Ethical and Legislative Issues in Child Abuse: A Case Study Analysis

This essay provides a critical analysis of ethical and legislative considerations in child abuse cases, using a case study of a two-year-old child, Milly, who presents with injuries indicative of physical abuse. The analysis identifies breaches of human rights, professional codes of ethics, and relevant legislation, including failures in forensic nursing practices and adherence to healthcare ethics principles. The essay highlights the importance of protecting children from abuse and ensuring they receive quality healthcare, advocating for forensic nursing education, hospital policy improvements, and campaigns to promote early reporting of child abuse. The essay concludes by summarizing the ethical and legal failures in Milly's case and reiterates the need for systemic changes to protect children and ensure ethical healthcare practices.

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Child Abuse
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Introduction
This is a critical analysis on the ethical and legislation issues that emerges in patient care.
It will start off with a brief description of a case study. Two, there will be identification of the
ethical issues that emerges from the case study. The ethical issues will focus on the human rights,
dignity, the professional codes of ethics/conducts, the relevant professional legislation/policies
and on the principles of the health care ethics. Three, the identified ethical and legislation
consideration will be described and analyzed further in details. Four, there will be
recommendations to the professional practice on the subject. Lastly, there will be a conclusion to
summarize all the above.
Case study
A case study of a two-year old child (Milly), who was rushed to the emergency
department by two paramedics. The mother (Sandra) reported that she fell. On examination by
the paramedics she is in pain and she is clutching her arm. The paramedics suspects that she has
a fractured humerus. There is a struggle to get Milly to the hospital as Sandra’s partner is
reluctant. He is intoxicated and verbally abuses Sandra and the paramedics. The paramedics
threatens to call the police if he continues to be reluctant. He finally agrees. On the journey to the
hospital, Sophie (paramedic) notices small burns on Milly legs and abdomen. On arrival to the
hospital, they handover the patient to the triage nurse, Beth. They report they concerns that Milly
has been physically abused. The nurse tells them that she will report it to the doctor. Before
attending to Milly, she is called in to check on morphine dose whereby they share the rest to
themselves.

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Child abuse.
It is estimated that more than 40 million children aged between 0-14 years are abused and
neglected every year. Most of these children requires health care and social care (World Health
Organization [WHO] 2016). Child abuse can be dated back in the ancient days. Children has
suffered lots of violence at the hand of the adults (Johnstone 2010). Today child abuse is one of
worlds tragic and longstanding public health issues (WHO, 2012); International Society for the
Prevention of child abuse and neglect [ISPCAN], 2016). In the current day, the issues of
children maltreatment and the urgency to have an effective protection services for children
remains a problem and an endless challenge in many countries in the world. According to the
Australian Institute of Health and Welfare [AIHW], (2013) the number of child protection
notification has doubled over the past five years. Despite child abuse being epidemic and being
addressed globally, its incidences and the negative effects/outcomes continues to be under-
reported, under-recognized and it is poorly addressed by most governments (Pinheiro 2016:
WHO, 2010; ISPCAN, 2016; Administration for Children and Families [ACF], (2011)
Ethical and legislation considerations
The following ethical and legislation issues/considerations emerges from the above case
study. Milly is being physically abuse. The fracture she got is probably as a result of abuse by
Sandra’s partner or from child neglect. She has burn scars on the legs and abdomen and Sandra’s
partner had refused the paramedics to take her to the clinic. This clearly supports that she is
being physically abused. Children who lives with intoxicated parent’s chances of being abused
are usually high (Ammerman, Kolko, Kirisci, Blackson, Dawes, 2011). Appel and Holden (2012)
states that children who are raised by co-parents the chances of being maltreated are also high.

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Milly lives with an intoxicated guardian and also it seems as if Sandra and her partner are co-
parenting.
When a child is being abused his/her human rights and dignity are breached. The law
states that a case of child abuse should be reported and responded to immediately. Milly’s case
does contrary to this law. Milly seems to have been physically abused for a while now with no
action being taken. Another law states that children should be protected from domestic violence.
This is not the case in Milly’s situation. On the hospital, this was a forensic case. It should have
been handled in a sensitive way following the professional codes of ethics and conducts. The
care given to her should have followed the principles of the health care ethics. The above were
not followed. Nurse Beth, did not incorporate the principles of forensic care, the principles of the
health care ethics and relevant policies when attending to her.
Milly’s ethical and legislation considerations.
Milly, is denied quality health care as the emergency nurse did not follow the
professional codes of ethics/conducts and the principles of health care. Milly’s case is a forensic
case. The emergency nurse should have followed the six principles of forensic nursing to manage
the patient (Goleman, 2016). Legally the Milly’s case should be followed up by the local
authorities. It should be reported, evidence collected and documented. This did not happen. Milly
is being denied quality health care and just. Secondly, the professional codes of ethics states that
the health care provider and in this case the nurse should respect the patient’s dignity, should be
responsible, accountable, should provide quality care and lastly should be trustworthy and
confidant (Rawls, 2013; Morrison, 2011). The nurse leaves the patient alone to go and help
counter check morphine dose and on top of that the remaining dosage they inject themselves.

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This clearly shows that this nurse is not responsible, competent and accountable. This will
translate to Milly not getting quality care. Thirdly, the nurse does not incorporate the principles
of care ethics in her care. There are four principles, autonomy, beneficence, non-maleficence,
and justice. Patient Milly is denied the last three (Beauchamp and Childress 2011). The kind of
care she is receiving does not benefit her and also is not just/fair. She has been physically
abused, her care should be done in accordance to the forensic principles.
Milly’s human rights and dignity are being compromised (UN, 2010). She has the right to
quality life and right to parents. The state has obligations to protect children against abuse or/and
maltreatment That is by ensuring that she is not tortured or subjected to degrading or inhuman
treatment. It is obligations to ensure that children who have been subjected to abuse gets good
recovery. Lastly, it is obligated to ensure they receive quality health care (Wenar, 2011). These
are compromised by, one, she has a fracture of the humerus and burn scars on her legs and
abdomen. This is as a result of child abuse. Her rights to quality life are being compromised. The
state has failed in providing protection and safety to her. As mentioned above the state has an
obligation to ensure she is not being tortured.
Recommendation.
The recommendations to the nursing practice are as follows; one, the emergency nurses
should get education on forensic nursing. This will be beneficial as patients whose cases has
legal issues will receive quality care. Two, the hospitals should have stipulated policies to ensure
that the nurses use their professional codes of ethics/conduct and principles of health care ethics.
Three, there should be campaigns to advocate early reporting of child abuse. Four, there should
be laws and policies on actions to be taken on those who abuses children.

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Conclusion
In summary, patient Milly was a forensic patient whose case was not handled as per the
expected standards. Ethical and legal issues/considerations were not followed. Her rights and
dignity was not observed. The health care providers attending to her were not responsible,
accountable and competent. The health care providers were not forensic nurses. They did not
incorporate the principles of forensic nursing, principles of health care ethics and the
professional codes in her care. With this it is clear that she did not receive quality health care.
The state also failed in protecting her from being maltreated and being tortured. It also failed in
ensuring that she received quality care as it is its obligation. As stated above, there should be
forensic nurses to handle these patients and also there should be policies and laws to ensure
professional codes are observed.

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References
Administration for Children and Families [ACF], (2011). Child maltreatment, 2010 report.
Washington, DC: U.S. Department of Health and Human Services, ACF.
Ammerman, R., Kolko, L., Kirisci, T., Blackson, M., Dawes, E., (2011). Child abuse potential in
parents with histories of substance use disorder. Child Abuse & Neglect. 23(12):1225-
1238.
Appel, A. E., and G. W. Holden. (2012). The co-occurrence of spouse and physical child abuse:
A review and appraisal. Journal of Family Psychology12(4):578-599.
Australian Institute of Health and Welfare [AIHW], 2013. Child abuse. Retrieved online
https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/.
Accessed on 8/5/2018.
Beauchamp G., and Childress, J., (2011). Principles of Biomedical Ethics. 5(9), 389-390.
Goleman, D., (2011). The roots of compassion. Principles of Biomedical ethics. New York:
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International Society for the Prevention of child abuse and neglect [ISPCAN], (2016). Child
abuse. Retrieved online https://clinicalgate.com/8-ethical-issues-associated-with-the-
reporting-of-child-abuse/. Accessed on 8/5/2018.
Johnstone, T., (2010). Child maltreatment. Retrieved online https://clinicalgate.com/8-ethical-
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Morrison, E., (2011). Ethics in Health Administration. 2(6). 48-52.

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Pinheiro, U., (2016). Child abuse and maltreatment. Retrieved online https://clinicalgate.com/8-
ethical-issues-associated-with-the-reporting-of-child-abuse/ . Accessed on 8/05/2018.
Rawls, T., (2014). A Theory of Justice. Cambridge, MA: Harvard University Press. 47-48.
United Nations, (2010). The rights of children. Retrieved online on
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Wenar, L (2011). Rights. Stanford Encyclopedia of philosophy. Retrieved online from
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World Health Organization [WHO], (2012). Child abuse. Retrieved online
https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/ .
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