When benefitting a patient increases the risk for harm for third persons — The case of treating pedophilic Parkinsonian patients with deep brain stimulation

This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation — given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.     

The measurement and influence of child sexual abuse supportive beliefs

Abstract

The identification of offence-related cognition is a major target of most cognitive–behavioural treatment programmes for sexual offenders, and a number of measures are available for this purpose. This study assessed the psychometric properties of a brief measure of beliefs that support and justify child sexual abuse: the Sex With Children (SWCH) scale. Factor analysis revealed two distinct types of belief: that sex with children is harmless, and that children actively provoke adults into having sex with them. The SWCH was also found to have good internal consistency, test–retest reliability and concurrent validity. Child molesters scored significantly more highly on the SWCH than did rapists or non-offenders, and high-risk child molesters reported more entrenched offence-supportive beliefs than lower risk child molesters. A relationship was also observed between general offence-supportive beliefs as measured by SWCH and offence-specific cognitions ascribing responsibility or enjoyment to the offender's victim. The SWCH subscales appeared to closely match two of the implicit theories hypothesized by Ward and Keenan (1999 Ward, T. and Keenan, T. 1999. Child molesters’ implicit theories. Journal of Interpersonal Violence, 14: 821–838. [Crossref], [Web of Science ®] , [Google Scholar]) to be related to child molestation. Sex offender treatment providers need to be aware of the relationship between underlying implicit theories and offence-specific distorted cognitions about the victim's experience.     

Why weren't (many) European women ‘missing’?

In a 1990 article, Amartya Sen observed “More than 100million Women … Missing” from the populations of parts of south and east Asia. Direct observation and census data suggested that gender ratios deviated sufficiently from what is known to be normal in modern human populations to suggest that the phenomenon was not random. Researchers have explored major proximate causes of “missing” girls and women such as female-selective abortion, routine neglect of young girls in their families including differential access to modern medical care, and even infanticide. This article uses Sen's work and the research of others on Asia to compare with evidence of the disadvantaging or even “mortal neglect” of girls and women in Western European society in the early modern and modern periods — roughly from the sixteenth to the nineteenth centuries. It argues that the current state of the evidence suggests little support for similar gender-specific forms of mortal neglect in Western Europe. It explores why this may have been so, using evidence from economic, social, demographic and religious life.     

The effects of visual priming on information processing in child sexual offenders

Abstract

Child sexual offenders are hypothesized to hold offence-supportive beliefs that set them apart from others. The current study seeks support for this view via a cognitive-experimental approach. Child sexual offenders and offender controls were exposed to pictures of semi-clothed children (priming condition) or clothed, mature adults (control condition). Participants then read ambiguous sentences describing children's actions that could be interpreted in a sexualized manner. Next, participants completed a surprise recognition test in which half the sentences were re-presented in an unambiguously sexual form, and half in an unambiguously non-sexual form. Contrary to hypotheses, primed and/or control child sexual offenders did not show a memory bias for sexualized sentences, suggesting that they did not interpret the original sentences in line with offence-supportive beliefs. Results raise questions about whether child sexual offenders universally hold abnormal beliefs that facilitate their offending. Results also highlight the need for further experimental research within this field.     

Social Control and Emancipation ? Ambiguities in Child Welfare

Child welfare may be regarded either as a tool used by the authorities to exercise social control over family life, or as a weapon supporting the cause of children, striving to emancipate them from both parental and societal neglect or oppression. Research into Norwegian child welfare in the period since the Second World War reveals an ambiguous picture: the intervention of the state into family life signals both tightening social control of all family members and emancipation of the less powerful from patriarchal rule. As the rights and needs of children are considered more important, the control of parents, especially the mother, is increased. The central position of children and their interests have been strengthened in child welfare legislation. However, it is not the child, but the child welfare officials who define what is 'in the best interest of the child'. Post-war development has not granted children autonomy. Child welfare legislation is still mainly paternalistic. In child welfare casework, there is a danger that the lived experience of the child never emerges from the shadows cast by the interaction between adults. In relation to older children who came in contact with child welfare primarily because of their own problem behaviour, the ambiguity of emancipation and control has taken a somewhat different shape. The authorities wanted to keep these children out of prison. Humanitarian considerations, however, have been coupled with hopes of more effective crime prevention. In the postwar years, misbehaving children were also embraced by the increasing importance of 'the best interest of the child' as the main objective in child welfare decisions. In order to secure both emancipation and control, 'the best interest of the child' and the state's interest in preventing crime had to be understood as one and the same.     

An Examination of Oversight and Review in the Child Welfare System

Abstract

Child welfare agencies are accountable to the community not only because they spend public dollars, but also, most critically, because they are charged with protecting vulnerable children. Over the past three decades multiple oversight processes have been initiated as part of an effort to improve accountability in public child welfare. In agencies around the country an array of advocates and monitors regularly review the performance of individual caseworkers. While caseloads grow in number and complexity the ranks of the workforce have not kept pace. The result is too many people watching too few workers serve too many vulnerable children and families.

This paper examines the cumulative effect of five groups of “watchers” that oversee child welfare services. It suggests that every group of watchers should be able to demonstrate that their activities contribute directly to the achievement of system goals.     

Joblessness and poverty in America's central cities: Causes and policy prescriptions

Abstract

Two paradigms pervade the policy debate on the causes of urban joblessness and poverty: (1) a structural, nonvoluntaristic perspective emphasizing the roles of urban economic change, residential segregation, and spatial and skills mismatches, and (2) a rational‐choice, voluntaristic perspective contending that the generosity and ready availability of welfare programs have removed the incentive for poor persons to accept low‐paying jobs. This article brings together propositions of each paradigm into a comprehensive theoretical model. The study measured and tested key causal operators of the model for a sample of 67 large U.S. cities, with special attention to race and gender.

Results show that structural and welfare disincentive perspectives are not in conflict but rather operate side by side to reinforce joblessness and poverty. Race and gender, especially the role of urban space for women's work, are important. The article raises pertinent policy issues derived from the two perspectives and from the analysis.     

The private safety net: The role of charitable organizations in the lives of the poor

Abstract

As welfare reform unfolds, nonprofit social service agencies will increasingly be called upon to help fill the gap between what unskilled and semiskilled mothers can earn in the low‐wage labor market and what they need to meet their monthly expenses. This article draws on in‐depth interviews with low‐income single mothers and multiyear observational studies of two nonprofit social service agencies.

Using these data, the authors show what kinds of resources these agencies provide low‐income single mothers, how mothers mobilize the resources available, to what degree agencies actually contribute to mothers’ cash and in‐kind resources, how agencies distribute their resources, and what effect agencies’ distribution practices have on these women. The analysis shows that although nonprofit social service agencies are a crucial part of many low‐income mothers’ economic survival strategies, they cannot come close to substituting for the eroding public safety net.