Ethics concepts and applications

Ethics of Reporting Child Abuse

In most states, nurses and doctors are required by the law to report suspected child abuse. For example, in California, nurses are warned: "Registered nurses must also be aware that failure to report as required is also considered unprofessional conduct and can result in disciplinary action against the RN's license" (Terry, 2004). However, in this case, the RN's opinion conflicts with the presiding physician's opinion although the doctor is also required to report suspected abuse. The two health care professionals are in conflict about the right way to read the scenario. The abuse case is ambiguous, as it is not clear if the mother or a day care worker is the perpetrator or if abuse is taking place at all.

The fact that the child is in the ER makes the case even more difficult to interpret, as neither the nurse nor the doctor knows the child well. The child may have a medical condition that makes him or her vulnerable to injury, and it is not clear from the facts if this is the first time the child has been injured, if this reflects a pattern of injuries, or if the nurse has access to the child's complete medical history. However, if abuse it taking place at the day care center, other children may be at risk if the child's case is not reported. The mother may also take the child back and put the child in harm's way at the center. Reporting the case as abuse may put the mother under scrutiny in a way that is unfair, and may not reflect the full facts of the case, but to do nothing is not a feasible alternative, either.

There is always a fear of misreporting abuse. According to the Journal of Advanced Nursing, 60 per cent of healthcare professionals have seen a child they suspect was being physically abused, but only 48 per cent reported it to the authorities, Over a fifth "said they were worried about getting it wrong" ("Child Physical Abuse Under-Reported by Healthcare Staff and 1 in 5 Worry About Getting it Wrong," 2006, Medical News Today). Interestingly, amongst medical professionals, of the 74 per cent who were aware of the mechanisms for reporting, community nurses showing the highest levels of awareness, followed by doctors and dentists ("Child Physical Abuse Under-Reported by Healthcare Staff and 1 in 5 Worry About Getting it Wrong," 2005, Medical News Today). This places an added and unfair burden upon the shoulders of nurses, as they may be able to note the emotional and physical signs of abuse, yet they may not have all of the child's medical facts and personal history at their disposal or full authority over the case.

Although the nurse may feel that he or she should defer to the physician's judgment, discussing with the physician why he or she does not wish to report the case as abuse is an important first step in taking proactive action. The physician may be reluctant to report the abuse, not because he or she does not feel that there has been some maltreatment, but because the physician does not think the child's mother is responsible. The nurse may need to remind the physician of their ethical responsibilities as health care practitioners in reporting abuse, regardless of the source. Also, the physician may even be unaware of how to report abuse. Together, the nurse and physician can see if they can gain access to the child's medical records to gain a better sense of the child's past history, and ideally the two could speak to the child's primary pediatrician.