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The Spectrum of Intent in Fatal Child Abuse-Reply

Michael Durfee, MD; George Gellert, MD, MPH, MPA; Deanne Tilton-Durfee
JAMA. 1992;268(18):2518. doi:10.1001/jama.1992.03490180049022.
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In Reply.  —McClain et al state that they did not use the word "intentional" to describe their data on child abuse and neglect, thereby raising an important issue about nomenclature. Their estimate may include cases that are "completely unintentional." They state that "it is not as important to assign blame as it is to identify addressable risk factors."We regret this misquote but are left with a dilemma. What terms should be used to differentiate fatal child abuse and neglect from child deaths unrelated to abuse or neglect? Perhaps it would be more useful to address the "responsibility" of behavior rather than the "intent" of thought.This still leaves us with a judgment as to what distinguishes an individual case of fatal child abuse and neglect from other deaths. For an individual case we may still want to address our judgment of the caretaker's apparent intent as we make our


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