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Respect for autonomy, beneficence,
non-maleficence, and justice. The four principal tenets of medical ethics that
every physician is sworn to uphold. The principles of beneficence and non-maleficence
are the forerunners in the setting of physicians dealing with cases of
suspected child abuse. The principle of beneficence in this context refers to
the physician acting in the best interest of their patient (the child) and non-maleficence
refers to physicians avoiding causing harm to their patients. While it seems
simple, the legal and ethical obligations held by physicians with regards to
child abuse is rather difficult and perplexed. In order to understand the challenges
faced by many physicians with regards to reporting child abuse, abuse must
first be identified.

abuse can be defined into four different categories, namely, emotional, sexual,
physical abuse and neglect (Health Service Executive, 2011). Emotional abuse revolves
around the relationship between child and carer and occurs when a child’s
developmental needs are not met (Health Service Executive, 2011). Sexual abuse includes
a sexual offence against a child, voluntary exposure of the child to
pornography, or voluntary sexual activity while the child is present (Children
First Act, 2015). Physical abuse can be defined as acts of a caregiver that
cause actual physical harm or have the potential of harm (World Health Organization,
2002). Neglect is indicated by the failure of a parent with adequate resources
to provide for the development of a child  (World Health Organization, 2002).

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aforementioned, it is a physician’s duty to act in the best interest of their
patients as well as avoiding causing them harm. In relation to children and
according to law, if a physician “believes or has reasonable grounds for
suspecting that a child is being harmed, has been harmed, or is at risk of harm
through sexual, physical emotional abuse or neglect…” the physician must report
this to the proper authorities without pause, as the welfare of the child is of
utmost significance (Medical Council of Ireland, 2016). In these cases, the
parents/guardians of the child in question should be informed of the physician’s
request to report their worries, unless doing so may further endanger the child
(Medical Council of Ireland, 2016). Though reporting their findings would be a
breach in confidentiality of their patient, protection of the child is
justifiable in the eyes of the law as long as there are reasonable grounds that
acts of abuse have been committed against a child (Medical Council of Ireland,
2016). Similarly, physicians who report cases of child abuse who believe what
they suspect is true and are acting in the best interest of the child cannot be
prosecuted for making false reports (Protection For Persons Reporting Child Abuse
Act, 1998).

reflection, this law seems to fall within a very grey area. While physicians
must practice within the full extent of the law, it is without question that a
physician who suspects probable cause beyond a reasonable doubt that a child
may be a victim or become a victim of abuse must report their findings to the
Health Services Executive. However, where is the line drawn of what constitutes
“reasonable grounds?” The
way the law is written implies a level of subjectivity among practitioners. Of
course every case is different and it is the decision of the physician to
pursue further action if they so choose; however, the means by which they form
their conclusion may be unclear or uncertain. Moreover, a physician reporting
a case of child abuse to the authorities is indeed following their moral
compass and acting on their principle of beneficence, but at the same time may
be impinging on non-maleficence. If there was an inquisition of child abuse with
probable cause that ended up to be false, they may be protected from
litigation, but may have breached their ethical duty of non-maleficence, where
harm and embarrassment are brought to the family dynamic. The law seems to be written
specifically to avoid turning a blind eye towards child abuse as this may lead
to criminal prosecution, where physicians who do suspect abuse are protected
even though their qualms may be false.

from the legal and ethical aspects physicians must be wary of, there are
several other challenges that physicians face when dealing with child abuse
cases. Many physicians feel as though their knowledge on the subject of child
abuse is insufficient and this may impact the timeframe of reporting abuse.
Many feel as though more convincing evidence is required before a report is
filed, but if a child is indeed being abused, this will allow it to perpetuate
causing more violence (Bannwart & de Faria Brino, 2011). This in turn with possibly
inadequate training on how to deal with victims of abuse may contribute to a
physician’s decision on whether to report child abuse. Physicians fear that
reporting potential child abuse may lead to damaging a family’s dynamics, but
more so their involvement in legal matters or receiving backlash from the
family (Bannwart & de Faria Bruno, 2011). Similarly, some physicians may
find it difficult to recognize emotional abuse and neglect, unlike physical
abuse which leaves visible damage (Bannwart & de Faria Brino, 2011).

order to minimize the challenges that physicians face regarding victims of child
abuse, physicians should be better educated about abuse and given the tools
necessary for early recognition and reporting their findings. Early reporting of abuse is
vital as it is a means to fight violence since it promotes the employment of
intervention strategies at different levels. These tools will allow
physicians to develop the skills and capacities necessary to identify situations
of abuse, diminish their fear of reporting abuse, and protecting the affected
child/adolescent. New strategies coincided with the law, will allow the
physician to act in the best interest of their as the safety of their patients is
of greatest importance. 

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