Children may be abused physically, sexually, emotionally and by omission or commission in any permutation under these headings. This is discussed in terms of the separate and overlapping responsibilities of parents, guardians, the community in which they live and the network of professional services developed to care for, protect and educate children. An attempt is made to place these issues within an ethical framework, with regard to the legislature of England and Wales. It is argued that professionals working within this field have an obligation either to keep up to date in respect of a large and growing body of research and practice knowledge or to consult 'experts' within the field when making complex and far-reaching decisions on behalf of abused children and their families. A representative, inevitably incomplete, bibliography is discussed and appended and there is brief reference to the role of expert witnesses concerning children involved in civil legal proceedings.

1. 8. Child, elder, or
spousal Abuse:
Dr. Ayub Abdulkadir (Dr. Alto)
Medical Ethics

2. Child abuse:
• Is when a parent or caregiver, whether through
action or failing to act, causes injury, death,
emotional harm or risk of serious harm to a child.
• These include:
1. Neglect.
2. Physical abuse.
3. Sexual abuse.
4. Exploitation.
5. Emotional abuse.

3. • The total abuse rate of children is 25.2 per 1,000
children,
a) with physical abuse accounting for 5.7 per 1,000,
b) Sexual abuse 2.5 per 1,000,
c) Emotional abuse 3.4 per 1,000,
d) and neglect accounting for 15.9 per 1,000
children.
• These categories overlap, with sexual and physical
abuse often occurring together.

4. Emotional abuse:
• Refers to the psychological and social aspects of child
abuse; it is the most common form of child abuse.
• Causes:
Parents have negative attitudes towards children.
Perceive parents as unrewarding and difficult to enjoy.
They associate their own negative feelings with the
child's difficult behaviour.
Poor parenting methods.
Parental mental health problems.
Domestic violence.
Drug and alcohol misuse.
Being abused when their children.

5. Sign in childhood:
• Emotionally abused children exhibit a range of specific
signs.
• They often:
1. Feel unhappy, frightened and distressed.
2. Behave aggressively and anti-socially, or they may act
too mature for their age.
3. Experience difficulties with academic achievement
and school attendance.
4. Find it difficult to make friends.
5. Show signs of physical neglect and malnourishment.
6. Experience incontinence and mysterious pains.

6. Neglect abuse:
• Refers to a range of circumstances in which a parent or
caregiver fails to adequately provide for a child's needs:
• Physical:
• Through the provision of food, housing and clothing.
• By exercising adequate supervision and control of the
child.
• By ensuring their access to medical care when
necessary.
• By ensuring that the child regularly attends school.

7. • Emotional:
• By providing them with care, love and support.
• By showing appropriate moral and legal guidance.
• Causes of neglect:
• Socioeconomic status.
• Number of children.
• Stress.
• Pychological problem.
• Drug and alcohol misuse.
• Strict Behaviour.

9. Physical abuse:
• Refers to physically damaged of children's body
may be hitting, slapping, kicking or striking with an
object to children.

12. Family violence, or
domestic violence:
• Refers to the physical assault of children and
women by male relatives, usually a father and
husband/partner.
• In these situations, a man uses violence to control
his partner and children, often in the belief that
violence is a male prerogative ("I'm a guy, I can't
control myself"), or that his victims are responsible
for his behaviour ("You bought it on yourself").

13. Sexual abuse:
• Describes any incident in an adult engages a minor
in a sexual act, or exposes the minor to
inappropriate sexual behaviour or material.
• Sexual abuse also describes any incident in which a
child is forced into sexual activity by another child.
• A person may sexually abuse a child using threats
and physical force.
• But sexual abuse often involves subtle forms of
manipulation, in which the child is coerced into
believing that the activity is an expression of love.

14. Kahaani 2

15. General sign of Abuse:
1. Repeated injuries.
2. Bruises such as blackened eyes and unexplained
swelling.
3. Unexplained fractures.
4. Bite marks.
5. Unusual marks, such as those occurring from a
cigarette burn.

16. 6. Bruising, swelling, or pain in the genital area.
7. Signs of inadequate nutrition, such as sunken
eyes and weight loss.
8. Venereal disease and genital abrasions and
infections.
9. Makeup used to hide bruises.
10. Sunglasses worn inside a building or hospital to
hide blackened eyes.

17. Child abuse in ethics:
• Physician are mandatory reports of child abuse. this
means that the physician has a duty to report child
abuse even if they feel uncomfortable doing so.
• There is no discretion on whether or not to report
abuse.
• In addition, even suspected child abuse must be
reported.
• The reporting to child protective services happen
immediately so that there can be an urgent
intervention to prevent further abuse.

19. • The first child protective agency in the world was
established in 1874 when a little 10-year-old girl, Mary
Ellen McCormack, explained to the court how her
mother beat and abused her.
• The New York Society for the Prevention of Cruelty to
Children began as a result of her story. She became
known as “the child who put a face on abuse.”
• The Child Abuse Prevention and Treatment Act of 1974
requires reporting of all child abuse cases.
• All states have statutes that define child abuse and
require that all abuse must be reported. To begin to
investigate questions of neglect and child abuse, the
state must have probable cause, which is a reasonable
belief that something improper has happened.

20. • The term battered child syndrome is sometimes
used by healthcare professionals to describe a
series of injuries, including fractures, bruises, and
burns, done to children by parents or caregivers.
• This is not a legal term but, rather, a description of
injuries.

22. • Most state statutes require that an oral report of
suspected abuse be made immediately, followed by
a written report.
• The written report should include:
1. Name and address of the child.
2. Child’s age.
3. Person(s) responsible for the care of the child.
4. Description of the type and extent of the child’s
injuries.
5. Identity of the abuser, if known.
6. Photographs, soiled clothing, or any other
evidence that abuse has taken place.

23. Elder Abuse:
• Defined in the modification to the Older Americans Act
(1987).
• It includes physical abuse, neglect, exploitation, and
leaving of adults 60 years and older and
is reportable in most states.
• The reporting agency varies by state but generally
includes social service agencies, welfare departments,
and nursing home personnel.
• As in the case of child abuse, the person reporting the
abuse is, in most states, protected from civil and
criminal liability.

24. • The same criteria described for child abuse
generally apply to elder abuse.
• Instead of child protective services, there are adult
protective services.
• Reports made in good faith can be done without
liability to the reporter.
• The circumstances with elder abuse are less clear
than with child abuse, because the elderly person is
often a still-competent adult.
• Nevertheless, you must report elder abuse.

26. Spousal Abuse:
• One of the most difficult situations that healthcare
providers confront is when they suspect that a
patient suffers from spousal abuse.
• Laws governing the reporting of spousal abuse vary
from state to state.
• The local police may have to become involved
when spousal abuse is suspected, and in some
cases a court will issue a restraining or protective
order prohibiting the abuser from coming into
contact with the victim.

27. • Questions that are frequently asked of a suspected
abused spouse include:
1. Are you or your children afraid of your spouse?
2. Does your partner threaten, grab, shove, or hit
you?
3. Does your partner prevent you from spending
time with your family or friends?
4. Do you stay with your partner because you are
afraid of what he or she would do if you broke
up?
5. Has your partner ever abandoned you in a
dangerous place?