuse as it will not alwayspresent in a straight forward manner and may in fact be observed through anindirect or uncertain interaction. There is a difficulty where the ethicalaction may lead to an outcome where the child in further compromised thanprotected. While recent legal framework recognises the injustice child abuseand the responsibility of those working with children to report instances ofthis it remains contradictory to practicalities at times.
Framework At present the framework in placefor reporting of child abuse falls under the umbrella of legislation aimed atprotecting children. These are the Children First Act 2015, the CriminalJustice Act 2012 and the National Vetting Bureau Acts 2012-2016.The Children First Act 2015 was fully enacted as of 11December 2017. The prominent changes from previous versions are as follows; theinclusion of mandatory reporting of abuse concerns to Tusla – Child and FamilyAgency, assisting with any investigations of Tusla, the undertaking ofassessment and Child Safeguarding Statement and the abolition of the Defence ofReasonable Chastisement. Considering this advancement, the non-statutory ChildrenFirst: National Guidance for the Protection and Welfare of Children 2017 was alsopublished on 11 December 2017 in combination with this. The Criminal Justice(Withholding of Information on Offences Against Children and VulnerablePersons) Act 2012 states that it is an offence to withhold information oncertain offences against children and vulnerable persons from An GardaSíochána. The National Vetting Bureau (Children and Vulnerable Persons) Acts2012-2016, provides for the mandatory vetting of those with children by theGarda Síochána National Vetting Bureau (Department of Children and YouthAffairs, 2017)Challenges The act of reporting abuse canpresent difficulties to doctors.
Confidentiality with patients is broken when anunrequested report is made. The trust between doctor and patient can be veryeasily destroyed in this process. Without being certain or without sufficient evidencegathered this report could lead to nothing and then at this point there is nolonger an opportunity for contact with the vulnerable child. If their suspicionproves to be incorrect and the child declines further visits then they haveunnecessarily broken the relationship with an otherwise vulnerable child. Legallythe doctor is obliged to act but ethically the doctor can be doing more harmthan good in some circumstances.
With abuse in the category of emotional andneglect this can be very ambiguous and subjective and so more difficult tosubstantiate then physical or sexual abuse. This was found to deter doctorsfrom making a report in such scenarios (Buckley 2015).While there may be a certainlevel of suspicion that abuse is ongoing it may be very possible that thealternative for the child is even worse. The recent Report on the Provision ofFoster Care Services 2017 and audit report by Special Rapporteur for ChildProtection Dr Geoffrey Shannon outline many ongoing issues for children takeninto care by the state. These include instances of poor Gardaí and Tuslaworking relationship, an inappropriate use of Garda stations as an “immediateplace of safety”, inadequate training in child protection, gaps in the out ofhours services and lack of available social workers.
Young adults previously incare can be very aware of these failings so may be less forthcoming thanyounger children also. With the knowledge of mandatory reporting they may beless likely to seek help or make disclosures to doctors when they just wantadvice or immediate help with an issue that has arisen from abuse. This can beobserved from a community perspective as well which may begin to distrust themedical practice considering obligatory reporting (Buckley 2015).