Save the Life of the Child

Madam: In Usual Suspects (HCR March-April 1992) a case of two young siblings, one of whom caused injury to the other, was presented. Two commentaries were offered regarding the appropriateness of the parents' lying about how the injuries occurred in order to prevent involvement of governmental child protection agencies. While both commentators make interesting observations and conclusions, another problem occurs when the treating physician has grave doubts about the integrity or capability of the governmental child protection services. If the physician legitimately believes that the governmental child protection agencies often act contrary to a child's best interests, what is the appropriate action for the physician to take? To notify the governmental agency may be to further endanger the wellbeing of either or both children, exactly as the parents fear. On the other hand, by not doing so the physician may be violating a legal obligation of mandatory reporting imposed by the state. The emergency physician may, in such a case, spend a great deal of time discussing the parents' fears (having discovered the lie), and dealing with them and the situation in a straightforward way. Experienced clinicians, in the judgment of both commentators, seem able to detect lies, assess the sincerity, and understand motives of patients and families. With these skills a clinician might be able to develop a plan that addresses the children and parents' needs and the overall family situation. The optimal approach could be to understand the parents' fear of the state agency, recognize their willingness to seek further help for their son, establish that the home environment can be made safer

Child and Adolescent Health · Ethics and Legal Issues in Pediatric Healthcare · Homicide, Infanticide, and Child Abuse · Psychology