Children may be abused physically, sexually, emotionally and by omission or commission in any permutation under these headings. This is discussed in terms of the separate and overlapping responsibilities of parents, guardians, the community in which they live and the network of professional services developed to care for, protect and educate children. An attempt is made to place these issues within an ethical framework, with regard to the legislature of England and Wales. It is argued that professionals working within this (...) field have an obligation either to keep up to date in respect of a large and growing body of research and practice knowledge or to consult 'experts' within the field when making complex and far-reaching decisions on behalf of abused children and their families. A representative, inevitably incomplete, bibliography is discussed and appended and there is brief reference to the role of expert witnesses concerning children involved in civil legal proceedings. (shrink)

The nature of children's early environment has profound long-term consequences. We are beginning to understand the underlying molecular programming of the stress-response system, which may mediate the destructive long-term effects of cruelty to children, explain the evolutionary stability of cruelty, and provide opportunities for its reversal of early trauma.

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data (...) were collected through in‐depth interviews with nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational ‘rule‐centred’ culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child‐centred approach. (shrink)

In Child Abuse, Family Rights, and the Child Protective System: A Critical Analysis from Law, Ethics, and Catholic Social Teaching, Stephen M. Krason gathers essays by leading scholars and practitioners to comment through the prism of Catholic social thought, on the plight afflicting American families and the role of the child protective system. Here readers will find critical essays on the deleterious effect of the 1974 passage of the Child Abuse Prevention and Treatment Act; (...) assessments of current American policies on child abuse and neglect and the role of the CPS within the context of prevailing international human rights principles and Catholic social teaching; a survey of the enforcement of CPS policies from a legal and constitutional perspective; research data disputing the CPS principle that all parents are potential abusers and illustrating the greater prevalence of abuse and neglect in broken, “blended,” and “untraditional” families; and arguments for poverty and unemployment as the prime culprits in the mistreatment of children. Also included are the amicus curiae briefs that the Society of Catholic Social Scientists submitted in two U.S. Supreme Court cases on parental rights, the CPS, and state control over the family. (shrink)

During the past 20 years, states have increasingly expanded the lists of individuals who are obligated to report their suspicions of child abuse and neglect. These legal requirements are juxtaposed with ethical considerations in research and professional practice. The ethical issues include the obligation to maintain both confidentiality of information provided by human participants and the safety and protection of these participants. This article reviews the types of state child abuse reporting statutes and outlines the (...) categories of mandated reporters. I develop a model of how individual researchers should approach deciding whether they are mandated reporters of child abuse and neglect. (shrink)

Introducción: El maltrato infantil se define como el abuso y la desatención de que son objeto los menores de 18 años; incluye el maltrato físico o psicológico, abuso sexual, desatención, negligencia y explotación comercial o de otro tipo que puedan causar un daño a la salud, al desarrollo o la dignidad del niño, y poner en peligro su supervivencia, en el contexto de una relación de responsabilidad, confianza o poder. Método: Se realizó un estudio prospectivo, con enfoque cuali-cuantitativo, modalidad de (...) campo, descriptivo, analítico y longitudinal en la escuela Manuela Espejo del cantón Ambato, provincia Tungurahua, Ecuador, durante el periodo 2013-2015 con el objetivo de determinar la incidencia de maltrato infantil y brindarle la atención o tratamiento adecuado. Resultados: El 7,67 % de los niños eran maltratados, predominó el sexo masculino con un 74 %, fundamentalmente en el medio familiar con un 52,17 % en la modalidad de maltrato psicológico en un 62,16 %. Conclusiones: La violencia infantil, continúa siendo un problema a nivel internacional. La asistencia continua a las víctimas del maltrato y a sus familias puede ayudar a reducirlo y a paliar sus consecuencias. Introduction: Child abuse is defined as mistreatment and neglect of children who are under 18. It includes physical or psychological abuse, sexual abuse, neglect, negligence and commercial exploitation or any other kind of exploitation that may cause damage to children´s health, physical development or dignity, and may endanger their survival in the context of a relationship of responsibility, trust or power. Method: A prospective, descriptive, analytical, longitudinal study was conducted using qualitative and quantitative approaches at Manuela Espejo School in Canton Ambato, Tungurahua province, Ecuador, during the period of 2013-2015 in order to determine the incidence of child abuse and provide adequate care or treatment. Results: 7.67% of children were abused; of those, males predominated at 74%. The abuse took place mainly in the family environment in the form of psychological maltreatment. Conclusions: Child abuse remains a problem internationally. Continuous assistance to victims of abuse and their families can help reduce and mitigate its consequences. (shrink)

During the past 20 years, states have increasingly expanded the lists of individuals who are obligated to report their suspicions of child abuse and neglect. These legal requirements are juxtaposed with ethical considerations in research and professional practice. The ethical issues include the obligation to maintain both confidentiality of information provided by human participants and the safety and protection of these participants. This article reviews the types of state child abuse reporting statutes and outlines the (...) categories of mandated reporters. I develop a model of how individual researchers should approach deciding whether they are mandated reporters of child abuse and neglect. (shrink)

Mandatory reporting laws, which vary slightly from state to state, require reporting by helping professionals when there is reasonable cause to suspect child abuse. Institutional Review Boards (IRBs) require researchers to warn subjects of this duty to report, which may have a chilling effect on subject rapport and candor. Certificates of confidentiality, in conjunction with other precautions, may reduce some barriers to valid research. Attempts to resolve problems created by reporting laws must produce the most valid research, while (...) minimizing harm and distress to research participants, their families, and the researcher and meeting local and federal legal requirements. (shrink)

The forced marriage of minors is child abuse, consequently duties exist to stop them. Yet over 14 million forced marriages of minors occur annually in developing countries. The American Bar Association concludes that the problem in the US is significant, widespread but largely ignored, and that few US laws protect minors from forced marriages. Although their best chance of rescue often involves visits to health care providers, US providers show little awareness of this growing problem. Strategies discussed to (...) stop forced marriages include recommendations from the UN, the ABA, and the UK. The author anticipates and responds to criticisms that first, no duty to intervene exists without better laws and practice guidelines; and second, that such marriages are not child abuse in traditions where parental rights or familism allegedly justify them. (shrink)

ObjectiveA sickness history from General Practice will be unfolded with regard to its implicit lived meanings. This experiential matrix will be analyzed with regard to its medico-theoretical aspects.MethodThe analysis is grounded in a phenomenology of the body. The patient Katherine Kaplan lends a particular portrait to the dynamics that are enacted in the interface between socially silenced domestic violence and the theoretical assumptions of human health as these inform the clinical practice of health care.ResultsBy applying an understanding of sickness that (...) transcends the mind-body split, a concealed and complex logic emerges. This logic is embedded in a nexus of the impact of childhood abuse experience and the medical disinterest in subjective experiences and their impact on selfhood and health. Its core is twofold: the violation of embodiment resulting from intra-familial abuse and existential threat, and the embodiment of violation resulting from social rules and the theoretically blinded medical gaze.ConclusionA considerable medical investment, apparently conducted in a correct and consistent manner as to diagnostic and therapeutic measures, results in the complete incapacitation of a young physician. (shrink)

In State v. McKnight, the Supreme Court of South Carolina decided 3-2 to affirm McKnight’s conviction for homicide by child abuse based on the finding that her cocaine use during pregnancy caused her daughter to be stillborn. Under South Carolina law, a person is guilty of homicide by child abuse if he or she “causes the death of a child under the age of eleven while committing child abuse or neglect, and the (...) death occurs under circumstances manifesting extreme indifference to human life.” During the trial, the pathologist who conducted the autopsy testified that the only way for the infant to have cocaine byproducts present in her system was ifthe mother had ingested cocaine, and the cause of death was intrauterine fetal demise. Another pathologist testified that there was a reasonable degree of medical certainty that the cause of death was intrauterine cocaine exposure. (shrink)

Mary Midgley asserts that my argument concerning the problem of child-abuse was inappropriately framed in the language of rights, and neglected certain pertinent natural facts. I defend the view that the use of rights-talk was both apposite and did not misrepresent the moral problem in question. I assess the status and character of the natural facts Midgley adduces in criticism of my case, concluding that they do not obviously establish the conclusions she believes they do. Finally I briefly (...) respond to the charge that my suggestions were illiberal. (shrink)

One million cases of child maltreatment and twelve hundred child deaths due to abuse and neglect occur per year. But since many cases of abuse and neglect remain either unreported or unsubstantiated due to insufficient evidence, the number of children who are abused, neglected, and killed at the hands of family caregivers is probably higher. One approach to combat child abuse in the U.K. has been the employment of hospital-based covert video surveillance (...) (CVS) to monitor parents suspected of Munchausen Syndrome by Proxy (MSBP). The use of CVS, however, raises concerns about voluntary informed consent, research on human subjects, privacy, and the appropriateness of healthcare providers to conduct CVS. More broadly, the use of CVS raises concerns about the ethical life of healthcare institutions and their moral obligations to the families and communities they serve. The U.K. protocol for CVS is examined in light of these concerns. Three alternative CVS protocols and two procedures for selecting a protocol are then proposed for use in the U.S. The paper concludes that any CVS protocol selected for use by hospitals ought to be selected by means of open and democratic processes that permit community input and, subsequently, the possibility of a consensus on the moral status and scope of CVS. (shrink)

To investigate the relationships among child psychological abuse and neglect, children’s learning engagement, family socioeconomic status, and children’s academic achievement, 271 children and their parents participated in this study with a longitudinal design. Results revealed that learning engagement at T1 mediated the relationship between CPAN at T1 and academic achievement at T2 when gender, age, grade, and academic achievement at T1 were under control. Family SES at T1 moderated the relationship between children’s learning engagement at T1 and (...) academic achievement at T2. The association between learning engagement and academic achievement was stronger among children from lower family SES. Our findings highlighted the negative impact of CPAN and the critical role of learning engagement in children’s academic achievement, especially for those from low SES families. (shrink)

Critical discursive analyses offer possibilities for equity‐oriented research, and are a resource for addressing resistant social problems, such as child neglect and abuse (CN&A). A key challenge for discourse analysts in health disciplines is the tensions between materiality and social constructions, particularly at the site of the body. This paper describes how Donna Haraway's ideas of figuration and technobiopower can augment critical discourse analysis to address this tension. Technobiopower, an intensification of biopower in the context of technoscience, (...) is seen as underpinning the melding of material and semiotic practices. The subject is no longer a material body, but a hybrid body that exists in tropic figuration between the real and unreal. This paper uses an analysis of the figuration of The Monstrous Perpetrator from a study of nursing responses to CN&A to illustrate how Haraway's figuration aligns with and provides an analytical tool to extend critical discursive analyses. Specifically, this methodology offers new ways to identify the discursive qualities of bodies, and how material aspects of bodies are exaggerated, concealing their hegemonic ideologies and discriminatory effects. By identifying discourses within or inscribed upon the body, they can be disrupted, opening new possibilities for social change. (shrink)

This article examines baby farming as an urban neighborhood-based system of group child care in Philadelphia in the late nineteenth century and considers the dangers and abuses the practice of baby farming posed for parents, children, and baby farmers. It explores reformers' early efforts to regulate the city's baby farms. Finally, the essay also investigates the ways in which the residents of Philadelphia's poor neighborhoods monitored the child-care establishments in their communities that catered to working mothers.

In this article, we explore the ethical issues related to the reporting of suspected abuse or neglect in research involving children. Ethical dilemmas related to reporting child maltreatment are often complex because the rights of children and their adult caregivers may conflict and determinations of abuse or neglect are socially constructed judgments that depend on particular circumstances. We argue that when reporting is legally mandated, investigators must follow the law and report their suspicions to (...) class='Hi'>Child Protective Services. When reporting is not legally mandated, investigators still have an ethical obligation to report to help prevent additional maltreatment and allow children to obtain access to services needed to recover from abuse or neglect. We also argue that investigators should include plans and procedures in the research protocol for making reports and training research staff in recognising evidence of child abuse or neglect. Although investigators should report evidence of abuse or neglect that is discovered incidentally, they have no mandate to actively search for such evidence when it is not related to the study’s objectives. Investigators should also inform parents and children about their obligations to report suspected abuse or neglect. (shrink)

Although previous studies have explored relationships between psychological abuse and social support, the pathways from psychological abuse to social support are still unclear, particularly in Chinese adolescents. This cross-sectional study attempts to delineate the prevalence of psychological abuse and explore the relationships between psychological abuse, social support, and self-esteem under the Chinese cultural context. Data were obtained from 417 Chinese adolescents aged 15–18 years old. All of them completed the Child Psychological Abuse and (...) class='Hi'>Neglect Scale, Rosenberg Self-Esteem Scale, and Multidimensional Scale of Perceived Social Support. Results indicated that the prevalence of psychological abuse in Chinese adolescents was 25.66%, and psychological abuse was negatively associated with self-esteem and social support, respectively. Self-esteem partially mediated the relationships between psychological abuse and social support. Findings highlight the importance of improving self-esteem in survivors of psychological abuse for decreasing the negative effects on social support. Additionally, the significance and limitations of the results were discussed. (shrink)

This book examines the negative power that child maltreatment has on individuals and society ethically and politically, while analyzing the positive power that parental love and healthy families have. To address how best to confront the problem of child maltreatment, it examines several policy options, ultimately defending a policy of licensing parents, while carefully examining the tension between child and adult rights and duties.

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse (...) or child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

In 2010, a South Carolina mother was taken to court when her fourteen‐year‐old son reached 555 pounds. An article on the story reported, “His mother, Jerri Gray, lost custody of her son and is being charged with criminal neglect. Gray is facing 15 years on two felony counts, the first U.S. felony case involving childhood obesity.” If the caretakers of obese children are negligent, then they are also morally and legally blameworthy. I want to suggest, however, that important ethical (...) differences exist between negligent or abusive caretakers and the caretakers of obese children and that these differences ought to make a moral and legal difference. The distinctions are nuanced, and the ethical pictures in cases of abuse, neglect, and obesity are far from black and white. However, the various types of harm that children face from their caretakers should be placed in neither the same ethical nor the same legal category.When children are beaten or sexually molested, the justification for taking them out of the home is clear: the caretakers are violating the rights of their children. Similarly, with neglect, caretakers are failing to provide their children the necessities to which they are entitled. The central question that I want to address in this article is whether the actions (or inaction) of caretakers that allow a child to become obese are morally or practically analogous to physical abuse or neglect. Ultimately, I will argue that parenting that allows a child to become obese is so morally different from both abuse and neglect that it is best understood as falling outside these categories altogether. This conclusion has important moral, practical, and legal implications. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse (...) or child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

Background: Hospitalized children have the right to “partake in practices related to their treatment and care.” Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children. Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes. Methods: This descriptive cross-sectional study included 122 midwives (...) and nurses in total. The data were collected through a questionnaire. Ethical considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted. Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child’s consent about the treatment by looking at the child’s facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child’s consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher. Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children’s rights make a difference in terms of children’s rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs. (shrink)

Infants are unable to make their own decisions or express their own wishes about medical procedures and treatments. They rely on surrogates to make decisions for them. Who should be the decision-maker when an infant’s biological parents are also minors? In this paper, we analyse a case in which the biological mother is a child. The central questions raised by the case are whether minor parents should make medical decisions on behalf of an infant, and if so, what are (...) the limits to this decision-making authority? In particular, can they refuse treatment that might be considered best for the infant? We examine different ethical arguments to underpin parental decision-making authority; we argue that provided that minor parents are capable of fulfilling their parental duties, they should have a right to make medical decisions for their infant. We then examine the ethical limits to minor parents’ decision-making authority for their children. We argue that the restricted authority that teenagers are granted to make medical decisions for themselves looks very similar to the restricted autonomy of all parents. That is, they are permitted to make choices, but not harmful choices. Like all parents, minor parents must not abuse or neglect their children and must also promote their welfare. They have a moral right to make medical decisions for their infants within the same ‘zone of parental discretion’ that applies to adult parents. We conclude that adult and minor parents should have comparable decision-making authority for their infants. (shrink)

Approximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child’s medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child’s biological parents should play in making serious medical decisions. Here (...) we highlight some of the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician. (shrink)

Studies of childhood abuse and neglect haveimportant lessons for considerations of natureand nurture. While each child has uniquegenetic potentials, both human and animalstudies point to important needs that everychild has, and severe long-term consequencesfor brain function if those needs are not met. The effects of the childhood environment,favorable or unfavorable, interact with all theprocesses of neurodevelopment (neurogenesis,migration, differentiation, apoptosis,arborization, synaptogenesis, synapticsculpting, and myelination). The time coursesof all these neural processes are reviewed herealong with statements of core principles (...) forboth genetic and environmental influences onall of these processes. Evidence is presentedthat development of synaptic pathways tends tobe a ``use it or lose it'' proposition.Abuse studies from the author's laboratory,studies of children in orphanages who lackedemotional contact, and a large number of animaldeprivation and enrichment studies point to theneed for children and young nonhuman mammals tohave both stable emotional attachments with andtouch from primary adult caregivers, andspontaneous interactions with peers. If theseconnections are lacking, brain development bothof caring behavior and cognitive capacities isdamaged in a lasting fashion.These effects of experience on the brainimply that effects of modern technology can bepositive but need to be monitored. Whiletechnology has raised opportunities forchildren to become economically secure andliterate, more recent inadvertent impacts oftechnology have spawned declines in extendedfamilies, family meals, and spontaneous peerinteractions. The latter changes have deprivedmany children of experiences that promotepositive growth of the cognitive and caringpotentials of their developing brains. (shrink)

Approximately one in three adults has reported being abused or neglected by a caregiver during their childhood (i.e., they have experienced child maltreatment), though the exact prevalence differs...

Due to the enormous disparity of power in the child welfare professional-client relationship, a high level of trust is necessary for this relationship to achieve its intended benefits, including protecting, caring for, terminating parental rights to, and finding appropriate adoptive homes for, abused and neglected children. This paper first defines conflicts of interest as necessarily including the exercise of judgment, and then argues that contractual relationships between private child welfare agencies and public departments of child welfare often (...) betray their fiduciary responsibilities through conflicts of interest inherent in these contracts, particularly as regarding incentives for and against finding permanent homes for abused and neglected children. Finally, I propose an evidence-based strategy to ameliorate conflicts of interest when making permanent placement decisions for foster children. (shrink)

Services for single parents constitute a category of child and family services. These services are carried out by public and non-governmental bodies for people who are single parents by the unfortunate events or by their own choice. Individuals come to single parenthood mainly through divorce, separation, birth outside of marriage, child abuse/neglect, death of a partner/widowhood, and adoption.

Nurses are well positioned to contribute to child protection efforts but are underutilised. This paper describes a critical discursive analysis of nursing responses to child neglect and abuse (CN&A) in British Columbia, Canada. Legal and practice guidelines were analysed alongside nurse interview texts, offering a glimpse into how nurses prevent CN&A in their everyday practice with families. Results show how the primacy of mandatory reporting to child protection authorities coordinates a series of deferrals and how (...) nurses engage with and interrupt these deferrals in everyday practice. Nurses' relational approaches are essential to gain access to the private sphere of the family to assess, plan, elicit cooperation with interventions and monitor the situation. They considered reporting to be one among many possible responses. This study highlights how nursing contributions to prevention are largely overlooked and points to the potential for a more significant role for nurses in a public health approach to child protection. (shrink)

This paper contrasts two prominent positions in contemporary Western feminist discourse about prostitution. The first is radical feminism, which emerged in the early 1970s; the second is libertarian feminism, which emerged in the late 1980s. The paper analyses the underlying assumptions and public policy recommendation of each position; it argues that each illuminates important aspects of the situations of some prostitutes but ignores or denies others. An approach to prostitution capable of providing an adequate guide to public policy must be (...) less dogmatic or “essentialist” than either radical or libertarian feminism; it should investigate how the sex trade operates in specific locations and the varying meanings it has in different cultural, contexts. Such investigations must be feminist not only in their commitment to ending the subordination of women but also in their respect for choices made by women who already must often endure not only exploitation but also stigmatization, discrimination and exclusion. In this paper, I sketch two prominent positions in contemporary Western feminist discourse about prostitution, discuss the strengths and inadequacies of each, and conclude by indicating an approach—as opposed to a substantive analysis—that I find more promising. (shrink)

In pediatric emergency rooms (ERs), social workers must navigate diverse responsibilities including acting as advocates and liaisons between families and multidisciplinary treatment teams, providing compassionate support to families in crisis, and assessing for and reporting any suspicions of child abuse or neglect. These potentially contrasting roles can place social workers at the center of dealing with ethical dilemmas and advocating against ethical violations, such as bias and discrimination toward families. This qualitative study seeks to gain insight into (...) ethical issues commonly encountered in pediatric ERs by exploring the perspectives of 23 social workers at Level 1 trauma centers in the United States. Thematic analysis was used to develop major themes and subthemes related to ethical violations, dilemmas, and best practices in pediatric ERs. Major themes emerged related to unfair treatment of families (with subthemes of bias, discrimination, and compassion fatigue), ethical dilemmas (with subthemes of cultural issues, safety and system issues), and promoting ethical practices (with subthemes of self-awareness, advocacy, and efforts to change the system). This study provides important insights into ethical issues in pediatric ERs as experienced by social workers and can inform efforts to improve the quality and equity of care for all families in pediatric ERs. (shrink)

The best-interests standard is a widely used ethical, legal, and social basis for policy and decision-making involving children and other incompetent persons. It is under attack, however, as self-defeating, individualistic, unknowable, vague, dangerous, and open to abuse. The author defends this standard by identifying its employment, first, as a threshold for intervention and judgment (as in child abuse and neglect rulings), second, as an ideal to establish policies or prima facie duties, and, third, as a standard (...) of reasonableness. Criticisms of the best-interests standard are reconsidered after clarifying these different meanings. (shrink)

Background A baby hatch called the “Stork’s Cradle” has been in place at Jikei Hospital in Kumamoto City, Japan, since May 10, 2007. Babyklappes were first established in Germany in 2000, and there are currently more than 90 locations. Attitudes regarding baby hatches are divided in Japan and neither opinions for nor against baby hatches have thus far been overwhelming. To consider the appropriateness of baby hatches, we present and examine the validity of each major objection to establishing baby hatches. (...) Discussion There are various objections to baby hatches as follows: It violates a child’s right to know the identity of his or her biological parents by allowing anonymous birth; it neglects fulfillment of the biological parents’ basic obligation to raise their child and its very availability induces abandonment of infants; some people abuse it for very selfish reasons; it cannot save babies’ lives; the rights of one parent can be ignored if the other surrenders a child without his or her consent; it puts a baby in medical jeopardy; and it has no clear legal basis. The authors would argue that there are many plausible refutations for each objection mainly based on priority of child’s right to life, pregnant women’s vulnerability and necessity of anonymity, social responsibility to protect and raise children, differences between dropping a child off at a baby hatch and child neglect, limited function of social childcare center, inevitability of abuse by a minority of people, necessary distinction between outcomes that occur only because baby hatches exist and those that occur regardless of their existence, important local direct and upmost measures for women in trouble, and difference between ambiguous legality and illegality. Summary We argue that a certain number of baby hatches should continue to be established as a last resort, in a form that can maintain anonymity if the parent dropping the child off so desires. It should be supported if it is initiated with good intentions; if the maximum possible effort is made at said facility to protect the interests, rights, and safety of the child; and if no clear evidence of harm exists. (shrink)

Potential ethical issues can arise during the process of epidemiological classification. For example, unnatural infant deaths are classified as accidental deaths or homicides. Societal sensitivity to the physical abuse and neglect of children has increased over recent decades. This enhanced sensitivity could impact reported infant homicide rates. Infant homicide and accident mortality rates in boys and girls in the USA from 1940 to 2005 were analysed. In 1940, infant accident mortality rates were over 20 times greater than infant (...) homicide rates in both boys and girls. After about 1980, when the ratio of infant accident mortality rates to infant homicide rates decreased to less than five, and the sum of infant accident and homicide rates became relatively constant, further decreases in infant accident mortality rates were associated with increases in reported infant homicide rates. These findings suggest that the dramatic decline of accidental infant mortality and recent increased societal sensitivity to child abuse may be related to the increased infant homicide rates observed in the USA since 1980 rather than an actual increase in societal violence directed against infants. Ethical consequences of epidemiological classification, involving the principles of beneficence, non-maleficence and justice, are suggested by observed patterns in infant accidental deaths and homicides in the USA from 1940 to 2005. (shrink)

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was discussed (...) in committee meetings. In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was discussed (...) in committee meetings. In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

LaFollette proposed that the best way to protect children from abuse and neglect caused by their parents would be to implement parental licenses to prospective parents. In this paper, I re-evaluate his proposal by looking at various facts and data related to child abuse and neglect. It will be suggested that (a) parenting as a profession does not satisfy the third of LaFollette’s criteria for the introduction of licenses, which is “The benefits of the licensing (...) program outweigh any theoretical reasons against it” (LaFollette 2010, 328), (b) it would subject too many people to unnecessary tests and (c) parenting cannot be compared to other professions licenses are usually issued for. (shrink)

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric (...) group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2= 52.66;p< 0.001) and had a high rate of unresolved loss/trauma (χ2= 18.64;p< 0.001). Comorbid psychiatric diagnoses (n= 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88;SD= 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2= 2.43;p= 0.30) and rates of unresolved loss and trauma (χ2= 0.70;p= 0.40).Post hocanalyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs. (shrink)

This article examines how domestic violence impacts the lives and education of young children, children, and young people and how they can be supported within the education system. Schools are often the service in closest and longest contact with a child living with domestic violence; teachers can play a vital role in helping families access welfare services. In the wake of high profile cases of child abuse and neglect, concerns have been raised about the effectiveness of (...) multi-agency responses to children living with abuse. In the UK, the case of four-year-old Daniel Pelka who died in 2012 following abuse and starvation by his mother, who experienced domestic violence, and her partner, led to a serious case review. It found recording systems in Daniel’s school were not used consistently, and details held by different agencies were not collated to enable the formation of a coherent assessment. The lack of integrated working cited in the report echoes findings from previous serious case reviews. A strong correlation exists between domestic abuse and child abuse, with approximately half of all domestic violence situations involving direct child abuse. Children can also be affected indirectly by violence occurring in their home by seeing or hearing it taking place. This article examines the impact of domestic violence on the mental health of children, and the impact on their education. Violence in children’s lives often causes disruption to their schooling and harms the quality of their educational experiences and outcomes. The abuse children experience can result in emotional trauma, physical and psychological barriers to learning, and disruptive behavior in school, while the underlying causes of these problems remain hidden. Knowing when and how to seek advice from multi-agency professionals is an essential part of effective practice among school staff. Despite their vital role in identifying signs of abuse and signposting referral pathways, research indicates teachers often lack confidence and knowledge for such work. The article examines how the professional learning and professional confidence of teachers can be developed, and how recent policy and practice developments in the UK have the potential to influence work in this area. (shrink)

As family physicians, general practitioners play a key role in safeguarding children. Should they suspect child abuse or neglect they may experience a conflict between responding to the needs and interests of the child and those of an adult patient. English law insists on the paramountcy of the interests of the child, but in family practice many other interests may be at stake. The authors argue that uncritical adoption of the paramountcy principle is too simplistic (...) and can lead, paradoxically, to greater harm. They argue for a more subtle and nuanced view of interests and of conflicts of interest in safeguarding children. (shrink)

God vs. the Gavel challenges the pervasive assumption that all religious conduct deserves constitutional protection. While religious conduct provides many benefits to society, it is not always benign. The thesis of the book is that anyone who harms another person should be governed by the laws that govern everyone else - and truth be told, religion is capable of great harm. This may not sound like a radical proposition, but it has been under assault since the 1960s. The majority of (...) academics and many religious organizations would construct a fortress around religious conduct that would make it extremely difficult to prosecute child abuse by clergy, medical neglect of children by faith-healers, and other socially unacceptable behaviors. This book intends to change the course of the public debate over religion by bringing to the public's attention the tactics of religious entities to avoid the law and therefore harm others. (shrink)

This is an exploratory study of perceptions of human dignity in childhood as recalled by young adults. Our goal is to discover the range of dimensions, sources and experiences, both those that supported and violated, of the concept of human dignity. This research, drawing on responses from over two hundred university students, may help to develop a language with which to explore the concept of human dignity in a broader, more systematic way. The approach taken here permits us to move (...) beyond the ‘legal’ frame that often confines us to discussions of the extremes of child abuse and neglect, to a frame that frees us to explore the meaning and real life experiences with human dignity in childhood and the impacts on later life. Violating and not supporting human dignity in childhood helps produce a world populated by adults who, having been harmed as children, go on to harm and violate others as adults. If our goal is to have a world populated by children who were nurtured to flourish into child-centered adults who are empathic, intelligent and responsive and who have no need to hurt others, then our understanding of human dignity in childhood must be increased. This paper and the materials on which it is based seek to provide preliminary insights into the language of human dignity. (shrink)

Consent for pediatric health care has been evolving for 50 years. Norms for child-rearing and laws concerning child neglect and child abuse are also evolving. Brummett correctly describes th...

General practitioners (GPs) have to negotiate a range of challenges when they suspect child abuse or neglect. This article details findings from a Delphi exercise that was part of a larger study exploring the conflicts of interest that arise for UK GPs in safeguarding children. The specific objectives of the Delphi exercise were to understand how these conflicts of interest are seen from the perspectives of an expert panel, and to identify best practice for GPs. The Delphi (...) exercise involved four iterative rounds with questionnaires completed by an expert panel. Results from each round were distilled and findings sent to panel members until consensus was reached. Panel members shared insights regarding their understanding of conflicts of interest in relation to GPs and safeguarding children and responses when conflicts of interests arise. Findings suggested a broader understanding of conflicts of interest (intrapersonal, interpersonal, interprofessional and interagency), the importance of professional judgement in uncertain situations when both action and inaction have potentially negative consequences and the importance of trust. The Delphi exercise was an effective means to bring together a wide range of professional and disciplinary perspectives on a complex topic. Findings caution against the oversimplification of the conceptual and practical issues, emphasise the importance of professional judgement, and support the development of open and trusting relationships with families and among professionals in health and social care agencies. (shrink)