Disclosure of child sexual abuse

Editor—In the recent ethical debate on child sexual abuse an allegation of a serious criminal offence was made in a situation of assumed confidentiality.¹ Revealed child abuse (physical or sexual) is rarely an isolated occurrence, and perpetrators tend to escalate their activities with time.² Sexual abuse of children is a personality disorder which does not spontaneously resolve and is refractory to intervention.³ If these allegations are true, other children may have been or may still be being abused.

Medical training inculcates an ability to make decisions. This can create an expectation of making a decision when it may be inappropriate for the decision to be made by an individual doctor. A fundamental tenet of child abuse work is to share information. Indeed, the Children Act makes this a duty.⁴ One person may be unaware of all the information. David is not in a position to make a decision not to proceed. Immediate medical and social work colleagues would be his first points of reference and, thereafter, the trust’s medical director (who will have access to legal advice) and his defence society.

If abuse to others occurred after the date of this woman’s disclosure and was uncovered and it then became known that David had had this information, it is not certain how a judge or the General Medical Council would regard a choice of maintaining confidentiality. Would a victim be able to sue the professor for placing confidentiality ahead of a future victim’s physical and psychological safety?

What of the woman’s best interests? It is difficult to take life decisions which are for the best in the long term but which will precipitate extreme short term difficulties. She has bulimia, and the prospects of resolving this without addressing the underlying psychodynamics are poor. Her main obstacle to disclosure is the real fear of further psychological difficulties. Victims of child abuse need help in coming to full disclosure. Did David inform her of the support and therapeutic options which could help her to cope and recover after disclosure?

He should meet this woman again to see if she has altered her views. If she has not, he should explain why he has to make disclosure. He should tell her how he intends to address her needs and liaise with her general practitioner.