Family Violence
Because of its prevalence and medical consequences, abuse must be
considered by physicians in the differential diagnosis for a number of
medical complaints, particularly when treating women, children, and
elderly persons.
Physicians who are likely to have the opportunity to detect abuse in the
course of their work have an obligation to familiarize themselves with (1)
protocols for diagnosing and treating family violence, (2) state reporting
requirements and protective services, and (3) community resources for
victims of abuse.
Physicians also have a duty to be aware of societal misconceptions about
family violence and prevent these from affecting the diagnosis and
management of abuse. Such misconceptions include the belief that abuse is
a rare occurrence; that "normal" individuals are not abusive; that family
violence is a private problem best resolved without outside interference;
and that victims are responsible for abuse.
The medical profession must demonstrate commitment to ending family
violence and helping its victims. Physicians must play an active role in
advocating increased services for victims and abusers. Protective services
for abused children and elders need to be better funded and staffed, and
follow-up services should be expanded. Shelters and safe homes for
battered women and their children must be expanded and better funded.
Mechanisms to coordinate the range of services, such as legal aid,
employment services, welfare assistance, daycare, and counseling, should
be established in every community. Mandatory arrest of abusers and greater
enforcement of protection orders are important law enforcement reforms
that should be expanded to more communities. There should be more research
into the effectiveness of rehabilitation and prevention programs for
abusers.
Informed consent for intervention should be obtained from competent
victims of abuse. For minors who are not deemed mature enough to give
informed consent, consent for emergency interventions need not be obtained
from their parents. Physicians can obtain authorization for further
interventions from a court order or a court appointed guardian.
Physicians should inform patients of a child abuse diagnosis and they
should inform an elderly patient's representative when the patient clearly
does not possess the capacity to make health care decisions. Safety of the
child or elderly person must be ensured prior to disclosing the diagnosis
when the parents or caretakers are potentially responsible for the abuse.
For competent adult victims, physicians must not disclose an abuse
diagnosis to caregivers, spouses or other third party without the consent
of the patient. (JC Rpt F, A-93) (Reaffirmed A-23)
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Abbreviations for House of Delegates report origination:
EC – Executive Committee; BT – Board of Trustees; CPA – Council on
Professional Affairs; JC – Judicial Council; CHS – Community and Health
Services