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	Child protection aims put doctors in dilemma Irish Independent July 25, 2011 http://www.independent.ie/lifestyle/child-protection-aims-put-doctors-in-dilemma-2830148.html Following the recent terrible revelations concerning child sexual abuse in the Cloyne diocese, showing a callous and reckless disregard for children who were being violated, and also for the Church's own guidelines on protecting children, there is incredulity and dismay among the public. This includes the ordinary men and women of Ireland, Catholics in the pews and the priests of that diocese and further afield. Alan Shatter, Minister for Justice, and Francis Fitzgerald, Minister for Children, promptly indicated plans to introduce a "withholding information on crimes against children and vulnerable adults act" and to "put children first" on a statutory setting. These bills will have an obvious impact on psychiatrists, in particular child psychiatrists, but also on the work of adult psychiatrists like myself. Authorities For some years employees of the HSE, including psychiatrists, have been obliged by their employers to report knowledge of child sexual abuse to the relevant authorities. However, the issue is complex and there are many nuances that the new laws need to delineate if psychiatrists are to have the trust of their patients, while at the same time protect children from abuse. A couple of examples highlight the intricacies of the issues confronting the legal draftsmen when framing the new legislation. Suppose a man is referred to me with depression and he discloses that he was sexually abused as a child by a family member. He indicates that the perpetrator is now married and has a young family. He absolutely refuses to report the abuse to the gardai or HSE and will not countenance the prospect that his abuser might be a danger to his young family. I do not know where the abuser lives, and my patient will not give me any indication. I telephone the gardai and explain my concern, but they tell me unless the victim, my patient, comes forward, there is nothing they can do. When I discuss this chain of events, my patient refuses to continue his treatment with me because I have ignored his wishes. A second example is a person who comes to see me because he exposed himself to his daughter on one occasion, he says, when he was a young man and had an alcohol problem. He has been dry for many years and his adult daughter has forgiven him. She tells me she is adamant that she does not want to pursue her father for this sexual act in any way. Finally, a young woman referred with alcohol misuse, drug problems and multiple episodes of self-harm tells me as a child she was sexually abused by her mother, a teacher who now runs a play-school. She refuses to go to the gardai. Her mother comes to see me to tell me that her daughter has been making false allegations of sexual abuse against her. Over months of treatment both stick to their stories, they continue to live in the same house and I cannot collaborate either position. These three real stories illustrate the issues that the legislation needs to consider and each poses its own dilemmas. Responsibility How much will the authorities expect of a doctor, such as myself, in relation to an unwilling complainant? Will I have to provide the address of my first patient so that social workers can interview him to ascertain the identity/address of his abuser, although my patient does not want this and even terminated his treatment when I told him I sought garda advice? The second example also raises questions in that the man has admitted to a prior history of exposing himself when he had an alcohol problem and has now come voluntarily seeking help. He might well have exposed himself to others besides his daughter, but his only known victim does not want to press charges. Should I report him to the authorities and risk losing his confidence, or continue to help him gain insight into the enormity of his behaviour? The third case raises the question of whom to believe. Certainly the behaviours of the daughter in relation to substance misuse and self-harm suggest abuse of some type, but of course her mother might not be the perpetrator. On the other hand, substance misusers are often unreliable. Should this troubled daughter be considered the vulnerable adult whom Shatter's bill is trying to protect? Should I ignore the wishes of this young woman and report the allegation? These scenarios are not black and white, and in all cases the gardai were contacted but were unable to act. It is important the future legislation clarify some of the borderline disputes around these issues. If they are not, then some psychiatrists might baulk at not being given legal protection and the fear of being reported to our regulatory body for breaches of confidentiality might become a reality. Unless these grey areas are soon made clear, doctors could next be joining journalists and priests behind bars.
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