Girl should have been offered a chance of safety

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7071.1549a (Published 14 December 1996) Cite this as: BMJ 1996;313:1549
  1. Juliet Butler
  1. Senior registrar in child and adolescent psychiatry Child Protection Team, Department of Psychological Medicine, Great Ormond Street Hospital for Children, London WC1N 3JH

    EDITOR,—I read the recent ethical debate on child protection with increasing uneasiness.1 Although the priority of the child's welfare and the danger of professionals “going it alone” are pointed out, other important issues are not addressed.

    Did it not seem worrying to the general practitioner that the girl behaved as she did when the allegations were made? Phrases such as “she offered no explanation” indicate to me a lack of insight into her experiences. Children subjected to sexual abuse, especially over a long period, may be unable to confirm that it occurred, even when there is irrefutable medical evidence. In this case, fetal DNA from samples obtained after termination of her pregnancy matched that of her stepfather. Her denial probably arose out of fear of her abuser. It would take a long time for such a child to trust any adult to keep her safe. In this case she was right not to “offer an explanation”: hopefully, that provided her with some protection when the judge decided that this family should remain intact.

    The general practitioner talks of the “so called abuser.” Impregnating a 14 year old girl would count as sexual abuse to most people; having been sexually abused as a child is an explanation but not an excuse. It seems that the abuser was not asked to take any responsibility for his actions but was allowed to remain at home. What message did this give him for the future?

    Did the general practitioner see no way of supporting the mother in protecting her children?

    If anything, this case report is an example of how child abusers can seduce and split professionals, no matter how experienced they think they are. No one says that the system we have now is perfect, but it is, as it must be, child centred. Not all residential care units or foster homes are abusive. I wonder if this girl, if given a chance of safety, would have been able to offer an explanation to satisfy her general practitioner.


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