Analysis of a Case of Child Abuse with Ethical Approach

Maliheh Kadivar--- Professor, Division of Neonatology, Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran,
Marjan Mardani-Hamooleh--- Assistant Professor, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran. (Corresponding Author),
Mansure Madani--- Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract


278

Background and Aim: Human rights issues are based on human dignity. In this regard, Rights of the Child are considered by most of world's organizations and the scientific communities. Different types of child punishment are prohibited according to international conventions as well as national legislation. Historically, the first legal action to protect the rights of children was taken in 1924. Then rights of the child were briefly referred to in the Universal Declaration of Human Rights approved in 1948. Afterwards, United Nations General Assembly adopted, in a resolution, the draft prepared by the Human Rights Commission under the Declaration of the Rights of the Child in 1959. Iran is also among the states that signed and approved this declaration in 1993. However, child abuse has become a global problem and violence against children is one of the major challenges for health care providers that has endangered their physical and mental health and creates serious problems for them in the future. According to Islamic-Iranian culture, children counts as trust and the family is responsible to take care of them and strive for their excellence. This study aimed to analyze a case of child abuse in 2016 with an ethical approach.

 

Materials and Methods: In this case study, a real case was referred to Tehran Children Medical Center in a monthly session of medical ethics, and the ethical analysis was later carried out based on ethical considerations raised by the medical staff and specialists in various fields. The case is a 5-year-old boy who was physically abused and was brought to the emergency department at Children's Medical Center in the morning due to the multiple fractures in different parts of the hands as well as cigarette burn caused by his parents in his hands and feet. According to his mother, she first noticed the swelling of the child's hands and referred to the physician. After exact examination and radiography of the child's body, physicians noticed old and new fractures in the arm, the elbow and wrist. The mother claimed that the child's fractures were caused by falling off the swings and slides. The physicians also saw scars of old wounds on the child's head, as the mother claimed, they were caused as a result of fractures associated with falls. The child's physical examination showed that part of the back and posterior side of the thigh of one of his legs was burned and traces of cigarette burns were seen on one of the child’s hands. Thus, physicians requested help from forensic experts. After examining the child's condition and examining him thoroughly, they, while acknowledging the child physical abuse, found that the victim underwent sexual harassment by some of the family boys.

 

Ethical considerations: While observing honesty in the case report, attempts were made to respect the confidentiality of personal information of the case and his family.

 

Findings: The mother has rejected the occurrence of physical child abuse in the form of for multiple fractures in areas of the hands and feet as well as multiple burn cases on the child's body and tried to mislead the medical staff. Investigations suggest that the child's father was responsible for the physical abuse, but the mother denied it. On the other hand, the mother tried to hide the child molestation by male relatives, and following this sexual abuse, the father also resorted to unethical manner and has punished the child rather than appeasing and supporting the child as well as denouncing the actions of those who commit this immoral act. Employees participating in the study, said that it is essential to examine all surfaces of the child's body in cases of child abuse. It is essential to monitor vital signs of the abused child, particularly his temperature because high temperature could be the reason for this accident and the fact that child abuse is committed through exposing him to high temperature. Physical examination must also include any examination of external genitalia and anal area. Considering that the sexual abuse is a hidden conduct, if there is suspicion of rape, the assessment is necessary. The child's privacy must be respected during a physical examination, and explanations should be provided regarding measures that are going to be taken. Considering the foregoing, obtaining thorough medical and social history, thorough examination of the naked body, lack of secrecy about sexual assault on children, respect for human dignity, honesty, privacy, confidentiality and privacy of information, respectful conduct, respect for the child's independence, neutrality and social protection are considered as the most important ethical considerations referred to in this analysis . Also, helping families adapt in order to prevent further incidents of child abuse is another finding of the present analysis.

 

Conclusion: In this study, it was found that the families of abused children deny and distort the facts about the children instead of supporting them for some reasons. However, medical staffs are usually the first individuals who are informed about the child abuse, so it is logical to consider their views in order to find appropriate solutions to help these children. In this case, one can provide better education and adequate facilities to properly deal with this vulnerable group. The relevant authorities are also recommended to design a written programs based on the ethical considerations raised and submitted it to the medical centers of the country. Also, a group consisted of pediatrics and medical ethics, social workers, psychiatric nurse and psychiatrist should assess needs of abused children and their families and plan to solve their problems. The importance of this lies in the right to social protection and care of abused children and their families to improve their quality of life. Effective measures can be taken in this regard through awareness raising at different levels of society, training for child rearing free from any violence, amending the Child Protection Act, identifying vulnerable families and providing rehabilitation services for victims of child abuse and finally take steps to prevent this phenomenon.

 

Please cite this article as: KadivarM, Mardani-Hamooleh M, MadaniM. Analysis of a case of child abuse with ethical approach. Med Ethics J 2017; 11(39): 27-35.


Keywords


Medical Ethics; Child Abuse; Human Dignity; Confidentiality

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References


Alavi Qazvini A, Sotoudeh H. Comparative approach to human dignity and its impact on biological research. Bioethics J 2015; 5(16): 41-76. [Persian]

Tabibi Jebeli M, Aliyan A, Raei Dehagi M. Legal and Jurisprudential Point of View About Mechanisms Protecting Rights Against Child Abuse. Fam Law Juris 2013; 18(58): 1-22. [Persian]

Aliverdinia A, Hasani M, Ebrahimi E. Family Factors of Child Abuse. Social Welfare 2014; 13(50): 71-110. [Persian]

Salehi H, Esmaeelpour M. Contemplation on the child abuse act with an emphasis on the protection of children and adolescents in 2002. Fam Law Juris 2014; 19(61): 117-142. [Persian]

Vaezi K. The Life Experience of Children Regarding Domestic Violence A Case Study: Children of Baneh. J Counsel Res 2016; 15 (58): 113-134. [Persian]

Derakhshanpour F, Hajebi A, Ahmadabadi Z, Seddigh B. Frequency of child abuse and related risk factors in clients feferred to urban healthcare centers in Bandar-Abbas. Iran Psychiatr Clin Psycho 2014; 20(3): 201-213. [Persian]

Regnaut O, Jeu-Steenhouwer M, Manaouil C, Gignon M. Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study. BMC Res Notes 2015; 8: 620.

Franco A, Ramírez L. Child sexual abuse: clinical perspectives and ethico-legal dilemmas. Rev Colomb Psiquiatr 2016; 45(1): 51-58.

Kvist T, Wickström A, Miglis I, Dahllöf G. The dilemma of reporting suspicions of child maltreatment in pediatric dentistry. Eur J Oral Sci 2014; 122(5): 332-338.

Milanifar A, Larijani B, Paykarzadeh P, Ashtari G, Mehdi Akhondi M. Breaching confidentiality: medical mandatory reporting laws in Iran. J Med Ethics Hist Med 2014; 7: 13.

Yazdanian A, Abdolahzade M. Confidentiality; Right of patient and civil responsibility of the doctor. Med Ethics J 2016; 10(35): 199-227. [Persian]

Lareau CR. Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court. Int J Law Psychiatry 2015; 42-43: 43-48.

Devries KM, Child JC, Elbourne D, Naker D, Heise L. "I never expected that it would happen, coming to ask me such questions": Ethical aspects of asking children about violence in resource poor settings. Trials 2015; 16: 516.

Mohammadi MR, Zarafshan H, Khaleghi A. Child Abuse in Iran: a systematic review and meta-analysis. Iran J Psychiatry 2014; 9(3): 118-124.

Nilchian F, Sadri L, Jabbarifar SE, Saeidi A, Arbab L. Evaluation of orofacial lesions relating child abuse, Esfahan, Iran: A quantitative approach. Dent Res J 2012; 9(6): 748-751.

Eslami-Shahrbabaki A, Eslami-Shahrbabaki M, Kalantari M. Association between Parental Addiction and Types of Child Abuse in High-School Students of Kerman, Iran. Addict Health 2013; 5(3-4): 108-114.

Douki ZE, Esmaeili MR, Vaezzadeh N, Mohammadpour RA, Azimi H, Sabbaghi R, et al. Maternal child abuse and its association with maternal anxiety in the socio-cultural context of iran. Oman Med J 2013; 28(6): 404-409.

Mikaeili N, Barahmand U, Abdi R. The prevalence of different kinds of child abuse and the characteristics that differentiate abused from nonabused male adolescents. J Interpers Violence 2013; 28(5): 975-996.

Hadianfard H. Child abuse in group of children with attention deficit-hyperactivity disorder in comparison with normal children. Int J Community Based Nurs Midwifery 2014; 2(2): 77-84.

Kara Ö, Çalışkan D, Suskan E. Comparison of the levels of knowledge and approaches in relation with child abuse and neglect in residents of pediatrics, pediatricians and practitioners working in the province of Ankara. Turk Pediatri Ars 2014; 49(1): 57-65.

Schönbucher V, Maier T, Mohler-Kuo M, Schnyder U, Landolt MA. Disclosure of child sexual abuse by adolescents: a qualitative in-depth study. J Interpers Violence 2012; 27(17): 3486-3513.

Schönbucher V, Maier T, Mohler-Kuo M, Schnyder U, Landolt MA. Adolescent perspectives on social support received in the aftermath of sexual abuse: a qualitative study. Arch Sex Behav 2014; 43(3): 571-586.

Ali NS, Ali FN, Khuwaja AK, Nanji K. Magnitude and Factors Associated with Child Abuse in a Mega City of Developing Country Pakistan. Iran J Pediatr 2014; 24(2): 140-146.

Nilchian F, Jabbarifar SE, Khalighinejad N, Sadri L, Saeidi A, Arbab L. Evaluation of factors influencing child abuse leading to oro-facial lesions in Isfahan, Iran: A qualitative approach. Dent Res J 2012; 9(5): 624-627.

Yaghoubi-Doust M. Reviewing the Association between the History of Parental Substance Abuse and the Rate of Child Abuse. Addict Health 2013; 5(3-4): 126-133.

Mohler-Kuo M, Landolt MA, Maier T, Meidert U, Schönbucher V, Schnyder U. Child sexual abuse revisited: a population-based cross-sectional study among Swiss adolescents. J Adolesc Health 2014; 54(3): 304-311.

Atrak H, Khoshdel Rohani M. The nature and scope of patient autonomy. Bioethics J 2015; 5(17): 91-116. [Persian]

Sofuoğlu Z, Oral R, Aydın F, Cankardeş S, Kandemirci B, Koç F, et al Epidemiological study of negative childhood experiences in three provinces of Turkey. Turk Pediatri Ars 2014; 49(1): 47-56.

Asai A, Ishimoto H. Should we maintain baby hatches in our society? BMC Med Ethics 2013; 14: 9.

Finkelhor D, Lannen P. Dilemmas for international mobilization around child abuse and neglect. Child Abuse Negl 2015; 50: 1-8.




DOI: http://dx.doi.org/10.21859/mej-113927

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