The it known to the doctor that they don’t

The ‘threshold’
for a doctor (mandated person) reporting child abuse is broken down into four
categories (DCYA, 2016) and It is important to note that a child may be subject
to more then one form of abuse at any time:


1.     Neglect

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Per the Children
First Act (2015) neglect is defined as ‘to deprive a child of adequate food,
warmth, clothing, hygiene, supervision, safety or medical care’. An example of
this is malnourishment, a lack of adequate food.


2.     Emotional abuse/ill-treatment


Per the Children
First Act (2015) ill treatment is defined as ‘to abandon or cruelly treat the
child, or to cause or procure or allow the child to be abandoned or cruelly
treated’. Per the Children First Act 2015 emotional abuse ‘is the systematic
emotional or psychological ill-treatment of a child as part of the overall
relationship between a caregiver and a child’. An example is a child witnessing
domestic violence in the home.


3.     Physical abuse


Per the Children
First Act (2015) physical abuse is defined as ‘when someone deliberately hurts
a child physically or puts them at risk of being physically hurt’. The Children
First Act 2015 abolished the common law defense of ‘reasonable chastisement’.


According to the
Children First Act 2015 the threshold for reporting neglect, emotional
abuse/ill treatment and physical abuse is when you suspect a child is ‘being abused
to the point where the child’s health, development or welfare have been or are
being seriously affected, or are likely to be seriously affected’.


4.     Sexual abuse


If a doctor
suspects that a child is being, has been or is at risk of being sexually abused
this must be reported to Tusla under the Children First Act 2015 (since
replaced by section 55 of the Criminal Law (sexual offences) Act 2017). All
sexual abuse is considered to be above the threshold noted above and so all
concerns must be reported to Tusla. However, there is one exception, when all
of the following conditions are met: Sexual activity between a child aged 15 – 17
and another with an age difference of not more than 24 months, once there is no
difference in capacity to consent, maturity, intimidation or exploitation
involved. Additionally, the child makes it known to the doctor that they don’t want
Tusla notified.


If a doctor is in
doubt about whether their concern reaches any of these thresholds they can
contact TUSLA for guidance. See figure 1 below for a flowchart on reporting any
abuse to Tusla. In the Children First Act there are no criminal retribution for
mandate people if they do not report incidences of suspected child abuse.
According to Buckley (2015) ‘a non-offence imposing mandatory reporting law should complement and
frame the reporting structure in place, which needs to be well financed and
leave little room for doubt on the part of the reporter, rather than driving
unnecessary and frivolous reports out of fear and uncertainty’.


When there is
ambiguity in concerns the ethical side of a doctor’s responsibility is
questioned. It is important to initially state that once a report is made in
the best interest of a child and without any malice a doctor cannot face civil
liability for breaching confidentiality (Tusla, 2015). However there are other
ethical concerns encountered. Doctors often delay reporting due to foreseen
outcomes and the consequences to a family of a wrongful report. Another concern
is that it might serve to isolate the child from the medical attention that
they require. It may also destroy the trust in relationships with other
patients as they may become more guarded.