Gerald P. Koocher

Children’s Competence to Consent

The question of children’s competence to give or refuse consent1 is of largely recent origin (see Chapter 9). Until the mid-sixties it was not clear that children were “persons” within the meaning of the Fourteenth Amendment, which makes the Bill of Rights applicable to the states. Although there were several early-twentieth-century “children’s rights” cases decided by the United States Supreme Court,2 each of these could be construed as a vindication of parents’ liberty interest in childrearing as they saw fit (Melton, 1982). In none of the early cases was there a clear indication of minors’ possessing constitutionally protected fundamental liberties independent of their parents. Children were perceived as properly dependent upon their parents who possessed a “right of control” over them.3 Even though parents’ rights in this regard are limited by the fact that they are not “free … to make martyrs of their children,’4 this restriction emanated from the state’s interest in the socialization of children.5 Indeed, the Supreme Court had held that it “would hardly seem open to question” that the state could impinge on basic freedoms of minors (e.g., freedom of religion) in ways that would be clearly unconstitutional if the same restrictions were placed on adults.6 Given clear indications that both parents and the state as parens patriae 7 could exercise control over minors (see Chapter 9 for additional discussion), the question of the limits of children’s actual competence to make personal decisions was moot.

Psychiatric sequelae of surviving childhood cancer.

Increasing survival rates for children with cancer raise questions about the long-term psychosocial impact of the disease and its treatment. Psychiatric evaluations of 114 survivors of childhood malignancies suggest a high rate of adjustment problems, with 59% indicating at least mild psychiatric symptomology. Interviews with former patients highlight the importance of adaptive denial in the face of the uncertainty connected with cancer survival.

PSYCHOLOGICAL SCIENCE AND THE USE OF ANATOMICALLY DETAILED DOLLS IN CHILD SEXUAL-ABUSE ASSESSMENTS

Many devices are used in child assessment and treatment as communication aids, projective tools, and symbolic means of interaction. None are as hotly debated in their application among mental health professionals as dolls with genital details. Anatomically detailed (AD) dolls are often used in sexual-abuse evaluation and treatment with children, but such applications are controversial. This article is the product of a working group formed to review AD doll research and practice. This article reviews historical use of dolls in clinical inquiry and research on sexual behaviors in children, normative use of AD dolls in nonreferred children, differences in childrens play behavior and emotional reactions to AD dolls, and memory and suggestibility issues relating to AD-doll use. Recommendations for future research are provided.

What scientists want from their research ethics committee.

Whereas investigators have directed considerable criticism against Institutional Review Boards (IRBs), the desirable characteristics of IRBs have not previously been empirically determined. A sample of 886 experienced biomedical and social and behavioral scientists rated 45 descriptors of IRB actions and functions as to their importance. Predictions derived from organizational justice research findings in other work settings were generally borne out. Investigators place high value on the fairness and respectful consideration of their IRBs. Expected differences between biomedical and social behavioral researchers and other variables were unfounded. Recommendations are offered for educating IRBs to accord researchers greater respect and fair treatment.

The IRB Paradox: Could the Protectors Also Encourage Deceit?

The efforts of some institutional review boards (IRBs) to exercise what is viewed as appropriate oversight may contribute to deceit on the part of investigators who feel unjustly treated. An organizational justice paradigm provides a useful context for exploring why certain IRB behaviors may lead investigators to believe that they have not received fair treatment. These feelings may, in turn, lead to intentional deception by investigators that IRBs will rarely detect. Paradoxically, excessive protective zeal by IRBs may actually encourage misconduct by some investigators. The authors contend that, by fostering a climate in which investigators perceive that they receive fair and unbiased treatment, IRBs optimize the likelihood of collegial compliance with appropriate participant protections.

Discredited Psychological Treatments and Tests: A Delphi Poll

In the context of intense interest in evidence-based practice (EBP), the authors sought to establish consensus on discredited psychological treatments and assessments using Delphi methodology. A panel of 101 experts participated in a 2-stage survey, reporting familiarity with 59 treatments and 30 as

Peers nip misconduct in the bud

A new survey shows that informal intervention can often avert much irresponsible scientific behaviour, and is not as risky as people might fear, say Gerald Koocher and Patricia Keith-Spiegel.

Psychosocial issues during the acute treatment of pediatric cancer.

Facilitating the psychosocial adjustment of the child with cancer begins at the time of diagnosis. This paper reviews the current status of psychosocial research and interventions useful during the acute phase of cancer treatment. Factors related to a favorable adaptation include the childs understanding of what is happening and the ability of the family to provide emotional support. Recent data suggest that a childs adjustment is closely linked to the social supports available to the parents and to parental distress levels. Continued progress has been made in the use of psychological techniques to control the behavioral side effects of chemotherapy and childrens distress levels during painful medical procedures. New research has also identified a number of factors related to treatment refusal and noncompliance among adolescent cancer patients. These new developments provide a basis for programs aimed at preventing or reducing the psychosocial problems of the child and family facing pediatric cancer. Cancer 58:468‐472, 1986.

Ethical and Legal Considerations for Internet-Based Psychotherapy

The provision of mental health services over the Internet is becoming increasingly commonplace as new technologies continue to develop. Evidence in support of the efficacy of many such interventions is accumulating. Given the potential global reach of Internet-based psychological services, the authors examine ethical issues relating to this growing area of practice through the lens of the Universal Declaration of Ethical Principles for Psychologists (International Union of Psychological Science, 2008). They also raise issues relating to potential liability risks and offer recommendations intended to guide mental health practitioners who are considering involvement in the provision of Internet-based services.

Questionable Methods in Alcoholism Research.

Alcoholism research paradigms that use substantial cash incentives to attract participants and that call for inducing alcoholics to consume ethanol in the laboratory raise significant ethical questions. Nonalcoholic family members observing such study methods may also suffer subtle emotional anguish by virtue of their participation. When using such questionable methods, investigators should be obligated to discuss their risk-benefit rationales and detail their precautionary behaviors to protect participants. Discussion of these ethical problems should be mandatory in any publications resulting from such research paradigms.