The GMC have asked for submissions in connection with child protection and the role of doctors. Below is a summary of the MEA`s response.
There are a number of ethical considerations concerning child protection such as natural justice, the common good, and issues of good medical practice and confidentiality.
When putting in place procedures to safeguard children and vulnerable adults it is vital that the requirements of confidentiality do not take precedence over the need to protect their welfare.
Particular difficulties may arise in the case of suspected fabricated or induced illness. Detailed investigations would be normative and the diagnosis may only emerge over time. An example of good practise would be for the doctor with ultimate responsibility to share the tentative diagnosis with consultant colleagues to see if there is agreement on the diagnosis. It would also be good practice to seek the advice of colleagues in a tertiary centre.
The confidentiality that is required by law in furnishing reports for prosecutors and the giving of evidence in the civil courts is proscribed. Open evidence will be required in Crown Court and the doctor should not be afforded any anonymity and publicity cannot be avoided. If, however, the doctor has taken the steps outlined above this will afford some protection. Rarely a doctor may choose to take independent legal steps to protect their interests.
Difficulties can arise when English is not understood or where because of a particular culture, the head of the family is the only person who will speak on behalf of parents and may fail to translate what is said by doctors. There can also be fears that translators may breach confidence in close knit ethnic groups. In Family Proceedings Courts and Criminal Courts accredited translators must be provided by law. In the clinical situation difficulties arise and an independent translator is advisable.
Regrettably many doctors are loath to become involved in child protection as a result of adverse publicity, threats of legal action or complaints to the GMC. Direct threats also occur and many doctors feel that they or their own families are endangered. Ultimately, if many doctors refuse to become involved in the legal process child protection will fail. Fortunately most doctors feel that they are obliged in conscience to do their utmost to protect children.
It has always to be remembered that, especially in cases of possible sexual abuse, the medical evidence is often only a small part of the evidence upon which the court will rely. Paediatricians should not feel that their evidence is decisive, it is likely to be collaborative at best.
Those who are likely to be front line doctors with children. Paediatricians, accident and emergency doctors and general practitioners in particular need to be trained by their respective colleges using such documents as the RCPCH compendium “ Child Protection Companion”, 2006 which should be used in the annual appraisal of paediatricians.
Clear guidance is required from the GMC which doctors would find helpful and supportive and in which they could be confident that their conscientious work and compliance would protect them from vexatious complaints.