Conflict of interest between therapist-patient confidentiality and the duty to report sexual abuse of children

All 51 jurisdictions in the United States require physicians to report suspected child abuse. In most jurisdictions, reporting requirements override both confidentiality and privilege associated with the physician-patient relationship. The authors review the literature relevant to the conflict between privacy and reporting abuse and report the results of a national survey of therapists at sex offender treatment units. They discuss ethical problems experienced under these statutes by therapists who attempt to provide treatment for sex offenders, and by therapists who are required to report past instances of child abuse even when there is no evidence of ongoing abuse.     

Changing epistemologies under conditions of social change in two Arab communities in Israel

The study of epistemic thinking focuses on how people understand and coordinate objective and subjective aspects of knowing and make sense of multiple and discrepant knowledge claims. Typically described in terms of normative development, cross‐cultural studies show differences in epistemic development and characteristics of epistemic thinking. This study focuses on within‐culture variations of epistemic thinking, with the assumption that social change will produce changes in development. Arab society in Israel has undergone notable change over the last half century. In this cross‐sectional research design, cross‐generational comparison and rural–urban comparison were used as proxies for longitudinal social change. Three generations of Muslim Arab women in a village in Israel (20 adolescents, 20 mothers and 20 grandmothers) and 20 Muslim Arab adolescents from a large, mixed city in the same region responded to six dilemmas invoking epistemic thinking. Village adolescents were more subjectivist than their mothers and grandmothers. Sociodemographic characteristics representing greater exposure to diverse people and ideas accounted for generational differences. Both urban and rural adolescents tended towards subjectivist perspectives, and they did not differ. Parents' education levels emerged as the sociodemographic variables most consistently related to epistemic thinking. Epistemic thinking mediated the relationship between generation and gender role/cross‐sex relation values.     

Development and validation of an appearance motivation attitudes scale for sun protection

A reliable two-factor instrument measuring appearance motivation attitudes for sun protection was developed using a longitudinal sample of beachgoers. At baseline, data on sun protection and appearance motivation attitudes were collected on 2324 individuals. Principal components analyses (PCA) indicated a two-factor solution measuring attitudes toward tan attractiveness and skin protection with only 2 items loading on the skin protection factor. At 12-months, the instrument was revised and shortened but including 3 new skin protection items. Split-half analyses were conducted to further refine and develop the instrument. PCA on half of the sample revealed a two-factor solution, which was confirmed using structural equation modeling on the remaining half. This resulted in a two correlated-factor, 10-item measure. Each factor was summed to create two scales. Both scales were internally consistent and demonstrated good external validity, correlating with sun protection specific Transtheoretical model variables. The tan attractiveness attitudes scale significantly improved prediction of sun protection outcomes over 24 months, over and above TTM variables.     

Knowledge-telling and knowledge-transforming arguments in mock jurors' verdict justifications

According to the “story model” a juror constructs an implicit mental model of a story telling what happened as the basis for the verdict choice. But the explicit justification of a verdict choice could take the form of a story (knowledge telling) or the form of a relational (knowledge-transforming) argument structure that brings together diverse, non-chronologically related pieces of evidence. The study investigates whether people tend towards knowledge telling or knowledge transforming, and whether use of these argument structure types are related to skilled argument and epistemic understanding. A sample of people on jury duty chose and justified verdicts in two abridged cases. Participants tended to display the same argument structure and argument skill across cases. Those using knowledge-transforming structures were more successful at the juror argument skills task and had a higher level of epistemic understanding. The discussion suggests that jurors approach their task with an epistemic orientation towards knowledge telling or knowledge transforming.     

Competence to be executed: An ethical analysis post Panetti

Competence to be executed evaluations in effect can prevent an execution or remove the last meaningful impediment to it. Forensic psychiatrists have primary duties to the legal system and truth and honesty, but like all other areas of medical consultation also should balance conflicting secondary traditional medical ethical duties. Participation in a legally authorized execution so violates medical roles, that it is ethically prohibited by the American Medical Association and American Psychiatric Association. This prohibition includes treatment intended to restore competence to be executed. However, despite the primary treatment intent otherwise being appropriate ethically, like relieving suffering or fostering prison safety, if competence to be executed almost predictably would be a treatment result, at least the risk of this result should be considered ethically as if it were intended. In contrast, competence to be executed assessments can be ethical. Diamond's approach of performing honest evaluations only for the defense is an ethical option for such assessments. However, it is challenging to persuade judges and juries of the objectivity of such honest legitimate assessments. Most practitioners therefore likely would consider assessing competence to be executed for either side. This ethically hazardous position necessitates sensitivity to potentially seriously conflicting duties and roles. Copyright © 2010 John Wiley & Sons, Ltd.