Child like; confidentiality, autonomy, beneficence, and veracity. These issues

Child protection within safeguarding refers to the prevention and reporting of child abuse. Within child safeguarding, confidentiality is a major issue. Confidentiality is defined as “the state of keeping or being kept secret or private”. This essay will discuss the legal, ethical, professional and communication issues surrounding child protection and how the right to confidentiality effects safeguarding. The main focus of this essay will discuss how child safeguarding breaks confidentiality and the laws, both civil and criminal that effect breaking confidentiality, relevant codes of conduct, and ethical issues that surround breaking confidentiality. Other issues that will be discussed are autonomy, beneficence, non-maleficence, and veracity. When child protection is suspected, the child’s right to autonomy, especially if they are Fraser competent, is overruled if the imaging professional believes they are acting in the prevention of a serious crime. Beneficence is the act of acting in the best interests or for the benefit of others, whereas autonomy is the right to the independence of your own actions. Therefore, all actions undertaken by the imaging professional must be explained, as they cannot break the patient’s trust. This is because if they say they can keep a secret, by following the procedures of child safeguarding, they will break that promise and thus be breaking the patient’s trust. Throughout this essay key issues relating to child protection will be discussed like; confidentiality, autonomy, beneficence, and veracity. These issues stem from Beauchamp and Childress’ four principles of biomedical ethics (2009) and are key in discussing child safeguarding. This is important in this case as they are all issues that affect an imaging professional’s procedures in situations concerning child protection. It is also important as it is necessary for each healthcare professional, including radiographers, to know the procedures, the codes of conduct, and the laws surrounding child safeguarding. It is also imperative that they know how to communicate not only with the child but members of the safeguarding team and how to write the report. Confidentiality is of the utmost importance throughout the healthcare system and can act as a conflicting interest in regards to child protection. This is because to report child abuse you must break confidentiality. However, within the College of Radiographers, the Child and the Law: The Roles and Responsibilities of the Radiographer brochure (2005) section 4.2 it states “…in relation to child protection, the key feature of confidentiality is that the interests of the child are paramount and may supersede all other considerations (Children Act 1989).” Hence, when an imaging professional is reporting on a suspicion of child abuse they must break confidentiality as the child’s safety is paramount over their individual wishes, even if the child is considered to be Fraser competent. Within the same document previously stated, it states in section 4.13 that “by virtue of Section 8 of the Family Law Reform Act (1969), children aged 16 – 17 years are deemed capable and therefore competent to give consent in the same way as an adult.” However, this only applies to their ability to consent to procedures. They are not able to refuse the imaging professional from contacting the appropriate authorities and filing a report if they deem it an act of beneficence as it is in the young person’s best interest and their protection from harm. As all imaging professionals must follow the guidelines set out for them by the HCPC (2013), it states in section 7 that imaging professionals must “understand the importance of confidentiality”. It Is further split into three sub-categories each referring to limits to confidentiality, principles associated with confidentiality and safe use of health and social care information, and appropriate reactions to situations involving safeguarding. Within the HCPC (2013), section 10.1 states the imaging professionals must “be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols, and guidelines.” As part of safeguarding it is imperative that accurate records of abuse are filed and an accurate report immediately was written. It also states that these reports must follow applicable legislation and this is key as each trust has different guidelines and protocols for dealing with child safeguarding.  Within the Code of Professional Conduct (2013), section 1.6 states that “You must respect patient confidentiality at all times and adhere to the provisions of current data protection legislation.” This stems from the Human Rights Act (1998) (Legislation.gov.uk, 2017) and the Data Protection Act (1998) (Legislation.gov.uk, 2017). ‘Vital interest’ is an expression that is used within the Data Protection Act to prevent information from being shared that does not prevent someone from serious harm or distress or a life-threatening situation. However, the laws and pieces of legislation that allow imaging professional to break the right to confidentiality are incredibly important because if they couldn’t break confidentiality, then they would not be able to protect children and young people from harm in cases of child protection, and they would not be able to inform the proper authorities or write the report. The Data Protection Act is to protect patients from any unnecessary information about themselves being distributed or used without their consent. It refers to information that is stored within computer systems and on paper documents like names, addresses, date of births and any medical history a person may have. There are eight principles of the Data Protection Act which cover how the data is collected, who stores it and how long it can be stored for. Principle 2 of the Data Protection Act (Legislation.gov.uk, 2017) protects data from being used for anything other than its collected purpose. For example, name, date of birth and the first line of a patient’s addresses are used as part of the identification process and as part of principle 2 they must not be shared for any other purpose as this breaches confidentiality. In principle 1 outlines that only necessary information can be processed and any information processed must be done so lawfully. It is further consolidated in principle 3 where it continues to discuss how the data kept must be relevant. Furthermore, another law that also allows the imaging professionals to break confidentiality is article 3 of the Human Rights Act (1998) ‘prohibition of torture’. It declares that “No one shall be subjected to torture or to inhuman or degrading treatment or punishment.” This means that each individual person has the right to live without abuse and is one of the main laws that allows imaging professionals to break confidentiality. The right to live free from torture surpasses the right to confidentiality as it is always in the best interest of the patient to be living without the fear of abuse and without receiving abuse in any form. Autonomy is closely linked with the prohibition of torture as it refers to the right to one’s own actions. But it is also linked to living free from abuse as the right to one’s own actions refers to being able to live without fear and without abuse.Autonomy, as previously stated, is the right to one’s own actions. This has conflicting interests with confidentiality. The right to the wishes of the patient can be overruled as part of the prevention of harm. However, some autonomy can still be preserved when confidentiality is broken. This can be done by respecting their wishes for their parent/s, guardian or carer to not be told, that can be kept confidential by the imaging professional as telling them would be breaking confidentiality unnecessarily. Allowing the patient to have as much autonomy as possible requires the imaging professional to follow the correct communication laws and legislation.As part of the HCPC (2013), section 8.1, “…to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice…”, indicates that all imaging professionals not only need to be aware of their verbal communication but how they communicating non-verbally. For example, in cases of child protection, eye contact with the child is key in keeping them talking as they know they have your full attention. In regards to verbal communication, however, imaging professionals must only answer with open-ended question and words of encouragement. This is because if they answer with a direct question then the investigation into the suspected child abuse has started and any information shared with the imaging professional could become inadmissible in court. They must also be able to clearly communicate verbally with the safeguarding team as well as in writing within the report. It is imperative that each member of staff understand their role in communicating with the patient as they need to feel comfortable and like they can trust whoever they may be speaking to. When communication directly with the patient, the imaging professional must do more listening than talking. This will prevent them from leading the conversation and allow the patient to control the conversation and control what they want to share. Once the child has finished speaking then imaging professional should then discuss confidentiality with the patient and explain why and who they need to inform of what the patient has disclosed. By communicating clearly that they can’t keep what they have been told completely confidential, they are protecting the child from further misconduct and if they communicate clearly with the child or young person that they must follow procedures that are in the patient’s best interests they will be more likely to consent or at least feel more comfortable, and by doing this they are keeping the communication honest from both sides. This allows the patient to feel as though they are a part of the decision that has been made. Finally, the imaging professional must write the report indicating clearly what they have been told and including all aspects of their interactions with the child and the safeguarding team, as well as who they specifically revealed the information to. Beneficence is to act in the best interest of the patient and is the main argument as to why imaging professionals can overrule a patient’s autonomy. They act as opposing arguments but both are key in issues of confidentiality. This means that imaging professionals should always act in the best interests of the patient even if they do not deem it themselves to be in their best interests. Beneficence is also closely related to non-maleficence. Non-maleficence by definition is “non-harming or inflicting the least harm possible to reach a beneficial outcome” (Medscape, 2017). Non-maleficence is closely linked to beneficence as to do no harm is acting in the most beneficial way for the patient. To do no harm can refer to harm physically and mentally. By breaking the patients trust the imaging professional could do harm. It could mentally affect the patient as they may feel guilt or shame about it so by breaking their trust more harm could be done. This is why breaking confidentiality is a key issue within child safeguarding.Ethically, an imaging professional is justified by reporting abuse. The ethical stance on child abuse is the same as non-maleficence, do no harm. Ethical issues regarding children are unique. This is because children are not deemed to be capable of making their own decisions. This is usually left to the parents to decide what is best for their child. A child’s consent is not necessary for child abuse cases. Obtaining consent is a huge part of an imaging professionals job, therefore, by bypassing the consent of a child can be perceived as an ethical dilemma. Ethically, the imaging professional must inform the proper authorities and write the report. However, consent is a key issue within safeguarding itself. Consent is necessary within all practices for procedures to take place, but consent from a child does not need to break confidentiality like it is an adult. This is because they are not deemed competent to make that decision. Consequently, the imaging professional can file a report without consent as it is in the best interests of the child to be kept from harm. In the Society of Radiographers (Sor.org, 2017) section 8.8 refers to how an alleged abuser may be in a position to consent for a child and therefore appropriate sensitivity should be used. Parents, guardians and legally appointed individuals by a court can consent for another person. In cases of child safeguarding the consent of the appropriate individual is not needed as it is not necessary to break the child confidentiality to inform the parent or guardian. It is stated with the Society of Radiographers Code of Conduct 3.2 “You must keep current, accurate and secure records and ensure that they are completed with honesty and integrity.” Veracity is another issue imaging professionals must consider when breaking confidentiality in issues concerning safeguarding. Veracity refers to how truthful someone is being. Therefore, if an imaging professional promises to keep a secret they are not being veracious. However, if they are honest throughout their interactions with the child and the safeguarding team then they have acted in the most veracious way possible. This will mean they have only revealed necessary information to those it concerns and they will have kept everything else confidential. Honesty and integrity signify that veracity is a key issue with regards to breaking confidentiality as they both refer to being truthful and morally upright.As part of common law duties, the imaging professional must share relevant information as it is vital to good safeguarding practice and all members of staff, including volunteers, must know, understand and be able to report all safeguarding concerns. Common law also states that confidentiality is not absolute right, therefore, no assurances should be given that everything remains confidential and consent should try to be obtained but it is not necessary. However, only those who it is absolutely mandatory should be told any information. As part of common law, it is also stated that others should not be put at risk. Others can refer to the patient themselves or other family members such as siblings. The Data Protection Act also dictates that no unnecessary information should be shared as this is breaching confidentiality without a justified reason.  As radiographers are considered to be professionals, they have a responsibility to report any and everything they deem to be a potential risk to someone’s safety or to the safety of the wider public. The professional issues associated with child safeguarding is when to break confidentiality and what the consequences are. Radiographers will suffer no consequences if they believe they are acting in the prevention of harm. Even in cases where they report something that they deem suspicious and it is later determined that the suspicions didn’t amount to any truth, as long as the imaging professional has followed the standard of care their trust has outlined and has acted in a way which the practice has accepted. As a professional, however, they are accountable for how they handle the situation involving child safeguarding. Like every member of staff as previously stated they must be aware of their trusts guidelines on dealing with child safeguarding and their procedures. Generally, all trusts mandate that each employee must have undergone safeguarding training. Each trusts policy varies slightly but generally as stated in (England.nhs.uk, 2017) radiographers must notify their line manager as well as their local safeguarding lead and the local Social Services department if their policy dictates it. They must also follow procedures for their area, the person should also consider informing the local Police if they believe there is an imminent danger to the child or young person.  In conclusion, an imaging professional will need to understand that within safeguarding there are laws that allow confidentiality to be broken. The right to autonomy, although important, does mean that a child can undergo abuse and decide for themselves that it is in their own best interests that it is not disclosed. It is overruled by beneficence and non-maleficence. However, imaging professionals must always try to be veracious. Veracity is very important in child safeguarding as it allows them to understand what is going on and prevents the trust between patient and imaging professional to not be broken. As a professional, radiographers must be held to a standard of authority and have a responsibility to report any suspicions of abuse they may come across. Be that in the form of verbal communication from the patient or a story of how an injury was obtained that doesn’t match the injury seen on the image. Confidentiality does not take precedence over the safety or a child or young person. Their right to live free from harm comes first and supersedes all other arguments.