Personal and family ethics

Mary is a 41-year-old single mother of four children, ages 11, 7, 5, and 2. She recently moved with her children to a new state 1,200 miles away from their previous place of residence, in part due to a history of significant domestic violence perpetrated by her former partner and father of two of her children.

You are a general pediatrician who sees Mary’s 2-year-old child for a bilateral ear infection. During the course of the visit, it is disclosed that she is leaving her children under the care of her 11-year-old most evenings at 5 pm in order to attend her shift as a medical assistant in a nursing home 30 minutes from their apartment. She returns home at approximately 7 am after her shift.

You counsel Mary that in this state, the law states that the minimum age at which children may be allowed to stay home unattended is 12, and that children should be 15 or older in order to care for younger children unattended. She responds tearfully that she cannot afford childcare for her children while she works the night shift, and she has been unable to obtain a position that would allow her to provide for her family and afford childcare while at work. Furthermore, given the current COVID-19 pandemic, she expresses many fears, including the following: that a caregiver other than herself could expose her children to the novel coronavirus; that if this were to happen, she herself could transmit the virus to the patients at the nursing home; and that if she loses her job, she will be unable to provide basic necessities for her children.

Questions:

1. Is it ethically imperative for you to file a report about Mary’s family with your state’s Child Protective Services?

2. How can clinicians navigate the changing landscape of “usual practice” and “acceptable risk” in the age of COVID-19?