7 Ethical Dilemmas Faced by Healthcare Professionals when Considering a Report to Child Protection: Experiences and Perspectives from a Tertiary Paediatric Centre

Background Child maltreatment is an important global problem that is increasingly being recognized as a public health issue as well as a violation of children’s fundamental rights. Mandatory reporting is a legislative attempt to decrease its prevalence and impacts. It is generally thought that these laws improve child maltreatment detection rates. However, the actual effects of such laws, as well as mandated reporters’ perspectives on them, remain unclear. Several studies have explored the many obstacles perceived in the reporting process, including some of which can be considered as moral dilemmas. Very few of these studies have explicitly adopted an ethical lens in the analysis of these situations. Objectives Through an exploratory study, our aim was to describe the experiences and perspectives of healthcare professionals from a large paediatric university centre when considering making a report to child protective services. We were interested in the reporting process rather than initial identification. We also explored how profession (nurse, doctor or resident), work environment (general paediatrics team, NICU or ED) and years in practice influenced participants' answers. Additional questions addressed the concept of disclosure of reports to families involved, training on child maltreatment and reporting, and perceived impacts of the COVID-19 pandemic on children’s safety. Design/Methods One hundred and thirty-five respondents answered an anonymous online survey constructed by the research team and based on a review of the available literature. Results Most participants (96%) had encountered situations of possible child maltreatment through their work and reported being committed to their mandated reporting obligations. However, only 44% of respondents had personally reported a situation to protective services. Teamwork and/or delegation of reporting duties seemed to contribute to the gap between exposure and reporting experiences. Sixty nine percent of participants felt that families should be told about healthcare professionals’ concerns at least as often as possible, but many expressed significant concerns, mostly related to their own safety and well-being. Training was lacking according to 88-89% of respondents. Regarding the COVID-19 pandemic and associated restrictions, participants were concerned for children’s safety in their homes. Conclusion Many ethical aspects of the reporting process should be considered when addressing a particular situati