Education And Debate

An Ethical Debate: Commentary: A flexible approach—but not too flexible

BMJ 1996; 313 doi: (Published 14 September 1996) Cite this as: BMJ 1996;313:672
  1. F N Bamford, reader in developmental paediatrics (retired)a
  1. a University Department of Child Health, St Mary's Hospital, Manchester M13 0JH

    The purpose of child protection procedures is to protect children. Usually doctors engaged in such activities will also be the servants of their families, and it is commendable that Dr X sees this as his role. However, the interests of abused children and their families may not necessarily coincide, and it is important to recognise that it is the child who is the patient to whom the doctor has a primary obligation.

    The “go it alone” approach is superficially attractive but can be extremely dangerous. It is naive to assume that episodes of abuse are single incidents and will not happen again. Experience teaches that they are often recurrent and commonly escalate in frequency and severity.

    Doctors have no power to intervene except by persuasion and advice; those with statutory powers are the police and social workers. Once a case is referred, control passes to somebody else. It is true, as Dr X states, that people in different occupations do not have the same …

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