Ethical/Legal Discussion of Abuse Child and elder abuse

Ethical/Legal Discussion of Abuse
Child and elder abuse are disturbing, unfathomable issues due to the helpless nature of the victims; however, many people are affected daily by maltreatment. Healthcare providers often discover this abuse by assessment rather than self-disclosure. It can also be an issue family members bring up to a healthcare provider. Abuse can occur in many forms such as neglect, emotional, stealing their belongings, or sexual abuse. It is vital for health professionals to recognize maltreatment and know how to handle the situation properly for the sake of the patient’s safety. This post will cover four resources covering ethical and legal aspects of child and adult abuse and how they concern psychiatric mental health practitioners in their field.
Elder Abuse Ethics
Saghafi et al. (2019) studied the ethical dilemmas healthcare professionals face while trying to manage elder abuse. The ethical concerns they discuss cover the difficulties care team members face when the abused elder chooses to stay in an abusive situation, the legality of telling other team members secretive patient information for help with how to properly intervene, and the issue of how nurses should intervene for patients with neurocognitive disorders. They also discuss federal law mandating elder abuse reporting and the importance of protecting the autonomy of elders without forcing what another person believes is best for them. This can overlap when it comes to what the healthcare provider believes is best for a patient but it is not what the patient wants.  Saghafi et al. (2019) pointed out the importance of clinical guidelines to help support care teams with making these ethical decisions.
Child Abuse Ethics
Glover and Justis (2015) discussed how many people believe taking care of child abuse when discovered is easy and should be taken care of immediately without realizing how many ethical dilemmas can make child abuse issues difficult to resolve. When people think of sexual or physical abuse, it seems understandable to know and report such abuse. However, when the abuse comes in the form of obese children, underweight children, verbal, or end of life care decisions, the ethics of what is right and wrong can become more difficult (Glover & Justis, 2015). Decisions that are difficult for all parties involved, including the health care provider that would be mandated to report it. Glover and Justis (2015) stated health care providers sometimes might find themselves having to intervene with parents and discuss decisions if not found to be in the child’s best interest, with a threshold of not reporting as mandated as long as their decisions do not cause harm.
Legal Considerations for the Elderly
Hess (2011) provided multiple types of elder abuse to assist health care providers to recognize what is legally mandated to be reported. Besides the more obvious physical or sexual abuse, she discusses psychological abuse that can present as being upset, withdrawn, agitated, or unusual behaviors such as biting, and also financial abuse, neglect, or abandonment. She provides the three R’s in detecting and reporting abuse of recognize, respond, and report. Health care teams should legally follow their reporting procedures for documentation, reporting abuse if needed, and following up to ensure patient safety. Hess (2011) points out a law in place to protect the elderly like the Older Americans Act of 1965. She also provides web sites like (http://www.apsnetwork.org/Abuse/index.htm that provide resources for reporting and http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx for numbers to call.
Legal Considerations for the Children
Fishe and Moffat (2016) discussed the Child Abuse Prevention and Treatment Act
(CAPTA) of 1974 that causes the Department of Human Services (DHS) to collect data and monitor the effectiveness of each state’s practices. By law, there are certain people required to report any type of child abuse. Fishe and Moffat (2016) provided those who are mandated to report child abuse which includes any medical or mental health professional and should be done quickly in most states (Fishe & Moffat, 2016). If abuse is discovered after a patient turns 18 or a while after the abuse happens, then the occurrences should still be reported (Fishe & Moffat, 2016). Another action required of healthcare professionals is collecting evidence by documenting findings, taking photos of evidence, and presenting lab results if ordered (Fishe & Moffat, 2016).
Personal Practice
Considering all medical or mental health professionals are mandated to report witnessed or suspected child or adult abuse, this directly affects my personal practice by providing an understanding of what, when, and who the information needs to be reported to. I was not aware that if patients report abuse from years ago, that I am mandated to report it so that changes my personal practice as well. According to Fishe and Moffat (2016), the state of Arkansas requires abuse to be reported immediately. Although it can be difficult to report suspected abuse, not knowing if more harm is being done than good, I would much rather live with that on my conscious than not reporting and having a terrible outcome for a patient.
References
Fishe, J. N., & Moffat, I. F. L. (2016). Child Abuse and the Law. Clinical Pediatric Emergency Medicine, 17(4), 302–311. https://doi.org/10.1016/j.cpem.2016.09.003
Glover, J., & Justis, L. (2015) Ethics and the Identification and Response to Child Abuse and Neglect. General Law. https://lawexplores.com/ethics-and-the-identification-and-response-to-child-abuse-and-neglect/
Hess, S. (2011). The Role of Health Care Providers in Recognizing and Reporting Elder Abuse: [1]. Journal of Gerontological Nursing, 37(11), 28–37. http://dx.doi.org/10.3928/00989134-20111012-50
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and history of medicine, 12, 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642445/