Clinical ethics in a tight spot: The thin line between protection and conviction for children growing up with adversity
Speaker: Jonathan McFarland, M.Sc. & Sergio Verd, M.D. Clinical Ethics Committee
COMETA, Department of Primary Care, Majorca, Spain
The main ethical principle in clinical paediatrics is the demand to do everything in the best interests of children. The difficulty for paediatricians is that they cannot be entirely certain what the best interests of children are in a complex situation. Children’s doctors have not only the responsibility to achieve the highest level of knowledge of the child-specific somatic, mental and social development, but also a duty to act as children’s advocates in child protection and services provision. Although countries may have cultural differences, most guidelines support that children's well being is best served by erring towards an absolutist approach to the recognition of maltreatment and towards a relativistic approach in determining how services respond to a harmful situation. On the other hand, given that there is convincing evidence that placement in out-of-home care is one of the strongest predictors for receiving a conviction among maltreated youth, doctors are responsible for providing sound evidence that maltreatment that commenced in childhood has not continued into adolescence. They are committed to following up these patients through empathic and trustworthy communication.
If it so happens that children become victims of the protection system, a discussion point is whether paediatricians have an ethical duty to campaign for a revised
social contract that adequately addresses the primacy of the children’s welfare, with a shift emphasis towards transparency and professional accountability that should serve to monitor or review difficult decisions that were made in this context.