An Ethical Debate: Child protection: medical responsibilities

Working Together, 19881

The title Working Together is attractive: it was the first of three documents produced by the Department of Health as guides to arrangements for interagency cooperation for the protection of children from abuse.1 Next came Working Together under the Children Act 1989,2 and recently an addendum to this has been published by a joint working party set up by the Department of Health, the BMA, and the Conference of Medical Royal Colleges chaired by Dr Sandy Macara, primarily for doctors: Child Protection: Medical Responsibilities.3 This document, in my opinion, does not resolve the doctor's dilemma over disclosure, though perhaps the advice is more balanced than in Working Together, paying due regard to ethical issues of confidentiality. On page 2 the General Medical Council's current advice (May 1993) is quoted: “Where a doctor believes that a patient may be the victim of abuse or neglect the patient's interests are paramount and will usually require a doctor to disclose information to an appropriate, responsible person or officer of a statutory agency.”

But on page 5 we read: “There comes a point after careful evaluation … when a doctor must refer these concerns to the statutory agencies” and on page 6: “Doctors must be aware … that the decisions rest ultimately with the statutory agencies.” Later (page 17) there is less compulsion in the advice given: “Knowledge or belief of abuse and …