Mutual Deference Between Hospitals and Courts

This Article explores the phenomenon of “mutual deference” between the medical and legal systems to show that placing mandated reporting responsibilities on clinicians results in lasting harm for families. On the medical side, clinicians are obligated to defer any “reasonable suspicion” that a child may be at risk to the legal system; their concern may be mild or severe, medical or nonmedical in nature. But the legal system, comprised of lay-people in the field of medicine, is illequipped to evaluate a medical concern, and so defers back to the clinician’s report when making critical decisions around family integrity. Thisdeference often functions to elevate a clinician’s “reasonable suspicion” to a finding of “imminent risk,” justifying needless and prolonged separation of families. More systemically, mutual deference creates and reinforces medical and legal associations between low-income communities of color and notions of child maltreatment. Mutual deference insulates the medical reporter and the legal system from liability while imposing tremendous harm on the families caught in the middle. That mandated reporting laws discourage clinicians from considering this harm when deciding whether to report a family reflects the extent to which the family regulation system has prioritized prosecution over supporting families. Efforts to re-envision how society’s support for and protection of families can move away from state-sanctioned violence and towards strengthening families within their communities must begin with removing mandated reporter responsibilities from medical providers.

Walking the Tightrope between Study Participant Autonomy and Researcher Integrity: The Case Study of a Research Participant with Alzheimer’s Disease Pursuing Euthanasia in Switzerland

This article addresses ethical issues in the conduct of ethnographic research with vulnerable study participants, such as individuals with cognitive impairment. Seven ethical issues emerged from this case study, in which a participant diagnosed with Alzheimer’s disease wished to pursue euthanasia in Switzerland: (a) How to protect the participant’s autonomy while ensuring his decision had not resulted from untreated depression or modifiable social factors; (b) How to interpret self-harm; (c) How to protect the research team members’ “mandated reporter” status; (d) How to counteract the attractive qualities of pro-euthanasia videos depicting an easy end to personal suffering; (e) How to find a better alternative to the common practice of reporting self-harm cases to Adult Protective Services and then removing these cases from studies; (f) How to leverage a participant’s trust to address these issues; and (g) Whether researchers should do anything further to help address unmet needs in similar situations.

Evaluation of Child Abuse and Neglect

Child abuse and neglect constitute a long-standing worldwide epidemic. Millions of cases of abuse and neglect are reported every year. As mandated reporters, clinicians are legally bound to recognize and report, but not prove, suspected acts of child maltreatment. Child protection agencies investigate the validity of the allegations. Only trained professionals should explore and gather evidence for suspected abuse or neglect of a child, while the clinician who has fulfilled his or her duty as a mandated reporter continues to provide clinical care for the child. Young children also benefit from forensic examinations by interviewers who are trained in early childhood development and age-appropriate interview techniques, such as open-ended questions, that minimize suggestion and allow children to freely recall the alleged offender’s behavior. A clear understanding of professional duties and responsibilities will promote the just adjudication of offenders and the well-being of children.