MONTREAL – A Quebec pediatrician whose work has been credited with helping to pass that province's first child protection legislation 25 years ago has called on physicians to address the issues at the core of violence against children and youth.
"Despite all the progress that child and youth protection laws have made possible, we have unfortunately still not successfully eliminated the violence children are subjected to, nor the underlying problems," said Dr. Gloria Jéliu, who was recently awarded the 2004 Victor Marchessault Advocacy Award of the Canadian Pediatric Society.
"We must continue our efforts and work farther upstream to eliminate the problems that we call 'risk factors,' meaning the poverty, the isolation and breakdown of families, the disappearance of support systems and more. Prevention and assistance for young parents must become the focus of our efforts."
Dr. Jéliu, a pediatrician at l'Hôpital Ste-Justine and emeritus professor of pediatrics at the Université de Montréal, also urged doctors who care for children to take the lead in addressing the question of corporal punishment.
Use of reasonable force justified
Earlier this year, the Supreme Court of Canada ruled that section 43 of the Criminal Code is constitutional. That section provides that a parent, teacher or person acting in the place of a parent is justified in using force to correct a child under his or her care provided the force used is reasonable.
The pediatric society was disappointed in the court's ruling that section 43 does not violate a child's rights to security of the person and equality, and is not cruel and unusual punishment. Specifically, the court held, in its January decision, that section 43 ensures that criminal law applies to any use of force that harms a child, but does not apply where the use of force "is part of a genuine effort to educate the child, poses no reasonable risk of harm that is more than transitory and trifling, and is reasonable under the circumstances."
The society strongly discourages the use of physical punishment on children, including spanking, and maintains that appropriate discipline techniques should be based on teaching and guiding, not just forcing children to obey. A statement from the society noted that physical redirection or restraint to support time-out or to prevent a child from harming himself or others may be necessary, but that it should be done carefully and without violence.Â
"Everyone now considers the rights of children to be of the utmost importance and international interest," Dr. Jéliu said. "The collective realization is such that in debates like the one that occurred surrounding the recent decision by the Supreme Court of Canada concerning article 43 of the Criminal Code, Canadians were deeply divided."
Physicians must take lead
"In this regard, I believe that the population is waiting for us, the physicians whose specialty is children, to address the issue so they can make an enlightened opinion."
Dr. Jéliu was given the advocacy award in recognition of her work in influencing political and judicial authorities on issues related to the protection of children in Quebec.
The statement announcing the award noted that in 1972 she founded the Clinique de protection de l'enfance at l'Hôpital Ste-Justine, one of the first if its kind in Quebec. That same year she made a presentation to the Commission parlementaire permanente des Affaires sociales du Québec that later led to the creation of the Comité québecois pour la protection de la jeunesse.
"Early in the 1970s, as the Quiet Revolution in Quebec was drawing to a close, I, along with some colleagues, was one of the first to make the medical profession aware of the diagnostic signs of abuse," Dr. Jéliu said in accepting the award at the society's annual meeting here last month.
"In those days, we were a few years behind the U.S., which for some time had begun to denounce the mistreatment and abuse of children. In those years, children were still considered the property of their parents. But the words of the French physician and psychoanalyst Dr. Françoise Dolto would soon permeate the education and health-care systems.
"The efforts of a few individuals to make people more aware were well received and coincided with the intention of the government of the time to provide tools for people working to protect children. This was accomplished with the introduction of the first youth protection laws in Quebec (the Youth Protection Act) whose 25th anniversary we have just celebrated."
The advocacy award, sponsored by the Children's Hospital of Eastern Ontario Foundation, was first given in 2002, and is presented every other year. It was renamed for Dr. Victor Marchessault after his death last year (see the Medical Post, July 15, 2003). A pediatric infectious disease specialist, he had been the society's executive secretary from 1964 to 1997.
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