The ‘threshold’for a doctor (mandated person) reporting child abuse is broken down into fourcategories (DCYA, 2016) and It is important to note that a child may be subjectto more then one form of abuse at any time: 1. Neglect Per the ChildrenFirst Act (2015) neglect is defined as ‘to deprive a child of adequate food,warmth, clothing, hygiene, supervision, safety or medical care’. An example ofthis is malnourishment, a lack of adequate food. 2.
Emotional abuse/ill-treatment Per the ChildrenFirst Act (2015) ill treatment is defined as ‘to abandon or cruelly treat thechild, or to cause or procure or allow the child to be abandoned or cruellytreated’. Per the Children First Act 2015 emotional abuse ‘is the systematicemotional or psychological ill-treatment of a child as part of the overallrelationship between a caregiver and a child’. An example is a child witnessingdomestic violence in the home. 3. Physical abuse Per the ChildrenFirst Act (2015) physical abuse is defined as ‘when someone deliberately hurtsa child physically or puts them at risk of being physically hurt’. The ChildrenFirst Act 2015 abolished the common law defense of ‘reasonable chastisement’. According to theChildren First Act 2015 the threshold for reporting neglect, emotionalabuse/ill treatment and physical abuse is when you suspect a child is ‘being abusedto the point where the child’s health, development or welfare have been or arebeing seriously affected, or are likely to be seriously affected’. 4.
Sexual abuse If a doctorsuspects that a child is being, has been or is at risk of being sexually abusedthis must be reported to Tusla under the Children First Act 2015 (sincereplaced by section 55 of the Criminal Law (sexual offences) Act 2017). Allsexual abuse is considered to be above the threshold noted above and so allconcerns must be reported to Tusla. However, there is one exception, when allof the following conditions are met: Sexual activity between a child aged 15 – 17and another with an age difference of not more than 24 months, once there is nodifference in capacity to consent, maturity, intimidation or exploitationinvolved. Additionally, the child makes it known to the doctor that they don’t wantTusla notified. If a doctor is indoubt about whether their concern reaches any of these thresholds they cancontact TUSLA for guidance.
See figure 1 below for a flowchart on reporting anyabuse to Tusla. In the Children First Act there are no criminal retribution formandate people if they do not report incidences of suspected child abuse.According to Buckley (2015) ‘a non-offence imposing mandatory reporting law should complement andframe the reporting structure in place, which needs to be well financed andleave little room for doubt on the part of the reporter, rather than drivingunnecessary and frivolous reports out of fear and uncertainty’.
When there isambiguity in concerns the ethical side of a doctor’s responsibility isquestioned. It is important to initially state that once a report is made inthe best interest of a child and without any malice a doctor cannot face civilliability for breaching confidentiality (Tusla, 2015). However there are otherethical concerns encountered. Doctors often delay reporting due to foreseenoutcomes and the consequences to a family of a wrongful report. Another concernis that it might serve to isolate the child from the medical attention thatthey require. It may also destroy the trust in relationships with otherpatients as they may become more guarded.