Editorial
The nature of professional child abuse
T
he care study Care o f a child with hypospadias: ethi The reason given for early repair of the hypospadias cal issues in practice in the last issue of British Jour was to improve the boy’s physical appearance and mini nal of Nursing (Vol 1(8): 393-8) raises many interesting mize teasing and questioning from other children which issues, not least the question of what constitutes child might cause psychological damage. Conversely, it could be argued, that the constant attention to the genitalia abuse. The article describes the case of a 6-year-old boy and the pain, distress and trauma generated by the cure undergoing his sixth hospital admission for repair of far outweigh any possible benefits that might result from surgery. a hypospadias. Previous attempts at repair had been hin dered by the child repeatedly pulling at his catheter — The further indignity and distress arising from plaster he was now showing signs of psychological disturbance, ing the boy’s arms across his chest must surely be classed missing school and had an increasing distrust of hospital as abuss, not only of the child himself, but also of the staff. In addition, repeated surgery had caused a great surgeon’s privileged position. Discussion with his par deal of scar tissue to form and it was unlikely that his ents and other healthcare team members would have penis would ever look normal. It was therefore impera produced a much more satisfactory and less distressing tive for the surgery to be a success. In view of this, method of preventing the child from fiddling with, and the surgeon decided, without consent, to encase the pulling out, his catheter. child’s arms in plaster of Paris to prevent him removing The main issues here are those of non-maleficence the catheter and thus causing a further failure. Can the — doing no harm — and of utilizing extraordinary surgeon’s actions be classed as child abuse? means to produce results. Non-maleficence requires that Child abuse is the term used to describe non-acciden besides attempting beneficence, or doing good for pa tal injury, ill-treatment, cruelty, avoidable impairment tients, we should actively avoid doing harm. The use of health or development, unexplained failure to thrive, of extraordinary means involves not only unusual treat sexual abuse, or neglect leading to any of the above situ ments and excessive expense, but also pain and suffering ations in a child. We are conditioned to seeing such without promise of benefit from the treatment. It would abuse perpetuated by those who usually have responsi appear that this little boy was certainly a victim of both bility for the day-to-day care of the child: parents, rela in the treatment of his hypospadias. tives, guardians, or friends who have a close association It is to be hoped that the increasing interest in ethical with the child concerned. issues will lead nurses to question more closely the deci The care study in question forces us to examine the sions made by their healthcare colleagues. This, in turn, nature of professional abuse. While it may be accepted will benefit the individual and society as a whole, and that the consultant acted with the best intentions by will lead to an increase in beneficence for all. instigating the repair of the hypospadias at an early Jean Beattie stage, the validity of such treatment needs to be ques Project Manager (Child Health) tioned, particularly in relation to the circumstances Birmingham College o f Nurse Education and described. The University o f Central England in Birmingham
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