Tuesday, January 16, 2018

Grim T&T choice: Doing legal duty and surviving

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Mark Fraser

The defiant response by a prominent obstetrician and gynaecologist to cited legal obligations of medical personnel to report child rape should stir national discussion on ethical responsibility, law enforcement, and personal safety. Such concerns were urgently flagged in Dr Sherene Kalloo’s rejection of applicable law as a “hysterical and frenzied demand” upon doctors.

As reported in yesterday’s Express, Dr Kalloo saw only negative effects from doctors’ notifying police of any case that looks like child rape. To do so, she warned, would be to undermine patients’ trust and confidence in physicians. The result would lead those needing medical attention to opt for dangerous “backstreet abortions”.

Further, making understaffed hospital doctors keep court dates would only undermine service in those institutions. Worse, yet, their reporting of child rape could expose doctors to criminal retaliation. “Could the government assure us of our safety?” Dr Kalloo’s question resonates widely in today’s T&T.

Clearly, no silver-bullet solution exists to the problem implied in official reports that up to 2,500 teenage pregnancies annually occur.

But the inconvenient fact, as asserted by Senior Counsel Dana Seetahal, remains: “There is no question of confidentiality in this.” She cited Sexual Offences Act requirements that, under pain of fine or jail, doctors and nurses must report to police any sexual offence they reasonably recognise. “The public interest demands it and the law demands it,” the Senior Counsel wrote.

This was reaffirmed last week by Prime Minister Kamla Persad-Bissessar, and Margaret Sampson-Browne, head of the Police Victims and Witness Support unit. In T&T, however, legal realities contend against other realities, with none guaranteed to prevail.

Similar contention had arisen last year when cocaine pellets were surgically removed from a patient’s insides, but no report was made to police. About that episode, too, Ms Seetahal clarified: “No question of confidentiality or ethical choice arises. The medical practitioner must (report) or face a charge.”

To medical personnel discovering it, a bag of cocaine must have represented a criminal offence they were legally bound to report. A Medical Association official pointed, however, to a “gray area” in which ethical and legal obligations were not unmistakably identified for compliance.

In that cocaine case, too, on behalf of the medical personnel, the potential for criminal retaliation was brought up as a factor motivating against reporting. Common to the apprehensions expressed by Dr Kalloo, and on behalf of the cocaine-surgery medical personnel, is a presumed incapacity of the state to protect from harm people performing their legal duty.

Clearly, under the rule of law to which T&T is dedicated, compliance cannot be left to personal choice. But, as Dr Kalloo and colleagues are emphasising, the State must make it believably possible for people both to obey the law, and to survive.