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The impacts on paediatricians testifying in cases of child maltreatment: A systematic scoping review
Alyce Horstman1, J Anne S Smith1, Richard B Bassed2
1Victorian Forensic Paediatric Medical Service, Royal Children's Hospital, Melbourne, Australia; Department of Forensic Medicine, Monash University, Melbourne, Australia.
Insights
Pediatricians face significant psychological and professional challenges when testifying in child maltreatment cases. Greater training and systemic reforms are needed to support these expert witnesses.
Area of Science:
- Medical Law
- Child Protection
- Forensic Pediatrics
Background:
- Pediatricians act as expert witnesses in child maltreatment cases, providing crucial information on injury.
- The personal and professional impacts of this role on pediatricians are not well understood.
Purpose of the Study:
- To systematically review and synthesize research on the benefits and harms experienced by doctors, especially pediatricians, when testifying in child maltreatment cases.
- To identify the impacts on individual doctors, their relationships, professional lives, and society.
Main Methods:
- A systematic scoping review following PRISMA-ScR guidelines.
- Searched six databases: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts, and Cochrane Library.
- Extracted and categorized data across individual, relational, professional, and societal impact levels.
Main Results:
- Testifying presents significant psychological, professional, and systemic challenges for pediatricians.
- Concerns include fear of discreditation, negative courtroom experiences, inadequate training, financial losses, and strained relationships with legal professionals.
- These challenges can reduce pediatricians' willingness to engage in child maltreatment cases.
Conclusions:
- The review highlights the diverse impacts on pediatricians serving as expert witnesses in child maltreatment cases.
- There is a lack of interventions to mitigate negative personal and professional consequences.
- Enhanced education, policy reform, and intervention research are crucial to better support pediatricians in their expert witness roles.
Background:
Paediatricians serve as expert witnesses in child maltreatment cases, informing decision-makers about injury mechanisms, likely injury-dates, and consequences. Despite paediatricians' multifaceted role in responding to child maltreatment, the impacts on paediatricians of their involvement in legal processes are not well understood.
Objective:
This systematic scoping review identified and synthesized scientific research findings on the benefits and harms to doctors, particularly paediatricians, who testify in child maltreatment cases.
Population, Concept And Context:
Included studies focused on doctors (paediatricians and paediatricians-in -training) who were subpoenaed and/or testified in court on child maltreatment cases.
Methods:
Following PRISMA-ScR guidelines, six databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts, and the Cochrane Library. Data were extracted and categorized across four levels of impact: individual, relational, professional, and societal.
Results:
Testifying posed significant psychological, professional, and systemic challenges for paediatricians. Individually, they reported stress and dissatisfaction stemming from fears of discreditation, negative courtroom experiences, and perceptions of legal systems failing to protect children. Professionally, inadequate training and low confidence in testifying, coupled with financial losses and disruptions to clinical schedules, further compounded these difficulties. Systemically, strained relationships with legal professionals and insufficient familiarity with court procedures, alongside broader concerns about the legal process, contributed to a reduced willingness among paediatricians to report and engage in child maltreatment cases.
Conclusion:
This review highlighted the range of the impacts on paediatricians who were subpoenaed and/or testified in child maltreatment cases and absence of interventions that reduce negative personal and professional impacts. Across the profession there is a need for greater education and training, policy/practice reform to better support paediatricians in their roles as expert witnesses, and intervention research to evaluate strategies that might reduce negative impacts.
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