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Learning Objectives:-
- Rights and Interests of children
- Capacity of young people to consent to and refuse treatment
- Role of parents/guardians/HCP/courts in decisions about treatment of children
- Ethical & legal issues in child protection
- Application of the duty of confidentiality to young people
Legal Aspects of the case
Children Act 1989 and 2004 :-
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The Act outlines that the child's welfare is of paramount importance when making decisions
- Based on the Children Act, local authorities have a "duty to investigate ... if they have reasonable cause to suspect that a child is ... likely to suffer significant harm" (section 47)
- Medical practitioners have a duty of care towards their patients, which means that when abuse is suspected, there is a legal imperative to report this suspicion to the relevant authorities
- If a child states that they have been the victim of abuse, these claims should be investigated. In these cases, parental consent is not required to conduct a formal investigation
Protection orders :-
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Protection orders are given out when a doctor believes that the children is at risk of significant harm.
- EPOs (Emergency protection orders) are used to prevent significant harm and/allow investigation.
- If it is a true emergency, the police may issue a PPO (Police Protection Order) which lasts for 72 hours.
- If the child is not at immediate risk then an CAO (Child Assessment Order) is given
Ethical Issues Raised
When child abuse is suspected, it may be acceptable to speak to and examine the child without the parents' consent. This is especially true of sexual abuses when the perpetuators may try and silence the child.
Should the doctor break the child's confidentiality? He is 12. If confidentiality is broken, the child may not trust this doctor again. Causing possible even more harm?
Again, comes back to Children Act 1989 - taking into account views of children, treating them with respect and taking their own wishes into account.
Doctors have a duty of confidentiality to patients. However, this can be breached in the public interest (which includes prevention of crime, including abuse)
In Clinical Practice
There is little likelihood that different clinical conclusions would be found in this case
In general, child abuse should be suspected if presentation of injury is disproportionate to its "history"
In clinical situations, parents would likely be discussed with before a protection order is issued
Would he be willing to talk to the Police and make a formal statement about this issue. If not ... what should happen?
Issues which might come into play include children with learning difficulties - are they at more risk of abuse?
References
- Children Act 1989 and 2004
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Author: Anna Allan
Editors: Philip Xiu
Voice Actors: Tom Jones, Zoe Monnier-Hovell
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