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J Med Ethics. 2011 Apr;37(4):254-7. doi: 10.1136/jme.2010.040394. Epub 2011 Feb 8.

General practitioners' conflicts of interest, the paramountcy principle and safeguarding children: a psychodynamic contribution.

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  • 190 Woodford Road Bramhall, Cheshire, SK7 1PB, UK.


Wainwright and Gallagher propose that when child protection concerns emerge significant difficulties arise for General Practitioners because of conflicts between the individual interests of children and parents who are their patients and the Paramountcy Principle. From a psychodynamic perspective their analysis does not give sufficient weight to the nature of personal as opposed to interpersonal conflict of a conscious or unconscious nature. When issues of major import arise, ordinary parenting inevitably involves parents in putting their children's needs first if competing possibilities occur. It is an over-simplification to present this as a conflict between the interests of children and parents. Parents' own best interests are served by securing their children's safety and welfare. An appreciation of this is crucial in order to implement child protection procedures appropriately. Errors may occur because the complex emotions and relationships involved lead professionals to experience themselves as potential agents of harm rather than benefit.

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