Informed consent in the psychosis prodrome: ethical,procedural and cultural considerations

Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts.     

Some ethical and legal issues in Germany involving informed consent and patenting

This paper elaborates on discussions in Germany regarding some of the ethical and legal issues in the area of the use and patenting of inventions involving human tissue. The issues discussed pertain to the benefits and problems regarding informed consent and the issue of property rights as they relate to the donation of cells and tissue. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004.     

Capacity to consent to or refuse treatment and/or research: theoretical considerations

This article discusses theoretical dimensions of competency to consent to or refuse treatment and/or research. We will consider a number of issues. Our first subject is the nature of assessments of competency-their empirical, normative, and conceptual aspects. We then discuss how we should divide up the components of capacity-understanding, appreciation, reasoning, and evidencing a choice; how we should understand these different components; and whether all are indeed necessary. We discuss where to draw the line between capacity and incapacity on each of the four elements of capacity. We ask whether we should have a variable competency standard, either in general or in different contexts (e.g. treatment versus research). Finally we consider the role of mental illness in competency assessments.     

Parental consent for psychological evaluations: Legal,ethical and practical considerations

This article explores the legal, ethical, and practical considerations underlying the requirement for acquiring parental consent prior to a psychological assessment of children in school settings. Publ. L. 94-142 now mandates that parents for all children potentially labeled as handicapped give permission for a preplacement evaluation. This article reviews in detail specific aspects of that mandate, argues that this procedure be generalized to all situations where psychologists propose to evaluate children by reviewing both current ethical codes and standards for practice and public policy which favors such an undertaking. Finally, the authors indicate methods for implementing the mandate by discussing such issues as who should obtain consent and what information parents should receive prior to giving consent.     

Qualitative research in multicultural psychology: philosophical underpinnings, popular approaches, and ethical considerations

This article reviews the current and emerging status of qualitative research in psychology. The particular value of diverse philosophical paradigms and varied inquiry approaches to the advancement of psychology generally, and multicultural psychology specifically, is emphasized. Three specific qualitative inquiry approaches anchored in diverse philosophical research paradigms are highlighted: consensual qualitative research, grounded theory, and participatory action research. The article concludes by highlighting important ethical considerations in multicultural qualitative research.     

Sexual modification therapies: ethical controversies, philosophical disputes, and theological reflections.

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available "treatments" are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation.     

Objective assessment of covert antisocial behavior: predictive validity and ethical considerations

Although less observable than the overt actions of fighting and assault, covert antisocial behaviors such as stealing and property destruction comprise an important subclass of externalizing behavior patterns, displaying considerable predictive power toward delinquency in adolescence. I discuss a laboratory paradigm for objective observation of such behaviors in children that has shown impressive concurrent and predictive validity among samples of boys with and without attention deficit hyperactivity disorder. Addressed herein are crucial questions regarding the ethics of tempting children to steal objects and small amounts of money and to deface property as well as the types of informed consent and debriefing procedures utilized in research with this paradigm. Weighing ethical considerations alongside the ability to predict delinquent behavior presents provocative issues for those interested in understanding the development of antisocial behavior.     

Skinner and the rise of behavior modification and behavior therapy

Skinner is, without a doubt, one of the most predominant figures in the development of Behavior Modification and Behavior Therapy. Skinners' work is essential to the development of Behavior Modification and Behavior Therapy. Beginning with the social need for efficient psychotherapy, and after having generated a solid theoretical body of behavioral laws, Skinner indicated and also developed the appropriate path towards efficient interventions for unadaptive behavior. He developed a new theory regarding abnormal behavior (psychopathology), as well as a procedural model for evaluation (diagnosis) and intervention: "The functional analysis of behavior". His applications for this kind of work are pioneering and at the same time, he is the agglutinant figure of what we today call "Behavior Modification and/or Therapy". It is remarkable that a scientist could change the theories and practices of a discipline as radically as Skinner and his work did. His work, however, still has its limitations. The best way to acknowledge and pay tribute to Skinners' work is to overcome these limitations.     

Freud's philosophical inheritance: Schopenhauer and Nietzsche in Beyond the Pleasure Principle

This essay explores the possible significance of Freud's references to Schopenhauer and Nietzsche in Beyond the Pleasure Principle. It attempts to reveal two sides of Freud's philosophical inheritance and explores the structure of Freud's ambivalence toward his intellectual predecessors.     

Family therapy beyond postmodernism: some considerations on the ethical orientation of contemporary practice

Ethics is a subject that is self-evidently important for systemic therapy, as for therapy generally, yet arguably it is one that has not received nearly as much attention in the literature as it warrants. This paper looks at the historical context for the marginalization of ethical discourse and suggests that the contemporary influence of postmodernist and hermeneutic thinking reinforces this tendency. Flaskas' (2002) recent argument for the reclamation of an idea of truth and reality as a social and emotional process is considered, and it is suggested that this needs supplementing with a perspective on truth and reality as an ethical process. Consideration is given to the enduring influence within postmodernist approaches of the modernist Kantian conception of ethics as centred in individual consciousness. I argue that important elements of contemporary systemic practice (for example, the reflecting team approach) are also pointing towards a different formulation of ethics that is focused more specifically on processes of communication. In elaborating this theme the paper draws on the work of the German social theorist Jürgen Habermas who writes on the ethics of communication.     

Hypothetical contractarianism and the disclosure requirement problem in informed consent

Two of the more deeply problematic issues surrounding the doctrine of informed consent are providing a justification for the practice of informed consent and providing an account of the nature and amount of information that must be disclosed in order for informed consent to take place. This paper is concerned with the latter problem, the problem of disclosure requirements, but it deals with this problem in a novel way; it approaches the problem by asking what fully informed and fully rational agents would agree to under certain hypothetical conditions. In general terms I juxtapose the hypothetical contractarianism found in Rawls' A Theory of Justice with that found in Gauthier's Morals By Agreement and ask what their respective hypothetical contractors would agree to with respect to choosing a particular standard of disclosure to govern the practice of informed consent. In more specific terms a contrast is made between what a Rawlsian agent behind a veil of ignorance would choose as compared to what, in Gauthier's terms, an ideal actor making an Archimedean choice would choose. The idea of an Archimedean point, and the subsequent choice made from that point, although technically identified by Rawls, originated with Archimedes of Syracuse.     

Participants' understanding of the process of psychological research: informed consent

Sixty-five undergraduates participating in a wide range of psychological research experiments were interviewed in depth about their research experiences and their views on the process of informed consent. Overall, 32% of research experiences were characterized positively and 41% were characterized negatively. One major theme of the negative experiences was that experiments were perceived as too invasive, suggesting incomplete explication of negative aspects of research during the informed consent process. Informed consent experiences were viewed positively 80% of the time. However, most of the participants had a limited view of the purpose of informed consent: less than 20% viewed the process as a decision point. Results suggest a number of common pitfalls to standard informed consent practices that have not generally been recognized. Results are discussed in terms of both ethical and methodological implications. Suggestions for improving the informed consent process are also provided.     

Reality therapy: Icing on the cake of behavior modification

The paper presents a conceptual model for therapeutic intervention based on a behavioral orientation. Behavioral therapy is viewed on a continuum ranging from basic operant techniques to cognitive strategies applied to human interaction. It is hypothesized that the elements of reality therapy, with its emphasis on human interaction, are needed to provide closure to the therapeutic intervention and to help maintain new coping behaviors. Utilizing the context of an institutionalized client, suggestions for how this process might occur are discussed.     

Routine screening: informed consent, stigma and the waning of HIV exceptionalism

The Centers for Disease Control and Prevention (CDC) recently recommended that HIV screening should become routine for all adults in the United States. Implicit in the CDC proposal is the notion that pre-test counseling would be more limited than at present, and that written informed consent to screening would no longer be required. If widely implemented, routine testing would mark a tremendous shift in the US HIV screening strategy. There are a number of considerations used to determine what screening tests should be routine, and HIV fits the bill in almost every regard. Yet the stigma associated with HIV infection remains, making the CDC's recommendation highly controversial. Will minimizing requirements for pre-test counseling and special written informed consent lead to unexpected or unwanted HIV testing, or do these stringent counseling and consent requirements needlessly scare people away? Will widespread and routine testing be associated with declining stigmatization, or will it drive some patients away from seeking desperately needed health care? These are high stakes questions, and we're about to find out the answers.