Doctors advocate for their patients with the
mindset of beneficence, non-maleficence, justice, autonomy and duty of care. When
reporting an incidence of either alleged or suspected child abuse; conflict may
arise amongst a doctor’s own moral judgement, the law and the fundamental
ethical principles:

 

Reporting alleged child
abuse against your patient breaks the doctor-patient confidentiality agreement
but also may cause harm to the alleged person and the child if the allegation proves
false. If the given allegation is untrue, an investigation by TULSA may lead to
a breakdown of the family unit. The child may temporarily be separated from its
parents, defamation of the character of the supposed offender would occur,
undue stress brought upon the child in question and a complete erosion of
trust. Loss of trust may not only be with the alleged
but may extend to the wider community, making other patients fearful that they too
could be subjected to investigation.

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However, if the allegation turns out to be
true; preserving trust and confidence are second to preventing harm to the
child. If the child was able to report abuse; there may be issues with
respecting the child’s privacy, if the child confided in you. This also leads to
conflict with communication between parent and child.  If you take the step to breach their confidentiality
they will likely no longer trust you. You must be sure that you are taking this
step for an appropriate reason.

 (Gault 2011) (Australian Nursing and Midwifery
Council 2008).

 

There is also the potential that abuse, even
though reported and true, may not be detected with further enquiry. This could
cause the abuse to potentially worsen for the child. The child may then associate
breaking the silence with severe consequences, and the abuse may then continue
for months and even years with no future investigation.  

 

Child abuse can be caused by a mixture of
individual, family, and socioeconomic pressures. The caregiver might be your
patient, suffering from problems that require treatment (depression, victim of
abuse themselves, substance problem and personality disorder). You may feel their
actions are due to factors outside their control. With the appropriate services
and support orientated to people in need, there is a potential for all parties
involved to receive help required and make the changes necessary to keep
children safe. However it may be necessary to report the abuse before this can
be achieved.

 

Reporting suspected child abuse or neglect to
Tulsa is aimed to benefiting the child, so that they can receive the support
and protection that is required. This should remain the forefront for doctors,
above moral and ethical principles, when questioning the decision whether to
report.