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Case vignette: Niki goes to school -- autonomy, control, and psychiatric hospitalization.

The following is a description of a case and a discussion by professionals of the ethical issues raised. Niki turned 18 years old just 3 months ago. She is a freshman student at Central State University, where her father is also a faculty member. Niki has been residing in her parents' home. On Monday afternoon, Niki arrives at the college health service asking for a walk-in appointment. An intake evaluation reveals that she is showing signs of anorexia nervosa and is having suicidal ideation. A decision is made to refer Niki for admission to a local psychiatric facility. She agrees to accept a voluntary admission but advises the staff at both the health center and the hospital that she does not want her parents to know where she is. By Monday evening, Niki's family is very anxious regarding her whereabouts and is telephoning everyone they can think of to try to locate her. Although staff members have been urging Niki to allow them to inform her family of her admission to the hospital, she is still refusing to authorize such disclosure. What should the professionals involved in the case do or say if they are contacted by the parents? What are the parameters of confidentiality in cases of children who are living at home but have attained the age of legal majority?

Adult↗

Reporting and referring research participants: ethical challenges for investigators studying children and youth.

Researchers studying at-risk and socially disenfranchised child and adolescent populations are facing ethical dilemmas not previously encountered in the laboratory or the clinic. One such set of ethical challenges involves whether to: (a) share with guardians research-derived information regarding participant risk, (b) provide participants with service referrals, or (c) report to local authorities problems uncovered during the course of investigation. The articles assembled for this special section address the complex issues of deciding if, when, and how to report or provide referrals for research participants who are minors (referred to hereafter as minor research participants). This paper focuses on two factors underlying these decisions: the validity of risk estimates and meta-ethical positions on scientific responsiblity. It is suggested that, before sharing information about minor research participants investigators should do the following: critically examine the diagnostic validity of developmental measures, include the scope and limitations of information sharing in informed consent procedures, and become familiar with state reporting laws. I discuss the impact of the traditionally accepted act utilitarian meta-ethical position on the investigator-participant relationship, and I recommend consideration of alternative positions as a step toward developing a research ethic of scientific responsibility and care.

Adolescent↗

Ethical issues in reporting and referring in research with low-income minority children.

Ethical research with children requires a special concern for their well-being as individuals. Researchers are therefore expected to report problems children experience and to refer children for assistance. This article addresses difficultites that can arise as researchers attempt to meet this obligation in research with low-income ethnic minority children. Potential difficulties include both failure to report and overreporting suspected problems. The role of institutional review boards in researchers' reporting and referring behavior is also discussed.

Adolescent↗

Rights to privacy in research: adolescents versus parents.

Conducting research on adolescents raises a number of ethical issues not often confronted in research on younger children. In part, these differences are due to the fact that although assent is usually not an issue, given cognitive and social competencies, the life situations and behavior of youth make it more difficult to balance rights and privacy of the adolescents. In this article, the three ethical principles of beneficence, justice, and respect for persons are discussed in terms of their application to the study of adolescents. Then, seven vignettes are presented to illustrate how these principles apply to real-life situations. How to balance the rights of adolescents and their parents is discussed, using adolescent girls and their parents for illustrative purposes.

Adolescent↗

The certificate of confidentiality at the National Institute of Mental Health: discretionary considerations in its applicability in research on child and adolescent mental disorders.

Child and adolescent researchers must balance increasingly complex sets of ethical, legal, and scientific standards when investigating child and adolescent mental disorders. Few guidelines are available. One mechanism that provides the investigator immunity from legally compelled disclosure of research records is described. However, discretion must be exercised in its use, especially with regard to abuse reporting, voluntary disclosure of abuse, and protection of research data. Examples of discretionary issues in the use of the certificate of confidentiality are provided.

Adolescent↗

Ethical problems in research on risky behaviors and risky populations.

The articles by Brooks-Gunn, Fisher, Hoagwood, Liss and Scott-Jones (all in this issue) present a panoply of real-world ethical issues in conducting scientific research on risky behaviors of children, adolescents, and their parents, particularly those from vulnerable populations. The universal, ethical principles of beneficence, justice, and respect for others are always applicable, but they do not resolve issues of child assent, parental consent, legal reporting requirements for illegal behaviors, and the special problems of studying risky behaviors in risky populations. Taken as a group, the articles raise some of the most interesting ethical problems that arise in developmental research. My discussion elaborates some issues and fails to resolve others. I hold the view that both science and ethics can be served by thoughtfully designed and implemented research on important social issues, but that the studies themselves cannot simultaneously solve the many societal problems of participants and be scientifically credible.

Adolescent↗

Mandatory parental involvement in minors' abortions: effects of the laws in Minnesota, Missouri, and Indiana.

OBJECTIVES: This study examined the effects of parental involvement laws on the birth rate, in-state abortion rate, odds of interstate travel, and odds of late abortion for minors. METHODS: Poisson and logistic regression models fitted to vital records compared the periods before and after the laws were enforced. RESULTS: In each state, the in-state abortion rate for minors fell (relative to the rate for older women) when parental involvement laws took effect. Data offered no empirical support for the proposition that the laws drive up birth rates for minors. Although data were incomplete, the laws appeared to increase the odds of a minor's traveling out of state for her abortion. If one judges from the available data, minors who traveled out of state may have accounted for the entire observed decline in the in-state abortion rate, at least in Missouri. The laws appeared to delay minors' abortions past the eighth week, but probably not into the second trimester. CONCLUSIONS: Several empirical arguments used against and in support of parental involvement laws do not appear to be substantiated.

Abortion Applicants↗