Ethical Principles Underlying - Essay Example

Running Head: The Ethical Principles Underlying The Ethical Principles Underlying [Name of the writer] [Name of the institution] The Ethical Principles Underlying Historically, responses to child abuse and neglect in common law countries have been seriously wanting. Even though the modern problem οf cruelty to children was formally recognised in the early 1800s (and, it might be added, even popularised through the fictional writings of the English author Charles Dickens), processes and procedures for protecting children at risk were either: (1) lacking, (2) existed but never enforced systematically, or (3) were themselves abusive or neglectful, thereby compounding further the harm caused to children by their initial maltreatment. Today, the problem of child abuse and protection remains one which is fraught with difficulties and invites controversy at a variety of levels (public, political, professional, legal and moral being key among them). Οf particular interest to this discussion is the moral controversy surrounding child abuse and the question it begs of what constitutes a morally just response to child maltreatment and protection — something which remains a moot point and raises many provocative questions. For instance: • is it the case, as tends to be assumed, that concerned citizens, professionals or public officials ought morally to intervene to protect children from known or suspected instances οf abuse and neglect? • is it unethical for those who hold suspicions about or know that a child is being abused, not to intervene in some way? • are the harms of child maltreatment sufficient to justify overriding a health professional's moral duty to maintain confidentiality in the professional‐ client relationship? • are the harms οf child neglect and abuse morally significant enough to justify the removal of children from the 'care' of an abusive parent/ guardian or dysfunctional family? • to what extent, if any, ought the state intervene in the private matters of its citizens (in this instance, parents/guardians who have lawful authority over their children and who have an interest in maintaining their autonomy in deciding how best to raise their children)? • is it immoral for the state not to intervene to protect children from known or suspected abuse and neglect? • and so on. At first glance, answers to these and similar questions might seem manifestly self evident and amenable to consensus. Upon reflection, however, it becomes clear that possible answers to these and related questions are not 'clear-cut', are sometimes hopelessly inadequate and are rarely free of controversy. One reason for this can be found in what appears to be a general reticence in treating the problem οf child abuse, neglect and protection as a bona fide moral problem. Whether driven by legal obligation or moral commitment, or both, a health care professional's decision to report child abuse (or not report it, as the case may be) never occurs in a moral vacuum and is never free of moral risk. A structured approach to moral decision making can be of value to the nurse in practice (Johnstone 2004, 57-60). Even in the face of clinical certainty (insofar as this is possible) and the threat of legal and professional censure for noncompliance with mandatory reporting requirements (insofar as this is probable), there is always room to question: Should I report this particular case οf known or suspected child abuse and/or neglect? Underpinning this question are the additional questions of: What are the possible consequences to the child of me reporting or not reporting this case? What are the possible consequences to the child's family/caregivers of me reporting or not reporting this case? and What are the possible consequences to me of reporting or not reporting this case? Possible answers to these questions will depend, in varying degrees, on an effective harm/benefit analysis οf the situation. The moral demand to report child abuse Child abuse (often used as 'an "umbrella" term that covers a wide range of activities that harm children in some way', can take a number of forms, including physical, sexual, emotional and spiritual. It can also involve neglect, defined here as 'the failure to provide the child with the basic necessities of life, such as food, clothing, shelter and supervision, to the extent that the child's health and development are placed at risk'. In some instances, all forms οf abuse may overlap; for example, a child who is sexually abused is ipso facto abused physically, emotionally and spiritually as well. (Johnstone 2004, 105-6) Although there is some disagreement about how child abuse can and should be defined, this is not sufficient to threaten strong moral arguments against child abuse and its intervention, as some have suggested. Child abuse can be defined in ways that unequivocally distinguishes it from other 'acceptable' behaviours directed at children (for example, play, discipline, 'character building', education) and it is spurious to suggest otherwise. A key feature of child abuse (not carried by other behaviours directed at children) concerns the risk of non-accidental and culpable harm that it poses to a child's genuine welfare and wellbeing. These risks are not merely speculative or imaginary, but substantive and known through the supportive findings of rigorous research, an increasing body of professional literature on the subject, and, not least, by the survivors of child abuse themselves who are increasingly coming forward to share their experiences by making their 'stories' public. In all its forms, child abuse can cause significant and lasting harm to children and, ultimately, the adults they become. As previously considered in Chapter 4 of this text, harm may be taken as involving the invasion, violation, thwarting, or 'setting back' of a person's significant welfare interests to the detriment of that person's wellbeing. The test for whether a person's interests and wellbeing have been violated or thwarted rests on 'whether that interest is in a worse condition than it would otherwise have been in had the invasion not occurred at all'. For instance, if a person (for example, a child, a young person or an adult survivor οf child abuse) is left psychogenically distressed (for example, emotionally unstable, anxious, depressed and/or suicidal) as a result of his/her abusive childhood experiences, our reflective commonsense tells us that this person's interests have been violated and the person him/herself 'harmed'. It is generally recognised in contemporary bioethical thought that people ought not to cause harm to or to impose risks of harm onto others. It is also accepted that people have a moral obligation to prevent harm to others if this can be done without sacrificing other important moral interests. By this view, acts which violate the interests of others, or fail to prevent the interests of others being violated, are prima facie morally wrong. The abuse οf children — and the failure to prevent it — clearly violates the interests of children (both as children and as prospective adults) and renders them seriously harmed. It is the profound risk of the harmful consequences of child abuse (at all stages οf life), and the utter preventability of these consequences, that makes intervention in child abuse at all levels morally compelling. Failure to prevent this harm is morally wrong. Further, the moral unacceptability of child abuse is underscored when it is remembered that the harmful consequences of child abuse do not remain quarantined in a 'lost and forgotten' childhood which a person can leave behind upon entering adulthood. (Johnstone 2004, 27-30) What is not always understood in this debate is that the negative effects of child abuse can be long term and sometimes devastating, affecting, in morally significant ways, not only the individuals who survive their traumatic childhoods, but those with whom they share relationships including family, friends, partners, co-workers, service providers and the community at large. This is so, even for those who receive professional help in dealing with their child abuse issues. As one commentator notes: Day to day, moment to moment, our feelings and perceptions οf the world can change. No matter how long you have been 'working' on your abuse, or how you may feel that at last you can live your life rather than just exist, there are times when you can be overwhelmed quite unexpectedly with painful feelings and memories of your abuse. The 'trigger' can be a smell, a sound, a memory apparently from nowhere. Of this, one survivor says: 'One day, one moment, you can believe that you are all right, that the world and the people in it are all right, and the next be right back down there in the pit of despair'. While many survivors of child abuse do go on to live productive and satisfying lives, this is not sufficient to negate or to override the moral obligation to intervene and prevent child maltreatment. There are at least two reasons for this. Firstly, maltreated children are still harmed as children by their traumatic experiences irrespective οf their survival into adulthood. To deny the suffering of children — or at least to render this suffering as irrelevant — is to discriminate against them in morally unjust ways; it seems to be saying that the suffering of children does not count (or, at least, does not count as much as the suffering of adults) just because it is children who are suffering. This 'adultist' view is morally indefensible. Secondly, even though adults who have survived child abuse do go on to live productive and satisfying lives, this is not to say that they do not also suffer in unjustly burdensome ways as a result οf their traumatic childhood pasts. Public policy requirements to report child abuse have historically been criticised and even rejected by a range of people including members of the medical profession, community support groups and, not least, members of the judiciary. The grounds for this criticism and rejection have mostly been utilitarian in nature, involving a calculation οf harms and benefits to the: (1) professional—client relationship, (2) parents and families of allegedly abused and neglected children, and lastly (3) allegedly abused and neglected children themselves. Requirements to report child abuse and neglect have also been criticised, controversially, on civil libertarian grounds. Here arguments are advanced to the effect that requirements to report child abuse stands as a fundamental violation of parental rights to be free of state interference and to decide how best to raise their children. Reference Johnstone, M. (2004) Bioethics: A Nursing Perspective, fourth edition. Elsevier Australia, Sydney. ISBN 0-7295-3726-9 Read More