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Editor,—Shabde and Craft1 have misunderstood several issues addressed by Foreman and Farsides.2 Consequently, they make recommendations that could lead to children being exposed to unnecessary risk.
The biggest ethical difficulty in covert video surveillance (CVS) is not that of breach of trust. It is the risk of harm to the child, who becomes a tethered goat, set to catch a tiger. These risks are not small.3 This makes CVS an investigation of last resort, as the “double effect” defence preferred by Shabde and Craft implies. Breach of trust is important to the extent that one must have good reason to break trust. Foreman and Farsides first demonstrated that this criterion was effectively the same as the burden of proof for action under The Children Act.4 Therefore, all cases for which CVS may be justified can also be referred to court. Secondly, medical expertise lies primarily in securing children's health, while children's welfare determines protection issues. So doctors, while being important participants in the process, cannot claim a privileged position in determining the outcome of child protection procedures.
Shabde and Craft recommend that CVS be used to ensure that court action is sufficient to protect the child. The Children Act makes protection of the child of paramount importance to the court. Shabde and Craft do not know whether (a) the court will take the same view as themselves, or (b) whether the court will be incorrect if it takes a different view. Clearly, successful court disposal is safer than CVS, and must be preferred as a first choice. Of course, courts are not always right. Foreman and Farsides agreed that CVS was ethical in restricted circumstances. If there was good reason to think that a court disposal was failing to protect the child, CVS might thenbe ethical to obtain the evidence needed for additional action.
Finally, Shabde and Craft persist in the error of calling CVS a diagnostic investigation, when in fact it is a forensic investigation used to detect a crime. Doctors merely administer it. This leads them to claim that CVS might be used to “prevent the separation of children from innocent parents”. All a negative finding shows is that no offence was recorded while the cameras were running. In these circumstances, CVS may be providing no more than a false sense of security.
Dr Shabde and Dr Craft comment:
We would like to reply to Dr Foreman's comments. He seems to have misunderstood the thrust of our arguments for and against CVS.
We believe that if operated under a strict and rigorous multiagency protocol, the risk to the child undergoing CVS is minimal. Southallet al demonstrated justifiable use of CVS for investigation of an apparent life threatening event in their series where abuse was revealed in 33 with attempted suffocation in 30 patients.
It has been suggested that The Children Act 1989 alone is sufficient to protect children with possible induced illness syndrome. It must be recognised that although there may be enough grounds for legal proceedings, courts may decide to make a supervision order or no order at all, unless an appreciable level of risk is shown and the child may be returned to his or her parents to face the same risk. We do not agree that if there was good reason to think that a court disposal was failing to protect the child, CVS might then be ethical to obtain the evidence needed for additional actions. Surely this is then too late.
Of course a negative finding on CVS shows that no offence was recorded while the camera was running but we strongly contend that CVS needs to be available as an investigative and assessment tool (not merely a diagnostic tool) that can be used for some forms of factitious/induced illness syndrome where there is serious risk of life threatening abuse. We reiterate that it must only be done in the context of adequate child protection procedures which include full child and family assessment, and that staff must be properly trained.