Family doctors have outlined their objections to mandatory reporting in a position statement from the Irish College of General Practitioners. However, other groups involved said yesterday mandatory reporting was necessary for child protection.
The college said it had consulted more than 2,000 members and felt there was an "urgent need for an effective and comprehensive system to be put in place in order to protect children in the future and to attempt to stop abuse currently taking place".
It agreed with the aims of mandatory reporting, which it said were to ensure that all cases of child abuse come to the attention of the authorities as quickly as possible, in order to allow intervention in the interest of the child. "The essential decision is as to whether mandatory reporting will best achieve this." Dr Brian Coffey, author of the statement, said yesterday that doctors were more aware now than ever of child abuse. Obvious cases were easy and straightforward to deal with, he said, but it was the less obvious ones that caused difficulty.
"If a child has a bad nappy rash and a sore bottom it could be due to eczema or wet nappies. Child abuse would also be on the list, but way down the list. We could be dealing with a family with a lot of social problems, nothing more than that. It is not clear cut. I would have thought it was reasonable to say you do not go rushing off and report that to a statutory body. It is different if it is obvious abuse with reasonable suspicion," said Dr Coffey. The position statement said confidentiality has always been fundamental to the doctor/patient relationship. Patients could come to their doctor with any problem and they knew it would not be revealed to a third party without their permission.
"It is the knowledge of this very fact that is persuading more and more people to reveal episodes of sexual abuse that happened to them when they were younger. This would no longer occur in many cases and these people would not be able to come to terms with their trauma."
Mandatory reporting, it said, could damage the therapeutic relationship between the doctor and the patient. A sexually-abused younger child would seldom complain directly to the doctor, rather it was a concerned older person who would reveal it. "The fact that the matter would have to be reported immediately, without any say on their part, would add to their trauma."
Less abuse would be reported, according to the statement, and there was no guarantee that the move would increase detection of child abuse. In the US there has been an "explosion" in child abuse reports but it had not been matched by an equivalent growth in substantiated cases, it said.
However, addressing this issue, Mr Owen Keenan, director of Barnardo's, said there had been an increase in the number of confirmed cases in the US. Mr Keenan said that while mandatory reporting did have complexities which needed be to overcome, these "should not be put forward as a reason for not doing it". On the issue of confidentiality, Mr Keenan said he would "refer the ICGP to the Medical Council guidelines that specifically refer to the necessity to safeguard the welfare of another individual or patient".
Mr Cian O Tighearnaigh, chief executive of the ISPCC, said it was no longer a question of whether mandatory reporting should be introduced but when. Professional bodies, he said, should be working towards ensuring their own concerns were addressed, not objecting to it.
The ICGP statement also said that with the introduction of new regulations in this area, rigorously enforced, "the whole system would be quickly overwhelmed and would break down". It also expressed concern about the "criminalisation" of professionals "who may in all good faith consider the reporting at a particular point in a therapeutic relationship to be inappropriate." The ICGP would favour a system of voluntary reporting, based on the Dutch model of the Confidential Doctors' Bureau, from which anybody can seek advice, including GPs.
In a statement, the Irish Association of Social Workers said it was concerned about the proposed introduction of mandatory reporting. According to the association, extensive consultations by the previous government with more than 200 organisations showed that the majority of those organisations "working the front line of child protection" were overwhelmingly against the move. It called for further debate on the issue.