Encyclopedia of Global Bioethics

Living Edition
| Editors: Henk ten Have

Abuse: Child Abuse

  • Amy MullinEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-05544-2_2-1

Abstract

Following a brief account of the evolution of our current understanding and practices with respect to child maltreatment, child abuse and neglect are defined as actions and omissions that avoidably cause children significant suffering or impair their development of basic physical, intellectual, and emotional capacities. Since children’s suffering and the basic capacities that are impaired may be physical or mental, abuse and neglect may be physical or emotional. Justifications for assignments of responsibility to care for children are discussed, along with a variety of proactive measures to prevent avoidable harms and reactive measures to respond to evidence of maltreatment. Attention is paid throughout to the impact of bias on child protection practices intended to prevent or respond to abuse and neglect.

Keywords

Abuse Neglect Children Children’s rights Care Parents Autonomy Child protection 

Introduction

It is now widely agreed that children, as inherently vulnerable and dependent people, deserve social protection when abused or neglected. This departs substantially from past practices and ideologies, in which children were the property of their fathers and could be beaten, killed, or sold (McGillivray 2011). It also departs from attitudes and practices that do not treat children as property but recognize parents as having final authority and sole responsibility to make decisions on their behalf. The United Nations Convention on the Rights of the Child (UNCRC) promises children the right to be free from abuse, both physical and mental, and stipulates that states should use a variety of means (legislative, educative, and social) to protect children from it. The large number of states who have signed and ratified this convention testifies to extensive cross-cultural commitment to protecting children’s interests in avoiding significant harm. However, there is less agreement about which actions and omissions constitute abuse and neglect, what proactive measures states should take to protect children, and what should be done when abuse or neglect is detected. This entry offers a brief account of changing global attitudes toward behaviors that seriously and avoidably harm children. I define abuse and neglect, suggest a standard to use to assess whether or not harm suffered amounts to abuse or neglect, and discuss justifications for individual and state responsibilities to protect children and respond to serious harm. This is followed by analyses of some ethical issues connected with child maltreatment. The entry however leaves aside issues about harms that occur to fetuses before birth or which prevent birth.

History and Development

The belief that children are the property of their parents, or more narrowly their fathers (the proprietarian view) has been traced to the Roman doctrine of patria potestas (McGillivray 2011). Fathers could treat their children as they wished, and children had no legal recourse. English common law introduced limits to the power of fathers, and John Locke argued that parental rights are grounded in parental responsibilities, the fiduciary view of parental rights (Archard 2004). Nonetheless for centuries rights were restricted to people thought to be autonomous, with the ability to self-govern in accordance with goals and commitments, and hence children had no legal rights (Brennan 2002). In the twentieth century, children’s rights, based on their significant interests, became increasingly recognized, with rights protecting either interests or choices (Brennan 2002). The UNCRC (1989) is the latest in a succession of twentieth-century international declarations of children’s rights. It has been ratified by 195 countries and signed by two others (Somalia and the United States). Ratifying states are subject to monitoring and required to make progress reports. The UNCRC recognizes children’s rights, outlines parents’ responsibilities to meet children’s needs, and identifies a role for states to support parents (Article 27) and protect children from abuse and neglect (Article 19).

Increasing recognition of children’s rights and the role states should play in protecting children from rights violations has been accompanied by growing international attention to instances of child maltreatment. Ian Hacking (1991) traces the evolution of the concept of child abuse, from the nineteenth-century concept of cruelty to children, closely associated with physical abuse and neglect, to the mid-twentieth century concept of child abuse. While the latter emerged in response to medical review of paediatric x-rays, it became increasingly medicalized (with abusers diagnosed as mentally ill) and was extended in the latter half of the twentieth century to include a variety of significant harms to children, such as emotional and sexual abuse. Greater public attention to children’s suffering was accompanied by a rise in laws that mandate reporting of suspected or witnessed abuse and global expansion in the size and role of child protection services. Heightened global concern about child abuse and neglect has also identified practices that exploit children’s labor (child slavery, dangerous work, work that prevents them from acquiring an education) as abusive.

Conceptual Clarification

There is broad consensus that children’s interests deserve social protection and those who abuse or neglect children are to be condemned. However, it is less clear what actions should be identified as maltreating children, particularly when cultural differences in interactions with children are taken into account (see Bayliss and Downie 1997), and what standard should be used to determine whether children have been harmed to a degree that constitutes abuse or neglect. In this entry, I define abuse and neglect, discuss the standard that should be used to identify them, and conclude with remarks about assigning responsibility to provide care without which one cannot assign responsibility for neglect.

Children may be harmed both physically and emotionally; either their current well-being or their future development may be negatively impacted; and they may be harmed by intentional activities, by incapable caregivers, and through ignorance of or inattention to their needs. When children are harmed intentionally, significantly, and avoidably, either physically or emotionally, this is abuse. Examples include deliberately burning a child or causing a child to be in sustained fear for life or safety. In addition, actions undertaken purposively, even if the perpetrators do not recognize them as harmful, can be abusive. For instance, involving children in activities intended to bring sexual pleasure to the adult, in the absence of children’s ability to consent and in a manner that causes emotional and physical damage to the child, is sexual abuse even if the adult involved believes the activity is not harmful. When children’s needs avoidably fail to be met through acts of omission, this is neglect, consistently one of the most prevalent forms of child maltreatment worldwide (Stith et al. 2009). Neglect can be physical (such as failure to provide adequate food) or emotional (such as persistent failure to respond to children’s significant distress with warmth and sensitivity).

Unlike abuse, which anyone with access to and ability to harm a child can commit, we can only charge those with some responsibility for meeting a child’s needs with neglect. In order to identify neglect, we must therefore identify those with responsibilities to meet children’s needs, since omissions are only understandable against a backdrop of responsibilities. Too frequently, only mothers are blamed for both abuse and neglect, and neglect is conceived in a gendered way (Stith et al. 2009). Fathers, other relatives, temporary caregivers, those whose social roles have assigned them responsibility, such as educators and child protection service workers, and the state, given its duty to support parents and protect children, share responsibility for children’s well-being with mothers and fathers. Hence all can neglect children.

A strong justification for responsibility to provide care to children, and avoid harming them via either neglect or abuse, must take children to have direct moral status. This moral status will depend upon children’s interests both in avoiding suffering and developing to maturity, at which point (and to some extent before) most will be capable of acting both autonomously and morally (Mullin 2011). Such justifications can be presented as a matter of children’s rights (as with the position of Archard, Brennan, and the UNCRC). Alternatively, they may be presented in terms of care ethics and the responsibility to respond to vulnerable and dependent children’s needs for care, with the latter defined as the activities undertaken to directly meet individuals current needs and develop their basic capacities (Mullin 2014a). Theories about the sources of parental responsibility run the gamut from purely causal to voluntarist (Brake 2010), as well as compromises between the two, such that those who cause children to exist have a responsibility to ensure that someone cares adequately for them and those who assume responsibility take it on in accordance with socially defined roles for parents. A voluntarist model of responsibility, in which responsibility is assigned to those who have explicitly or tacitly agreed to take it on, is in keeping with responsibility to care for children assigned to those who interact with them in capacities other than parental, such as educators, child care workers, child protection workers, and health care workers. The 195 states that ratified the UNCRC have voluntarily assumed responsibility for protecting children from abuse and neglect. I leave aside discussion of political theories that assign states such responsibility even without an explicit undertaking.

Abuse and neglect can only be understood with reference to what constitutes significant avoidable harm to children, and this requires an understanding of their needs, both regarding current well-being and development. It also requires a standard of meeting those needs, to avoidably fall below which constitutes either abuse or neglect. David Gil (1975) offers an extreme standard which counts as abuse any circumstance that fails to serve children’s best interests, including not facilitating their optimal development. However, this not only ignores parents’ interests and social interests in the well-being of adults more broadly but also makes the categories of abuse and neglect so broad as to undermine social interest in preventing these forms of child maltreatment. Instead, both Archard, working from a rights perspective, and Mullin, working from a care perspective, define child abuse and neglect as treatment that avoidably fails to provide minimally adequate care and enable children to develop their basic physical, emotional, and intellectual capacities (Archard 2004; Mullin 2014a). These capacities include living safely, with access to adequate nutrition and shelter; bodily health and survival; and the abilities to reason, trust, imagine, recognize one’s own emotions and those of others, self-govern in the interests of personally meaningful goals (autonomy), form relationships with others, and exercise some control over one’s physical and social environment. Activities and omissions that avoidably cause children significant suffering or damage their development and exercise of basic capacities rise to the level of abuse and neglect.

Ethical Dimension

Parental Licensing

Since the state has an ethical obligation to protect children from abuse and neglect, it is necessary to ask how it should undertake this obligation and what proactive as opposed to merely reactive measures it should take to prevent abuse and neglect. Hugh Lafollette (1980) is well known for his controversial proposal that prospective parents (those expecting to parent a child whose arrival is en route via pregnancy or adoption) be required to receive a license to parent, a proactive measure. In the decades since his original argument, he and others have debated various proposals for a parental licensing scheme, which to date has been undertaken only with respect to prospective adoptive parents (licensing is further explored in Weinstock and De Wispelaere). The state’s responsibility to protect children can justify taking proactive measures, but licensing schemes tend to founder on one of three grounds (Mullin 2014a). The first problem is uncertainty around risk factors for parents engaging in abuse or neglect, and especially uncertainty around extent of risk, along with questions about what degrees of risk justify interference with parental liberty on a topic as important to many as the ability to raise children. The second ground for concern regards the extent to which it may be discriminatory to deny parents in poverty or parents with cognitive disabilities or those lacking education, for instance, a license to parent, as opposed to providing them the supports they need to meet children’s needs. The third ground for concern involves the inadequacy of alternative sources of care for children whose parents would be denied licenses (either prospectively or once engaged in parenting) and concerns with abuse and neglect in alternative forms of care (such as foster care and institutional care). Serious concerns have emerged in several countries around neglect or abuse of children in institutional care.

Concerns with licensing schemes should not apply automatically to other proactive measures taken by the state. For instance, widespread public education around children’s needs and close monitoring in the face of known risk factors interfere with liberty less than licensing generally in the Western context. This approach would however be more acceptable in family-oriented climes in Asia and Africa, though licensing is still likely to be problematic. Increasing accuracy in judgments about risk along with improvements in the monitoring and design of alternative and supplemental forms of care (such as childcare designed to respond to children’s emotional needs) can justify requirements that parents participate in interventions designed to improve both their own circumstances and their parenting skills, while helping children develop physically and emotionally. General public education around children’s needs and development can also be justified as in the public interest.

Privacy and Surveillance

Some degree of privacy is arguably important for family intimacy, and yet family privacy (particularly in wealthier countries in which many families live in private dwellings) can serve to shield abusers and prevent detection of neglect. In contexts that present relatively low risks of abuse and neglect, for instance, no past history of domestic violence or child abuse and neglect, no known substance abuse, no known serious family conflict, or history of parents with difficulty controlling anger or very low self-esteem (Stith et al. 2009); interferences with privacy in the context of home life will not be justified. Moreover, children’s public interactions with other members of society will make it possible for signs of child abuse or neglect to be detected. Given the many jurisdictions that mandate reporting signs of child abuse and neglect, either for designated professions (such as teachers and doctors) or universally, for all adults, there are real opportunities to detect abuse and neglect while maintaining privacy within the home. When known risk factors are present, however, particularly as research into risk factors increases in volume and sophistication, monitoring will often be justified. With the presence of some risk factors (such as when children repeatedly present at hospitals with serious symptoms of mysterious origin), significant violations of privacy, such as covert video surveillance of parents’ interactions with children in hospital rooms, may be justified (discussed in Bauer).

Children’s Health

Actions and omissions that damage children’s health will rise to the level of abuse or neglect whenever that health is significantly and avoidably impacted, but often responsibility for the abuse or neglect will go far beyond the family unit. Undernutrition is clearly a major source not only of damage to children’s health but also avoidable death with responsibility only rarely in the hands of parents able but unwilling to provide adequate food. States with the resources to feed their people if those resources were more equitably distributed are more typically the responsible party, and the global community may also share responsibility so long as it is possible for aid to reach those in need. Obesity is a major source of damage to children’s health in developed countries, and parents often play a role in children becoming obese, although environments that offer few opportunities for healthy physical activity and significant exposure to unhealthy foods play a role, as do children themselves. Proactively, states offer public health campaigns that promote healthy eating and active living, and can require nutrition information to be made widely available. Other proactive measures (such as controlling portion size or limiting food availability in public educational institutions) may be justified if they are deemed likely to be effective as can reactive interventions in cases where children’s health has been significantly impacted, but obesity treatment programs should only be mandatory if there is strong evidence that they are effective and less coercive measures have been explored and rejected (proactive and reactive measures are discussed in Mullin 2014b). Given the complexity of the causes of obesity and children’s own role in shaping their eating and activity, prosecuting parents for child abuse as a result of contributions to obesity that severely impacts a child’s health would rarely be justified.

Parental smoking around children in enclosed environments is another health-related activity that may rise to the level of abuse when children’s health is significantly impacted (discussed in Cooley). Given privacy concerns and the personnel required, it is unlikely that proactive measures for detecting smoking in the home would be justified, but evidence that children’s health has been significantly impacted by exposure to tobacco smoke could justify reactive measures that restrict parental liberty to smoke around their children, along with supportive measures to help parents who wish to stop smoking but find it difficult to do so. Different children will be more or less susceptible to the health-related impact of exposure to smoking, and it is important to observe that the same extent of parental smoking may be abusive with respect to one child (because of the impact to his or her health) but damaging without being abusive in regard to another.

A third way in which actions and omissions may significantly and avoidably impact children’s health is medical neglect, or parents’ refusal to seek health care for their children when it is available and affordable. Sometimes this refusal is based on parents’ religious or cultural attitudes toward the medical care practiced in their communities. In the United States for many years laws allowed religious exemptions to laws governing child abuse and neglect, and parents who withheld medical care from their children for religious reasons, including the view that all healing should be spiritual, would not be prosecuted for neglect even when children avoidably died as a result (Hughes 2004). When the standard of medical care has been questioned and confirmed as evidence based and the medical care in question preserves life and basic capacities, denying it to children to whom it is available on the basis of religious or cultural objections should constitute neglect.

Bias and Child Protection

There are various ways in which bias relating to gender, race, class, culture, or religion can impact child protection practices. Regarding gender, as mentioned above, mothers are more likely to be held responsible for child neglect than fathers, and the way neglect is understood can be inappropriately affected by the gender of the parent involved (Mullin 2014a). With respect to abuse, mothers are often held to a higher standard than fathers. Most egregiously, mothers who do not protect their children from abuse at the hands of their fathers are sometimes held to greater account than the abusive fathers themselves (Friedman 2014). Insufficient attention to the role of men in being abusive or neglectful means that some instances of abuse and neglect and some means to prevent them are ignored. As also mentioned above, parental licensing or monitoring schemes may discriminate against poorer parents or parents with cognitive disabilities. In addition, parents who belong to minority races or cultures may be illegitimately subjected to greater scrutiny than parents belonging to dominant cultural groups.

Awareness of bias in child protection practices has led to calls for more culturally competent assessments of risk and damage to children. This is particularly important in assessing children’s emotional needs, as the meaning of interactions between parents and children is affected by culture, and it is necessary to understand the meaning of interactions to know whether children’s emotional needs are being met. Nonetheless, all children deserve to have basic physical and emotional needs met, and all are entitled to minimally adequate care that meets needs for both current well-being and development of basic capacities (including the capacity for autonomous action). It is valuable to ensure that mainstream beliefs about children’s needs enter into dialogue with minority views (not only the views of parents suspected of being abusive or neglectful but also the attitudes and practices of members of their cultural community), in order to enrich understanding of children’s needs and how they may be met in a variety of ways. However, it is equally important to ensure that misguided attempts to be culturally sensitive do not lead to minority children suffering abuse or neglect. Moreover, it is not only nations whose children are abused by foreigners (as in sex tourism in Thailand) that have a responsibility to act to protect children in their jurisdiction. Governments of wealthier countries also have an obligation to prosecute their citizens who abuse children abroad.

Conclusion

Despite increased attention to child abuse and neglect, and recognition of the state’s responsibility to protect children from maltreatment, there is need for more clarity around what constitutes abuse and neglect, and where and when blame for neglect is justly assigned. Child maltreatment should be understood in terms of avoidable and significant impairment of children’s basic needs, not only for current well-being but also for development of basic capacities. In making assessments of risks of child maltreatment, and presence of abuse or neglect, it is important to be culturally sensitive without compromising commitments to meeting all children’s basic needs whenever possible. Child protection services – and those who report suspected abuse or neglect – need to be informed by an understanding of children’s needs and attention to the possibility of various forms of bias (with respect to gender, class, and culture, among other factors) in detecting child maltreatment. They also need to take account of the larger social context in which parents raise children, and factors such as poverty and a weak social safety net that may lead parents in poorer nations to tolerate activities such as street hawking, a form of commercial abuse. When these judgments are well informed, intrusions on parental liberty and family privacy are justified in the name of protecting children from significant harm, so long as the least invasive and most effective forms of intervention are employed.

Cross-References

References

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Further Readings

  1. Bauer, K. A. (2004). Covert video surveillance of parents suspected of child abuse: The British experience and alternative approaches. Theoretical Medicine and Bioethics: Philosophy of Medical Research and Practice, 25(4), 311–327.CrossRefGoogle Scholar
  2. Cooley, D. R. (2009). Environmental tobacco smoke as child abuse or endangerment: A case for expanded regulation. Public Affairs Quarterly, 23(3), 181–201.Google Scholar
  3. Mullin, A. (2014b). Children, parents, and responsibility for children’s health. In J. D. Arras, E. Fenton, & R. Kukla (Eds.), The Routledge companion to bioethics, part VI. Reproduction (pp. 381–392). New York: Routledge.Google Scholar
  4. Weinstock, D., & Wispelaere, J. (2012). Licensing parents to protect our children? Ethics and Social Welfare, 6(2), 195–205.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.University of Toronto MississaugaMississaugaCanada