Child Abuse and the Moral, Ethical and Legal Obligations of the Healthcare Worker

Abstract

Approximately one million children are abused in the United States each year. The health care worker is in a position to help these children and have a moral, ethical and legal obligation to do so. In the American culture, child abuse is wrong and everyone, including the health care worker, has a moral obligation to report suspected child abuse. However, as a member of a professional society, health care workers are also bound by a code of ethics requiring them to act in the patient’s best interest. Finally, all states and territories have laws requiring certain professions to report suspected child abuse and the health care worker is among those with this legal mandate.

There is no greater tragedy than an abused child. In the United States, nearly one million children are victims of physical, mental, or emotional abuse or neglect each year ¹. Due to the nature of their profession, health care workers are in a unique position to help these children and have a moral, ethical and legal obligation to intervene. A health care workers failure to act when necessary occurs to the detriment of the child. So, what is the health care worker’s moral obligation to report child abuse?

A person’s moral obligation arises out of a consideration for right and wrong ². In terms of reporting child abuse, one’s moral obligation is defined by cultural tradition. This moral code is established by a society dictating appropriate activity ³. For example, in Islamic culture, it is acceptable for a man to marry and have sexual intercourse with a child as young as nine years ⁴. This would be considered an act of child abuse in the United States and although our moral code would require reporting of the act, in Iran it would be a cause for celebration. Therefore, the moral obligation to report child abuse is defined by the culture it is applied to and everyone within that culture would be morally bound to take action when confronted with it. In this respect, a health care worker’s obligation is no different that that of anyone else’s. If everyone in a given culture has a moral obligation to report child abuse, when would it become a matter of ethics?

An ethical obligation to report child abuse would be defined by the “nature of ultimate value and the standards by which human actions can be judged right or wrong” ⁵. Therefore, one who has a moral obligation to do something would more than likely have an ethical obligation as well. For the health care worker, the ethical obligation to report child abuse stems from a system of applied ethics. This is an attempt by a profession to establish certain norms or standards of conduct for members of the profession ⁶. Professional ethical standards exist to help members resolve ethical dilemmas. For the health care worker, the axiom “protect the patient” would establish an ethical standard requiring the reporting of child abuse. However, sometimes ethical standards conflict with one another or run contrary to law.

In addition to protecting the patient from physical, emotional or sexual harm, a health care worker also has a legal and ethical responsibility to protect a patient’s privacy. Absent clear guidance, when the ethical standard is in conflict with another ethical standard or an applicable law, the health care worker would likely resolve the issue according to the greatest utility achieved. For example, a nurse would have no responsibility to keep suspected child abuse information confidential, because the child’s right to be protected takes precedence over laws of confidentiality ⁷. Richard Tur, Faculty of Law at the Oxford University, writing for the Journal of Applied Philosophy, echoes this sentiment and argues that,

“…the duty of confidentiality is relative, not absolute; and that it is primarily a matter for the professional judgment of the reflective health practitioner to determine in the particular case whether competing public interests (or other compelling reasons) override that duty.” ⁸

Fortunately, most states provide immunity for health care workers who act in good faith, so a breech of confidentiality would be overlooked if the health care worker were acting in the best interest of the child ⁹. Finally, in addition to a moral and ethical obligation, health care workers also have a legal obligation to report child abuse.

Recognizing the need to protect children from abuse or neglect, all states, the District of Columbia and all United States territories have statutes identifying those required to report suspected child abuse ¹⁰. In most states, individuals are identified by profession and are normally those who typically have contact with children. Among those with a legal duty to report are social workers, school personnel, childcare providers, law enforcement personnel and health care workers ¹¹. Although the agency receiving the report may differ (i.e. law enforcement or child protective services), the intent of the law is to protect the child from harm. This is an important responsibility for the health care worker.

Should a health care worker fail to perform an ethical duty, the likely result is an official censure, a form of discipline, from the profession’s governing body ¹². Although an ethical breech can have a devastating effect on one’s career, failing to fulfill a legal responsibility may constitute a crime. For the health care worker, failure to report child abuse may result in the health care worker being held criminally liable for abuse that occurs later ¹³. Therefore, not only is reporting suspected abuse in the child’s best interest, it is in the health care worker’s best interest as well.

Whereas, all members of American society have a moral obligation to protect children from abuse or neglect, the health care worker also has both an ethical and legal obligation. These obligations have been established based on the health care workers opportunity to intervene. By fulfilling one’s moral, ethical and legal obligations, the health care worker can ensure a child is protected from further abuse, and perhaps set the stage for holding the abuser accountable for his or her crime.

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