Doctors advocate for their patients with themindset of beneficence, non-maleficence, justice, autonomy and duty of care. Whenreporting an incidence of either alleged or suspected child abuse; conflict mayarise amongst a doctor’s own moral judgement, the law and the fundamentalethical principles: Reporting alleged childabuse against your patient breaks the doctor-patient confidentiality agreementbut also may cause harm to the alleged person and the child if the allegation provesfalse.
If the given allegation is untrue, an investigation by TULSA may lead toa breakdown of the family unit. The child may temporarily be separated from itsparents, defamation of the character of the supposed offender would occur,undue stress brought upon the child in question and a complete erosion oftrust. Loss of trust may not only be with the allegedbut may extend to the wider community, making other patients fearful that they toocould be subjected to investigation. However, if the allegation turns out to betrue; preserving trust and confidence are second to preventing harm to thechild. If the child was able to report abuse; there may be issues withrespecting the child’s privacy, if the child confided in you. This also leads toconflict with communication between parent and child. If you take the step to breach their confidentialitythey will likely no longer trust you.
You must be sure that you are taking thisstep for an appropriate reason. (Gault 2011) (Australian Nursing and MidwiferyCouncil 2008). There is also the potential that abuse, eventhough reported and true, may not be detected with further enquiry. This couldcause the abuse to potentially worsen for the child. The child may then associatebreaking the silence with severe consequences, and the abuse may then continuefor months and even years with no future investigation. Child abuse can be caused by a mixture ofindividual, family, and socioeconomic pressures.
The caregiver might be yourpatient, suffering from problems that require treatment (depression, victim ofabuse themselves, substance problem and personality disorder). You may feel theiractions are due to factors outside their control. With the appropriate servicesand support orientated to people in need, there is a potential for all partiesinvolved to receive help required and make the changes necessary to keepchildren safe. However it may be necessary to report the abuse before this canbe achieved. Reporting suspected child abuse or neglect toTulsa is aimed to benefiting the child, so that they can receive the supportand protection that is required. This should remain the forefront for doctors,above moral and ethical principles, when questioning the decision whether toreport.