Professor Eileen Munro writes in 2007 about how the emerging child safeguarding policies promoting preventive and early intervention services posed a challenge to professional ethics, raising a problem of ethics of confidentiality. UK policy is, she explains, shifting the balance of power away from families and towards the State and professional decision making and sharing of information.
Power corrupts’ is a well-known truism but there is no acknowledgment of the possible danger of increasing State power over families. There is no recognition of the fact that liberal societies have placed a high value on privacy and confidentiality
“At first sight, a policy of prevention and early intervention in child welfare looks beguilingly altruistic.” Munro goes on to break down the complexities and show why it isn’t without serious risk and compromise. Important questions are raised about the balance of power. Who gets to decide who needs help and what help they need? Furthermore, is help to be voluntary and accessed by anyone requesting it? Are services to be primary ones, such as Sure Start, open to all?
“With the Every Child Matters policy for England, the government have decided to opt primarily for secondary prevention, targeting services on those deemed most at risk. Consequently, monitoring and assessing parental factors as well as children’s development becomes a central concern. The concept of children ‘at risk’ has now been extended from its familiar meaning of children at risk of abuse to include a number of other outcomes that the Government wishes to change, in particular children at risk of social exclusion and at risk of anti-social and delinquent behaviour.”
Evaluating a screening programme
The point of collecting and sharing so much information about families is to screen them to find ‘high risk’ families. Although this was a common strategy for disease it is a new approach for social issues. It is necessary to assess the accuracy of the predictions, whether it is possible to ‘treat’ it and what the damaging effects of both screening and interventions are.
Predictability: Does screening result in risk assessments that have acceptable levels of accuracy? She highlights how research has found unacceptably high levels of false positives (families inaccurately deemed to be high risk) and high level of false negatives (dangerous families wrongly judged safe). It is unclear how accurate screening is to predict criminality and social exclusion. “Even if there were no ethical objections to putting “potential delinquent” labels round the necks of young children, there would continue to be statistical barriers. Research into the continuity of anti-social behaviour shows substantial flows out of – as well as in to – the pool of children who develop chronic conduct problems.”
“In the final analysis, judgments about ‘acceptable’ levels of accuracy come down to a moral judgment: how many innocent children is it acceptable to wrongly label ‘a future menace to society’ (Blair, 2006a) in order to catch a high number of accurate predictions?”
Treatability: can the condition predicted by screening be usefully treated? In a review of interventions for reducing criminality for example, McLaren (2000) offers the remarkably wide estimate of between five and 50 percent success rate.
The level of damaging effects: this applies to both the screening process itself and to the subsequent interventions used to alter the condition.
“The proposed screening system for England requires a major change in the balance of power between families and professionals and its repercussions are as yet unknown.” Munro highlights the problem that if midwives take on the task prescribed by the Blair of judging ‘which parents will be dysfunctional and which children will grow up to be a menace to society’ (Blair, 2006), it might affect the trust between parent and practitioner. Government guidance only talks about confidentiality and privacy in a negative light as an “obstacle” to the effective sharing and management of information. “However, privacy and confidentiality are rights and therefore not to be lightly disregarded.” Confidentiality is also a valuable tool in helping people.
She discusses the way consent is sought for information sharing, finding it problematic, highlighting examples of how the ‘choice’ to consent is presented.
“This biased view of the rationality of giving consent colours the way that consent may be sought and carries with it the implication that anyone who withholds consent is in some way questionable. Indeed, in one illustrative vignette, it is suggested that it is acceptable to seek consent from a parent with the warning that if it is withheld, it will be interpreted as grounds for suspecting the parent of being abusive or neglectful (DfES, 2005b).”
Munro praises the intention to tackle social injustice but says that the decision to opt for secondary not primary prevention (ie relying on risk assessment and targeted interventions) rely on problematic assumptions. These are, that it is possible to predict which children will be problematic, that they can intervene effectively, using coercion if necessary, to change the course of children’s development, and that there will be adequate resources to meet the needs identified through screening. “It fails to consider what harm may be caused by the process of surveillance of families and by labelling children as future problems.”
When discussing policy it is assumed that there is objective truth about what is in a child’s best interests as well as objective standards of good parenting. There is no acceptance of the possibility of rational disagreement between a parent and a professional as to what is in the child’s best interests at a particular point in their lives. This failure is possibly the most serious problem with the UK policy.
“‘Power corrupts’ is a well-known truism but there is no acknowledgment of the possible danger of increasing State power over families. There is no recognition of the fact that liberal societies have placed a high value on privacy and confidentiality precisely because they present an obstacle to the State. While the State sees this in a negative light, the individual values it as a protection of their freedom. The professional ethic of confidentiality is seen by the government as an obstructive barrier to be removed in implementing their monitoring and assessment programme but this should remind us that the ethical principle is playing its rightful part as a protective barrier, defending the individual against excessive intrusion by the State.”
Read it in full: Confidentiality in a preventive child welfare system (Munro 2007)