Child a stranger or someone who is known to

abuse can be categorised into four different types: neglect, emotional abuse,
physical abuse and sexual abuse. A child can be subjected to abuse by a stranger
or someone who is known to the child.

In modern-day Ireland there is an onus upon
the medical practitioner to act in both a legal and ethical fashion where they
suspect they may have encountered a child who is being subjected to abuse in
the home. The potential scale
of the issue is one that is reflected in the number of child protection and
welfare referrals per annum in Ireland. That figure has grown from 9,461 in
2012 to 19,044 in 2015.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!

order now

There has been a sustained legislative effort by the State to ensure
that a greater proportion of the children being abused have their circumstances
uncovered by State authorities. The approach in this regard is evident in
legislation such as the Children First Act 2015, Criminal Justice (Withholding
of Information on Offences against Children and Vulnerable Adults) Act 2012 and
the Persons Reporting Child Abuse Act 1998.

Children First Act 2015

The Children First Act 2015 places several statutory obligations
on specific groups of professionals and on particular organisations providing
services to children. (
) Section 7 of the Act stipulates that
the best interests of the child are to be the paramount consideration in all
interactions with children or others whilst section 14 legislated mandatory
reporting of child protection concerns where an individual:

“Knows, believes or has reasonable
grounds to suspect, on the basis of information that he or she has received …
in the course of his or her employment… that a child — has been harmed, is
being harmed, or is at risk of being harmed”

Medical practitioners are mandated reporters and are under a legal
obligation under the Children First Act to report where they believe that a
child is, has been or may be at risk.

The Children First,
National Guidance for the Protection and Welfare of Children 2017

The Children First,
National Guidance for the Protection and Welfare of Children 2017 was launched on October 2nd, 2017 and aims
to digest the Children’s Act and its practical implications and aid its
practical application.

The National Guidance document sets out that those encountering children
should be constantly open to the possibility that said children may be
suffering from abuse or neglect of some form.


It is accepted that there are generally three stages in the
identification of child neglect or abuse. Firstly, the identifier (who may or
may not be a “mandated” person under the Act) must firstly consider the
possibility of neglect, secondly, he or she must actively look for signs of
neglect or abuse and finally, he or she must record any relevant information
that comes to light in this regard.


After identifying abuse or potential abuse the identifying person must
ensure that the actions they take reflect a desire to place the safety and
well-being of the child in a paramount position. Any reports subsequently made
should be made in a timely fashion to TUSLA (Child and Family Agency).

Wherever possible, reports should be supported by evidence.

Under Sections 2 and 3 of the Criminal Justice (Withholding of
Information on Offences against Children and Vulnerable Adults) Act 2012 a
person may be found guilty of an offence where they know or believe that an
arrestable offence was committed against a child or vulnerable adult and they
have in their possession and control material information which might be of
assistance in securing the apprehension, prosecution or conviction of the
offender but they have failed, without reasonable cause, to disclose that
information to the Gardai?.

There is, however, a defence to such actions insofar as a designated
professional may show that he or she reasonably formed the view that the matter
should not be disclosed to the Garda Si?ocha?na.

A further defence arises in relation to confidentiality. Naturally, the
medical practitioner will have to evaluate, on a case by case basis, when their
duty of confidentiality to their patient is superseded by their duty to report
under the Criminal Justice (Withholding of Information on Offences against
Children and Vulnerable Adults) Act 2012. No medical practitioner may be
prosecuted for refusing to breach confidentiality in this regard.   

The Protection for Persons 
Reporting Child Abuse  Act  1998, rather than seeking to place an onus on
those in possession of information relating to child abuse, protects said
individual from civil liability where they disclose said information.

The aim of this legislation is to remove the barriers to reporting
rather than to obligate those dealing with children.

Under the Children First Act 2015The prudent medical practitioner should also be aware that it is a
criminal offence to disclose information shared by TUSLA in the course of its
investigations with a third party, save in accordance with law or authorised by


on Challenges that arise for the Medical Practitioner in reporting

abuse can be categorised into four different types: neglect, emotional abuse,
physical abuse and sexual abuse.


Doctors advocate for their patients with the
mindset of beneficence, non-maleficence, justice, autonomy and duty of care. When
reporting an incidence of either alleged or suspected child abuse; conflict may
arise amongst a doctor’s own moral judgement, the law and the fundamental
ethical principles:


Reporting alleged child
abuse against your patient breaks the doctor-patient confidentiality agreement
but also may cause harm to the alleged person and the child if the allegation proves
false. If the given allegation is untrue, an investigation by TULSA may lead to
a breakdown of the family unit. The child may temporarily be separated from its
parents, defamation of the character of the supposed offender would occur,
undue stress brought upon the child in question and a complete erosion of
trust. Loss of trust may not only be with the alleged
but may extend to the wider community, making other patients fearful that they too
could be subjected to investigation.


However, if the allegation turns out to be
true; preserving trust and confidence are second to preventing harm to the
child. If the child was able to report abuse; there may be issues with
respecting the child’s privacy, if the child confided in you. This also leads to
conflict with communication between parent and child.  If you take the step to breach their confidentiality
they will likely no longer trust you. You must be sure that you are taking this
step for an appropriate reason.

 (Gault 2011) (Australian Nursing and Midwifery
Council 2008).


There is also the potential that abuse, even
though reported and true, may not be detected with further enquiry. This could
cause the abuse to potentially worsen for the child. The child may then associate
breaking the silence with severe consequences, and the abuse may then continue
for months and even years with no future investigation.  


Child abuse can be caused by a mixture of
individual, family, and socioeconomic pressures. The caregiver might be your
patient, suffering from problems that require treatment (depression, victim of
abuse themselves, substance problem and personality disorder). You may feel their
actions are due to factors outside their control. With the appropriate services
and support orientated to people in need, there is a potential for all parties
involved to receive help required and make the changes necessary to keep
children safe. However it may be necessary to report the abuse before this can
be achieved.


Reporting suspected child abuse or neglect to
Tulsa is aimed to benefiting the child, so that they can receive the support
and protection that is required. This should remain the forefront for doctors,
above moral and ethical principles, when questioning the decision whether to