Nontreatment decisions for severely compromised newborns

The authors draw on Kipnis' experiences in the clinical presentation of ethical problems arising in a newborn intensive care unit to analyze substantive criteria for decisions to stop life prolonging treatment and to determine the limits of parental authority to decide for nontreatment. They identify three decisions--treatment obligatory, treatment discretionary, and nontreatment obligatory--and apply the criteria of patient burdens and capability for a subjectively valuable life to each. Kipnis and Williamson consider parental authority to be a custodial role which should be assumed by others if the parents are unable or unwilling to secure for the child a subjectively valuable life.     

Strength of evidence, judged probability, and choice under uncertainty

This paper traces, within subjects, the relationship between assessed strength of evidence, judgments of probability, and decisions under uncertainty. The investigation relies on the theoretical framework provided by support theory (Tversky & Koehler, 1994; Rottenstreich & Tversky, 1997), a nonextensional model of judgment under uncertainty. Fans of professional basketball (N = 50) judged the probability that each of eight teams, four divisions, and two conferences would win the National Basketball Association championship. Additionally, participants rated the relative strength of each team, judged the probability that a given team would win the championship assuming a particular pairing in the finals, priced prospects contingent on the winner of the championship, and made choices between chance prospects. The data conformed to the major tenets of support theory, and the predicted relationships between assessed strength of evidence, hypothetical support, judged probabilities, and choices under uncertainty also held quite well.     

Parental Rights

ABSTRACT This paper is concerned with the philosophical foundations of parental rights. Some commonly held accounts are rejected. The question of whether parental rights are property rights is examined. It is argued that there are useful analogies with property rights which help us to see that the ultimate justification of parental rights lies in the special value of parenthood in human life. It is further argued that the idea of generation is essential to our understanding of parenthood as having special value and that parental rights properly belong, in the first instance, to natural parents.     

Whose Rights Count? Negotiating Practice,Policy, and Legal Dilemmas Regarding Infant–Parent Contact When Infants are in Out‐of‐Home Care

This article takes a human rights perspective with a view to articulating the infant's perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well‐being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow‐up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infant–parent attachment relationships as well as infant mental health to illuminate the infant's subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often associated with contact.     

Three types of freedom 1

Freedom interpreted as absence of restraints, as such, is a vacuous ideal. It requires reference to some setting and course of action in order to distinguish those restraints that block human effort from those, say, that support it. More broadly, this notion of freedom has little meaning and less value without some external criterion for evaluating human action and its conditions. Many thinkers have argued that the. criterion must be the absolute Truth — truth that is unconditioned, indubitable, and imperative. They have often argued that there is no freedom of error, and that the many persons who do not know such Truth are free only in obeying the few who do. This concept of freedom is often regarded as intolerable. A third possibility is to interpret freedom as a name for a range of significant alternatives for thought and action. Freedom, here, is compatible with truth interpreted in terms of the process of inquiry, rather than as substantive possession. It is a necessary condition for judging which restraints are real obstacles and which courses of action may be harmless, legitimate or good. The third meaning, especially, is illustrated with reference to the freedoms of utterance (expression) and speech (communication).     

From the casino to the jungle

Clear-cut cases of decision-making under risk (known probabilities) are unusual in real life. The gambler’s decisions at the roulette table are as close as we can get to this type of decision-making. In contrast, decision-making under uncertainty (unknown probabilities) can be exemplified by a decision whether to enter a jungle that may contain unknown dangers. Life is usually more like an expedition into an unknown jungle than a visit to the casino. Nevertheless, it is common in decision-supporting disciplines to proceed as if reasonably reliable probability estimates were available for all possible outcomes, i.e. as if the prevailing epistemic conditions were analogous to those of gambling at the roulette table. This mistake can be called the tuxedo fallacy. It is argued that traditional engineering practices such as safety factors and multiple safety barriers avoid this fallacy and that they therefore manage uncertainty better than probabilistic risk analysis (PRA). PRA is a useful tool, but it must be supplemented with other methods in order not to limit the analysis to dangers that can be assigned meaningful probability estimates.     

Maternal Intrusiveness,Family Financial Means,and Anxiety Across Childhood in a Large Multiphase Sample of Community Youth

Intrusive parenting has been positively associated with child anxiety, although examinations of this relationship to date have been largely confined to middle to upper middle class families and have rarely used longitudinal designs. With several leading interventions for child anxiety emphasizing the reduction of parental intrusiveness, it is critical to determine whether the links between parental intrusiveness and child anxiety broadly apply to families of all financial means, and whether parental intrusiveness prospectively predicts the development of child anxiety. This study employed latent growth curve analysis to evaluate the interactive effects of maternal intrusiveness and financial means on the developmental trajectory of child anxiety from 1st grade to age 15 in 1,121 children (50.7 % male) and their parents from the NICHD SECCYD. The overall model was found to provide good fit, revealing that early maternal intrusiveness and financial means did not impact individual trajectories of change in child anxiety, which were stable from 1st to 5th grade, and then decrease from 5th grade to age 15. Cross-sectional analyses also examined whether family financial means moderated contemporaneous relationships between maternal intrusiveness and child anxiety in 3rd and 5th grades. The relationship between maternal intrusiveness and child anxiety was moderated by family financial means for 1st graders, with stronger links found among children of lower family financial means, but not for 3rd and 5th graders. Neither maternal intrusiveness nor financial means in 1st grade predicted subsequent changes in anxiety across childhood. Findings help elucidate for whom and when maternal intrusiveness has the greatest link with child anxiety and can inform targeted treatment efforts.     

Parent–Child Informant Discrepancy is Associated with Poorer Treatment Outcome

In child clinical psychology, parent and child reports are typically used to make treatment decisions and determine the effectiveness of treatment. However, there are often moderate to large discrepancies between parent and child reports, and these discrepancies may reflect meaningful information about the parent, the child, and the parent–child relationship. Additionally, parent–child discrepancy may predict treatment outcome. This study examined parent–child discrepancy in a sample of 62 children (10.15±1.26 years old) with prominent social competence deficits and mixed diagnoses who were treated with a resilience-based, cognitive–behavioral group therapy program (the Resilience Builder Program) in a private clinical setting. Further analyses were conducted to investigate whether parent–child discrepancy related to treatment outcome. Consistent with the literature, prominent parent–child discrepancy was found across domains, with parents generally reporting more severe symptomatology. Treatment with the Resilience Builder Program resulted in significant improvement in parent report of multiple domains of functioning, including resilience, social skills, and emotion and behavior regulation. Importantly, larger parent–child discrepancy at the start of therapy was predictive of poorer overall treatment response. Given its impact on therapeutic effectiveness, these results suggest that parent–child disagreement regarding the child’s impairment at the onset of therapy is worthy of assessment prior to treatment, and may itself be a topic worthy of targeting in treatment.     

Loss aversion in the eye and in the heart: The autonomic nervous system's responses to losses

The common view in psychology and neuroscience is that losses loom larger than gains, leading to a negativity bias in behavioral responses and Autonomic Nervous System (ANS) activation. However, evidence has accumulated that in decisions under risk and uncertainty individuals often impart similar weights to negative and positive outcomes. We examine the role of the ANS in decisions under uncertainty, and its consistency with the behavioral responses. In three studies, we show that losses lead to heightened autonomic responses, compared to equivalent gains (as indicated by pupil dilation and increased heart rate) even in situations where the average decision maker exhibits no loss aversion. Moreover, in the studied tasks autonomic responses were not associated with risk taking propensities. These results are interpreted by the hypothesis that losses signal the subjective importance of global outcome patterns. Copyright © 2010 John Wiley & Sons, Ltd.     

Child,parent, and peer predictors of early-onset substance use: a multisite longitudinal study

The purpose of this study was to identify kindergarten-age predictors of early-onset substance use from demographic, environmental, parenting, child psychological, behavioral, and social functioning domains. Data from a longitudinal study of 295 children were gathered using multiple-assessment methods and multiple informants in kindergarten and 1st grade. Annual assessments at ages 10, 11, and 12 reflected that 21% of children reported having initiated substance use by age 12. Results from longitudinal logistic regression models indicated that risk factors at kindergarten include being male, having a parent who abused substances, lower levels of parental verbal reasoning, higher levels of overactivity, more thought problems, and more social problem solving skills deficits. Children with no risk factors had less than a 10% chance of initiating substance use by age 12, whereas children with 2 or more risk factors had greater than a 50% chance of initiating substance use. Implications for typology, etiology, and prevention are discussed.     

What do category-specific semantic deficits tell us about the representation of lexical concepts?

A reassessment of category-specific semantic deficits in light of their contribution to a theory of the representation of lexical concepts is proposed. Two theories are examined: one, held by the majority of researchers in the field, claims that concepts are represented by sets of features; another, in contrast, claims that concepts are atomic representations. An analysis of category-specific semantic deficits in terms of inferential relations (of the meaning-postulates type) between atomic concepts is elaborated. It is argued that this theory can better account for the pattern of performance exhibited by patients with semantic deficits.     

Parental Stress and Children’s Social and Behavioral Outcomes: The Role of Abuse Potential over Time

Parental stress is a well-established risk factor for adverse child outcomes, including the development of aggression, externalizing behavior problems, and anxiety, as well as compromised emotional coping, impaired social cognition, and diminished treatment response. Abuse potential represents a mechanism by which parental stress may impact child social competence and behavior; evidence links parental stress to abuse potential, and abuse potential to a range of negative child social competence and behavioral outcomes. The current study assessed relationships between parental stress, abuse potential, and child social and behavioral outcomes over time. Parents of children ages 2–6 years (N?=?610, 44% girls) reported on perceived parental stress and attitudes towards abuse and neglect, as well as child social competence and behavior problems, before and after a caregiver-directed, community-based intervention. Changes in parental stress, abuse potential, and child social and behavioral outcomes were examined using panel analyses, while controlling for intervention effects and demographic variables. Parental stress predicted child social competence, anxiety/withdrawal, and anger/aggression over time; while the links between stress and anxiety/withdrawal, and stress and social competence, were mediated by child abuse potential, the link between stress and anger/aggression was not mediated by child abuse potential. Findings suggest that abuse potential represents a mechanism by which parental stress and child social and behavioral outcomes are linked. Further, screening for child social competence deficits may identify children at risk for abuse, as well as parents in need of services to reduce stress.     

Parental Cooperation with Social Services and Termination of Parental Rights in Israeli Court Cases of Child Maltreatment

Parental cooperation with social services in child maltreatment cases is fundamental to all forms of family intervention. If rehabilitation efforts fail and the child cannot be safely reunified with his parents, the state is authorized to initiate termination of parental rights (TPR) proceedings. Given the scant literature on parental cooperation and TPR, the present study examined associations between parental cooperation and TPR in Israeli court cases of child maltreatment. Comparisons between uncooperative (n = 106) and cooperative parents (n = 155) revealed that uncooperative parents were more than three times more likely to have their parental rights terminated than cooperative parents, controlling for child and parent characteristics. Parents who did not cooperate with social services had high levels of mental health problems, substance abuse, criminal records, and poverty and their children had more mental health concerns and suffered more from neglect. We discuss the important implications resulting from these findings, which include: the need to view the engagement of parents in the child welfare process as a specific goal in itself and develop research-based models specifically targeting multiple-problem families at high risk of TPR; the need for professionals to build a good working alliance with parents in order to strengthen their participation; the need to take into account different background conditions and stressors related to the parents in order to facilitate greater cooperation; and the need to assess the potential mental health needs of children involved in cases of maltreatment with low parental cooperation.     

SLOTE'S SATISFICING CONSEQUENTIALISM

The article discusses Michael Slote's Satisficing Consequentialism, which is the view that moral agents are not required to maximise the good, but merely to produce a sufficient amount of good. It is argued that Satisficing Consequentialism is not an acceptable alternative to Maximising Consequentialism. In particular, it is argued that Satisficing Consequentialism cannot be less demanding in practice than Maximising Consequentialism without also endorsing a wide range of clearly unacceptable actions. It is then argued that Slote's inability to provide adequate reasons for moral satisficing stems from a mistaken analogy between rationality and morals. The sense of ‘good enough’ which is relevant to morality is one which focusses on the effort an agent puts in, rather than on the outcome she produces. However, replacing outcomes with efforts would undermine Slote's Consequentialist project. Finally, it is suggested that similar problems will be faced by others who seek to construct essentially Consequentialist theories which are not unduly demanding.     

Gamete donation and parental responsibility

Abstract Unlike surrogacy and cloning, reproduction via gamete donation is widely assumed to be morally unproblematic. Recently, a number of authors have argued that this assumption is mistaken: gamete donors, they claim, have parental responsibilities that they typically treat too lightly. In this paper I argue that the 'parental neglect' case against gamete donation fails. I begin by examining and rejecting the view that gamete donors have parental responsibilities; I claim that none of the current accounts of parenthood provides good reason for ascribing parenthood to gamete donors. I then argue that even if gamete donors do have parental responsibilities for 'their' children, it is not clear that they treat these responsibilities too lightly. I conclude the paper by examining the wider question of just what kind of responsibilities gamete donors might have towards the children that they have a role in creating.     

Parental Experiences of Having a Child with Obsessive-Compulsive Disorder: Associations with Clinical Characteristics and Caregiver Adjustment

We examined parental experience of having a child with obsessive-compulsive disorder (OCD) in 62 parent–child dyads. Youth with a primary diagnosis of OCD and their parent(s) were administered the CY-BOCS jointly by a trained clinician. Parents completed several measures about their child’s OCD-related impairment and accommodation, emotional and behavioral functioning, parental distress, caregiver stress, and parental experiences of having a child with OCD. Results indicated that parents of children with OCD are considerably distressed about their child’s condition. As expected, negative parental experiences (e.g., anxiety about child’s condition, uncertainty about their future) were directly related to OCD symptom severity and impairment, as well as child internalizing and externalizing problems, family accommodation of symptoms, and caregiver strain. The presence of emotional resources was negatively related to most outcomes, although some of these relationships did not achieve statistical significance. The presence of internalizing symptoms mediated the relationship between parental experiences and parental distress. Given these findings, addressing parental experiences as part of a family based cognitive-behavioral treatment program for pediatric OCD may help reduce parental distress and improve patient prognosis.     

In Defence of State Directed Enhancement

This article considers the ways in which a liberal society ought to view the potential to cognitively or physically enhance children. At present, the dominant approach in the literature is to leave this decision to parents. I suggest that the parental choice approach is often inadequate and fails to account properly for the interests of children and wider society in enhancement decisions. Instead I suggest that the state should play a greater role in determining when, and how, to enhance. To make this case, I compare the case of enhancement with existing practices of education, an area in which the state already plays a significant role. Finally I suggest that some concerns with a statist approach are not as serious as has been argued.     

Family Contexts: Parental Experiences of Discrimination and Child Mental Health

Research on the mental health correlates of discrimination traditionally has been intra-individual, focusing exclusively on the individual directly experiencing discrimination. A small number of studies have begun to consider the links between parental experiences of discrimination and child mental health, but little is known about potential underlying mechanisms. The present study tested the independent mediating effects of parent mental health and household socioeconomic status on the associations between parental experiences of discrimination (past-year perceived discrimination and perceptions of being unaccepted culturally) and child mental health (internalizing and externalizing symptoms) using a bootstrapping analytic approach. Data were drawn from racial/ethnic minority (n = 383) and White (n = 574) samples surveyed in an urban Midwestern county. For all measures of discrimination and child mental health, findings supported an association between parental experiences of discrimination and child mental health. Whereas parent mental health served as a significant mediator in all analyses, socioeconomic status did not. Mediation findings held for both the White and racial/ethnic minority samples. Results suggest that parental experiences of discrimination and mental health may contribute to child mental health concerns, thus highlighting the role of family contexts in shaping child development.     

Personal efficacy, external locus of control, and perceived contingency of parental reinforcement among depressed, paranoid, and normal subjects

Bandura (1982) suggested that judgments of personal efficacy and outcome expectancies (i.e., locus of control) jointly affect behavior. We hypothesized that different combinations of these two sets of beliefs would characterize the thought structures of normal subjects and of psychiatric patients suffering from distinctly different disorders. Normal subjects, depressed subjects, and paranoid subjects completed scales with which we measured beliefs in personal efficacy and beliefs that outcomes are controlled either by chance or by powerful others, as well as a scale with which we assessed perceived contingency of parental reinforcement. The major findings were as follows: Normals judged themselves to be more efficacious than did psychiatric subjects; whereas depressives expected outcomes to be controlled by chance, paranoids expected outcomes to be under the control of powerful others; among the normals, outcome expectancies were strongly associated with personal efficacy, but among the psychiatric patients, these beliefs were unrelated; depressives and paranoids equally reported more noncontingent parental reinforcement than did normals; and perceived contingency of parental reinforcement was predictive of outcome expectancies but not of personal efficacy. The data suggest that low personal efficacy may be a distinguishing characteristic of all psychiatric patients, whereas outcome expectancies may determine the specific nature of the psychiatric disorder.