The Children First Act (CFA), officially implemented December 11th, 2017, has as its primary mission to “promote the safety and well-being of children”. This Bill is based on the fact that when parents, guardians or families are unable, for whatever reason, to provide the care necessary for their child, they may need a ‘helping hand’ in the form of more professional and concentrated support. The Government policies that provide a foundation for this stipulate that the welfare and safety of children are central to the Act, as is the promotion of and support of a healthy family life. The goal of the act is to use the least amount of intervention needed in order to keep children safe. This is to be accomplished through inter-agency cooperation and support as well as through collaboration between State and civil society, all with the purpose of providing safer and more efficient services to allow children to reach their full potential.
This is no small undertaking, and a first step requires the definition of the abuses and neglect being targeted. The CFA identified neglect as being matters of omission: where a child may suffer due to inadequate food, clothing, safety, warmth, hygiene and intellectual stimulation. Unlike other forms of abuse, neglect often develops over time, such as gradual weight loss or developmental delay, as opposed to presenting all at once as may be seen with physical abuse. Emotional abuse is defined as an environment in which the child’s need for attention, affection, approval and security are not met. This is based on the relationship between the caregiver and the child, and can take the forms of criticism, hostility, and the placement of unrealistic expectations and responsibilities on the child. Physical abuse is defined as anything, within the control of the guardian, resulting in the potential or actual physical harm of a child such as hitting, slapping, kicking, suffocating or shaking. Finally, the Act defines sexual abuse as any instance in which a child is used for the sexual arousal or gratification of others. This does not simply encompass physical sexual abuse, it also related to situations where sexual acts are performed in the presence of the child.
Legally, physicians fall under the category of mandatory reporters for instances of child abuse. It is a general practitioners (GP) duty to report any instance in which they have reasonable grounds to suspect abuse is occurring. However, these concerns need to be supported by a certain amount of evidence. The knowledge that many GPs have about their patients, including family settings and dynamics, places them in a privileged position and provides a lens through which they can gauge whether or not there is abuse or neglect occurring. The Act outlines the 3 steps to identifying child abuse or neglect as: considering the possibility, looking for signs of abuse or neglect, and recording the information. GPs also have legal protection if they incorrectly report abuse, as long as they acted in good faith when making the report. This, however, leads to a certain ‘grey’ area, as the Act also stipulates that the reporter must tell the family or guardian of the report they are making. This inherently places both the reporter and the child at a higher risk of some form of retaliatory action from the family.
Another aspect of the Act that has garnered much backlash is the lack of consequences for those who fail to report suspected neglect or abuse. In many realms of life as well as the law, a person who has the ability to prevent harm and knowingly chooses not to is subject to punishment, whether it be in the schoolyard or the courts. Therefore, it is troublesome, to say the least, to eliminate consequences for failing to report something as serious as child abuse or neglect. In the initial bill of 2011, there was a minimum penalty for failing to report, however, in the final bill passed, those sanctions were removed.
These grey areas of the law lead to a powerful ethical discussion of a physician’s duties when it comes to reporting child abuse and neglect. The Act does not truly oblige one to report instances of suspected abuse or neglect, as there are no repercussions that one must fear. While it may be the physicians moral and ethical duty to report, this places the onus on their conscience, as opposed to the law. This is at odds with similar acts and laws in other countries, where there are penalties for failing to report. The counter-argument, however, maintains that the lack of punishment will encourage reporting from a place of well-founded concerns, as opposed to fear of punishment. It also asks physicians to tell the potential abuser that they are being reported, which can be seen as at odds with reporting as an attempt to protect the child. A physician, then, must not only consider whether the child is being abused… but also whether reporting the abuse will lead to further injury to the child, as well as whether the suspected perpetrator will attempt to “silence” them. The rules of due process allow the guardians the right to know why they have been reported and to refute those claims with their own proof, though this can be done in a manner that does not place the child in any potential danger.
The obligations and laws surrounding the reporting of suspected child abuse are fuzzy, to say the least. What is not fuzzy nor debatable, though, is the responsibility of society to protect its children. It is known that the majority of abuse and neglect is not immediately obvious, but with proper training in identification and reporting, a better system can be developed that works best for those it aims to protect.