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General practitioners' conflicts of interest, the paramountcy principle and safeguarding children: a psychodynamic contribution
  1. Adrian Sutton
  1. Correspondence to Dr Adrian Sutton, 90 Woodford Road Bramhall, Cheshire, SK7 1PB, UK; adrian.sutton{at}


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.

  • Applied and professional ethics
  • quality/value of life/personhood
  • minors/parental consent
  • interests of health personnel/institutions

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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