Mandatory Reporting of Child Abuse - Essay Example

1 Mandatory Reporting of Child Abuse “ From 1976, when the first notifications for child maltreatment were generated, to 1990, the most recent year covered by the National Child Abuse and Neglect Data System, reports of maltreatment have grown from 416,033 per year (affecting 669,000 children) to 1,700,000 per year (affecting 2,712,917 children)”(NCCAN,1992). “Prominent groups, such as the U. S. Advisory Board on Child Abuse and Neglect, have labeled the increase in reported cases as an “epidemic” of child maltreatment in the United States, and calls the problems of child abuse and neglect a national emergency”(USABCN 1990). “By 1967, all states had adopted mandatory reporting laws, largely in response to the widely publicized cases of child maltreatment following the publication of “The Battered Child”(Kempe 1962). The mandated reporting concept is presenting problems for many nurse practitioners. There seems to be a gray area between confidentiality as a medical concept, and the ever engaging precept of privileged communications as a legal reality. “Nursing codes of ethics bind nurses to the role of patient advocate and compel them to take action when the rights or safety of a patient is jeopardized. Reporting misconduct is known as whistle blowing and studies indicate that there are personal and professional risks involved in blowing the whistle”(Ahern, McDonald 2002). 2 “Whistle blowers supported the beliefs inherent in patient advocacy, while non whistle blowers retained a belief in the traditional role of nursing. Participants who reported misconduct (whistle blowers) supported the belief that nurses were primarily responsible to the patient and should protect a patient from incompetent or unethical people. Participants who did not report misconduct (non whistle blowers) supported the belief that nurses are obliged to follow the physicians order at all times and that nurses are equally responsible to the patient, the physician and the employer”.( Ahern, McDonald 2002) According to Megan-Jane Johnstone, “Today, the problem of child abuse and protection remains one which is fraught with difficulties and invites controversy at a variety of levels ( public, political, professional, legal and moral being key among them). Of particular interest to this discussion is the moral controversy surrounding child abuse and the question it begs of what constitutes a morally just response to child maltreatment and protection. Something which remain a moot point and raises many provocative questions”(Johnstone 1994). Is it the case, as tends to be assumed, that concerned citizens, professionals or public officials ought to morally intervene to protect children from known suspected instances of abuse or neglect? Is it unethical for those who hold suspicions about or know that a child is being abused, not to intervene in some way? Are the harms of child neglect and abuse morally significant enough to justify the removal of children from the ‘care’ of an abusive parent/guardian 3 or dysfunctional family? To what extent, if any, ought the state intervene in the private matters of its citizens (in this instance, parents/guardians who have a lawful authority over their children and who have an interest in maintaining their autonomy in deciding what is best to raise their children”( Johnstone 1999) “The alarming rise in the number of reported cases of child abuse is a significant development, but the full dimensions of its meaning are not yet clear. A significant number of cases reported to Child Protective Services agencies are not substantiated. The results of the second national incidence study, for example, indicate that in 1986 the alleged maltreatment was unfounded for 47 per cent of those children reported in CPS cases” (NCCAN 1988). With the adoption of mandatory reporting laws by all states, according to Kaslow 1990, “It can destroy a relationship and may risk a malpractice suit”. “The ethical codes of the various helping professions (of which nursing is included) are intentionally vague, general, and elastic to cover all types of situations, but take confidentiality very seriously”(Keith-Spiegel & Koocher 1985). “Nurses now live in a world in which there is no one single reality, but many coexisting realities (multiple realities) among which they must choose”(Anderson 1990) In assessments by Bouman 1993 and Wildes 1993, 1994, “the world in which we live, and the contexts in which we work, have all become increasingly characterized by moral indiscernability, ambiguity, uncertainty, controversy and perplexity”. 4 The laws of the states require that the health professional put the childs’ best interest above the medical relationship. Clearly, the laws have contributed considerably to the increase in reported incidents to the protective agencies.. Nursing ethics can be said to involve an evaluation by the nurse of the risks, social concerns and the merits. Since the beginning of nursing in the late nineteenth century, ethics have been an important and critical entity contributing to its successful perpetuation. The nurse has always been a respectful practitioner whose initial interest has been the human rights of the person charged to their care. As a consequence, during the early years of the nursing profession, when attention was drawn to ethics within the profession, a considerable amount of emphasis was placed on the virtues of the individual nurses. According to Johnstone 1994, “dealing with everyday ethical problems requires of decision- makers an exquisite moral sensibility, ‘moral knowing’, ‘moral imaginations’, ‘life experience’, virtue (e.g. compassion, empathy, integrity, care decency), being generally informed (e.g. about law, social and cultural processes, human nature, politics), and a deep personal moral commitment to ‘doing what is right’. In some instances ‘being moral’ also require political savy and an ability (personal and otherwise) to transcend the many obstacles that threaten to obstruct the realization of morally just outcomes in given contexts. At times, although it should be otherwise, deciding and acting morally can require enormous moral courage and even ‘moral heroism’ on the part of those choosing to take a moral course of action. This is especially so in the case of nurses who despite 5 an apparent increase in professional status over the past two decades, continue to lack sovereignty in their own realm of practice, continue to be burdened with enormous responsibilities without the legitimated authority to fulfill these, and continue to be coerced into silence when what they have to say on important issues threatens the status quo in which others have a powerful vested interest”(Johnstone 1994). Rumbold 1999 sketches the symbiotic relationship of nursing ethics as they relate to medical ethics. “Although historically, much of nursing ethics has been derived from medical ethics there are some factors that differentiate it from this. The key difference is that paternalism, which is often a key factor in theories of medical ethics, is generally nit compatible with nursing ethics”.(Rumbold 1999) The point made by Rumbold is particularly salient and begins to elucidate the non-existence of bioethical conflict when nurses exercise their mandated responsibility to report child abuse cases. Rumbold 1999, further explains, “nursing theory seeks a collaborative relationship with the person in their care. Nursing ethics although it is a derivative of medical ethics, which promotes paternalism”. He further states that, “nursing theory emphasizes autonomy, in that framework for the codes of ethical conduct of nurses are more prone to be established in deontology”(Rumbold 1999). Which are premised on the rights of the patient and those practices which the nurse perceives as their duties, instead of the utilitarian idom of the consequence justifying the action, as practiced in medical ethics. 6 Rumbold perceives the nurse as an objective entity, whose sole purpose is the welfare of the patient. “The nurses role is one of advocate for the interests of the people in their care. In terms of ethical theory, this means having a respect for autonomy of the person to make decisions about their own treatment and be provided with information available in order to do this. So the principle of informed consent, where a person understand fully the implications of having or refusing a treatment, is one which is held in the nurses mind when suggesting treatment options”(Rumbold 1999). Obviously, the issue of confidentiality weighs very heavily in the ethical code of nurses. This issue is a compelling one and presents itself when information about the patient is shared with others, only after the patient has been duly appraised and has rendered consent for its sharing. There are of course, two sets of circumstances which might preclude the patients consent or approval, which tends to mesh the matter of confidentiality into the category of paternalism; (1) if it is felt that the information must be shared to preserve the well-being, or (2) if the physical and or emotional health of the patient has been so affected by means of maltreatment, then the nurse is both obligated by mandate and her own professional ethics, to report the condition to the proper authorities. In a study conducted by Ahern and McDonald 2002, they concluded, “nursing codes bind nurses to the role of patient advocate and compel them to take action when the rights or safety of a patient is jeopardized. Reporting misconduct is known as whistle blowing and studies indicate that there are personal and 7 professional risks in blowing the whistle”(Ahern et al) “Whistle blowers supported the beliefs inherent in patient advocacy, while non whistle blowers retained a belief in the traditional role of nursing. Participants who reported misconduct ( whistle blowers) supported the belief that nurses were primarily responsible to the patient and should protect a patient from incompetent or unethical people. Participants who did not report misconduct ( non whistle blowers) supported the belief that nurses are obliged to follow physician’s order ar all times, and that nurses are equally responsible tyo the patient, the physician and the employer”(ibid) According to Swoboda,Elwork, Sales and Levine, 1978, “There is musch confusion about confidentiality and privilege, especially where it pertains to investigating and treating child abuse. The two concepts are not interchangeable. Privileged communication refers to a rule in evidence law that permits a litigant in a legal proceeding with the right to withheld evidence that was originally communicated in confidence. Confidentiality originated as an ethical standard for the medical profession and aimed to uphold the integrity of the individual coming to seek help0 and free him or her from the fear of disclosing anything that may help the doctor decide on an appropriate treatment”.(Swoboda, et al 1978). Bibliography Ahern, Kathryn, McDonald, Sally, (2002) The beliefs of nurses who were involved in a whistle blowing event, Journal of Advanced Nursing 38 (3), 303-309 Johnstone, M. J. (1994) Bioethics; A Nursing Perspective, 2nd edition, Sydney Harcourt Brace Johnstone, M. J., Bioethics: (2004)A Nursing Perspective, 4th edition, Sydney Harcourt Brace Kaslow, R. (1990) Children who Sue Parents. A New Form of Family homicide? Journal of Marital and Family Therapy, 16 (2), 151-163 Keith-Spiegel,P., Koucher, G.P. (1985) Ethics in Psychology, Professional Standards and Cases, New York, Random House Kempe, Henry 1962, Battered Child Leesfield, I., (1987) Negligence of mental health professionals Trial 23, 57-61 Leong, G., Silva, R., Weinstock, R., (1988) Ethical Consideration of Clinical use of Miranda-like warnings, Psychiatric Quarterly, 59 (4), 293-300 Marinelli, R., (1988) (1988) Stress and its relationship to legal vulnerability and its management, Journal of Law Ethics 1 (2), 88-91 Miller, R. D., & Weinstock R.,(1987) Conflict of Interest between therapist-patient confidentiality and the duty to report sexual abuse of children, Behavioral Sciences and the Law 5 (2), 161-174 National Center for Child Abuse and Neglect (1993) Understanding Child Abuse and Neglect, Commission on Behavioral and Social Sciences and Education Rumbold, G., (1999)Ethics in Nursing Practice, Balliere Tindall Swoboda, J. S., Elwork, A., Sales, B. D., & Levine, D., (1978) Knowledge and Compliance with privileged communication and child-abuse-reporting laws, Professional Psychology, 9 (3), 448-457 Wildes, S. J., (1993) View from somewhere: The Bioethics of Particular communities, Journal of Medicine and Philosophy, 18 (December 1993) Read More