Ethical framework in clinical psychiatry

I found the philosophical discussions of Bloch & Green (2006) interesting, without necessarily revealing anything new. However, I was deeply concerned by the case used as an illustration. It appeared to reflect a rather paternalistic, single-professional, single-agency approach to child protection. Clinically this perspective can lead to serious mistakes. As named doctor for child protection for the Leicestershire Partnership NHS Trust I train other staff to seek advice from me and from the named nurse. There was no mention by Bloch & Green of statutory duties of care to the child. The fundamental principle of paramountcy was not mentioned. It was identified that with a mother with psychosis there was a significant risk of harm to the young child. Once this is identified, the children's social services department should be notified (Department of Health, 1999), and should take the lead role in carrying out Section 47 child protection enquiries. All agencies have a duty to assist in collating and sharing all relevant information, to update on the situation and assist in monitoring the child and providing additional support. Reder et al (1993) give many examples where information is known to one or two individuals in single agencies who fail to share it, resulting in the omission of any child protection plan. If anything seriously untoward were to happen to the baby, a thorough case review would be undertaken by the area child protection committee/local safeguarding board and a doctor could potentially be found negligent for failing to carry out child protection procedures. I wonder whether this highlights the need for many doctors to update their child protection training?