Doctors have many roles, most of which are reflected in the Hippocratic oath. The first line of the oath outlines the basic responsibility of the doctors; “To first do no harm” (McLean, 2016). This role of the doctor has now evolved to identify others who are causing harm to vulnerable persons and to take the necessary steps in reporting cases same. Unfortunately, in Ireland, we have a vast history of child abuse which left many children in unacceptable situations (Ringer, 2017). However, it is now apparent that child abuse has now come to the forefront of the government’s, healthcare’s and public’s concern.
In order to ensure the safety of children in Ireland, the Irish Government has developed a legal framework to clarify the roles of responsibilities from that of the public to that of the Garda Síochána. Most importantly these acts identify that the safety and protection of the child are paramount at all time. This legal framework includes the following Acts:
Child Care Act 1991
The Child Care act of 1991, was brought about to replace the Act of 1908. This Act is the foundation of childcare in Ireland, and clearly identifies a number of key issues relative to the care and safety of the child. Most importantly it defines a child as “a person under the age of 18 who has not married”. (Child Care Act, 1991). It also identifies the roles of key organisations such as Tusla, the HSE, adoption agencies. Perhaps one of the most important specifications in the Act are the powers of an Garda Síochána remove a child in emergency situations, whereby there is an immediate or serious threat to the child and the power of the courts (Child Care Act, 1991).
This act is currently under review by the Department of Children and Youth Affairs in line with the commitment to Better Outcomes, Brighter Futures and the national policy framework for Children and Young people 2014-2020. (Department of Children and Youth Affairs, 2017)
Protections for persons reporting child abuse 1998
Following the Child Care Act of 1991, came a vital piece of legislation to protect those who report abuse. This Act ensures that those who make a report in good faith, to a designated officer or the Gardaí, cannot be prosecuted in instances whereby the suspected abuse is unfounded. (Department of Children and Youth Affairs, 2017). This is vital in encouraging the reporting of child abuse and elevates some fear of repercussion for the person reporting same. In addition to this law, the reporter should also be protected under common law by the defence of qualification. (Department of Children and Youth Affairs, 2017)
However, it is important to note that care should still be taken when investigating child abuse. This was clearly showcased in the case where members of the Gardaí, removed a Roma child from their family which was heavily publicised and lead to an audit of the enforcement of the Child Care Act by Gardaí. (Shannon, 2017)
Criminal Justice Act 2006
The Criminal Justice Act acts in tandem with the Protect of the Person Act but from the consideration of the child. Under the Act, it is an offence whereby an individual does not report instances of child abuse, as soon as is reasonably practical to do so. This Act ensures that when an individual suspect that child abuse has or is taking place, they have a legal responsibility to report same. (Department of Children and Youth Affairs, 2017) This Act should encourage reports of all suspect child abuse. However, its effectiveness is largely dependent on the public’s awareness of their obligations under the Act and the protection they will receive in reporting suspect abuse under the Protection of the Persons Act.
National Vetting Bureau Act 2012 – 2016.
This act simply ensures that the employers of anyone working with vulnerable persons, are vetted by an Garda Síochána. This a compulsory requirement and the Act ensures that any failure in compliance is an offence. (Department of Children and Youth Affairs, 2017) This is a rudimentary step in preventing child abuse.
Children First Act 2015
This Act has lead to the requirement of mandatory reporting of any abuse, welfare or protection concerns by key professionals who work with children in education, health, justice and childcare services. (Department of Children and Youth Affairs, 2017) The key professionals include a vast array of people from medical practitioners to members of the clergy. This Act only came into full commencement in late 2017 with only some section of the bill being in full effect over the past two years.
Criminal Law (Sexual Offences) Act 2017.
The final act relating to children is the Criminal Law (Sexual Offences) Act of 2017. This Act makes it an offence to obtain or provide sexual exploitation of children. (Department of Children and Youth Affairs, 2017) It also considers modern predatory actions such as the use of technologies to prey on children or indeed the arrangement of meeting a child with the purpose of sexual exploitation. Interestingly, this Act also provides for underage consensual sex within very specific age limits as not being exploitative (Department of Children and Youth Affairs, 2017).
Challenges faced by doctors in Reporting Child Abuse
Doctors have always had a moral and ethical duty to report any suspected child abuse and this has not been crystallised under the Children’s First Act of 2015. However, this responsibility does not come without great challenges which was acknowledged by Catherine Zappone, the Minister for Children in November 2017. (McGee,2017) The first challenge is always identification of the abuse itself. Neglect is to be the most reported form of abuse in Ireland (Department of Children and Youth Affairs, 2017). However, other forms of abuse such a physical and sexual abuse can sometimes be more difficult to identity due to lack of access to the child by the healthcare system.
This kind of abuse goes on behind closed doors with a strongly aligned story for the doctor’s office. Without a doubt the most difficult form of abuse to identify is the emotional abuse, where the indicators aren’t as obvious and often it requires close attention to the child which can be difficult since children may present with their abusers.
The second challenge is how to handle the identification of suspect child abuse. In that moment you are not only a doctor but a sort of judge. Multiple decisions must be made; whether to ask the parent who the injury occurred, if this was in fact an accident or an indented injury, as your understanding of the body language of the child. In small towns there is also an element of disbelief as abuse can be conducted by friends, family or those of a high order in society which can further cloud the judgement of the doctor.