Mental Health and Justice: ethical issues related to incest and pedophilia

Abstract

Sexual abuse is a problem that must be addressed by both the health and justice systems. A recent situation involving a ten-year-old child who was raped by her uncle and wished to terminate the pregnancy sparked off intense debate. The procedure was widely covered by the media and exposed on social networks, and while attention was turned to moral and ethical issues, the child and her family’s suffering was neglected, leading to more abuse beyond the sexual violence. Using this case as an example, this work aims to discuss the differences between incest and pedophilia and the possibilities of addressing and treating them. The Sexual Abuse Study and Treatment Center (CEARAS) of the University of São Paulo Medical School has been studying the subject and assisting families with reported cases of intrafamilial sexual abuse since 1993. This experience has shown specific characteristics of incest that characterize it as a dysfunctional family dynamics, whereas pedophilia is an individual disorder. Distinguishing pedophilia and incest is fundamental, since in the latter the whole family must adhere to the treatment to interrupt the cycle of violence. An ethical approach to child sexual abuse requires suspending moral judgements so that all the human relationships involved may be understood. The coordinated action of mental health services and the justice system when dealing with incest and pedophilia tends to be more effective. Treating the whole family in cases of incest and the individual in cases of pedophilic disorder contributes to the prevention of sexual abuse.