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Dr. Lewis Responds
306
LETTERS TO EDITOR
psychiatrist's obligation to advocate for the child is an overriding principle. Hence, issues of commitment or treatment which are complicated by what the parents want, what the state desires, what the legal system demands and what the child perceives is in his or her interest are in part dealt with by Principle XIV, which states that when: "The child psychiatrist is called upon to participate in attempts to control or change the behavior of children or adolescents and in his/her opinion, those efforts ignore individuality or are counter to the needs of the child or adolescent, or impede optimum development, or involve efforts solely directed toward conformity, the child psychiatrist will avoid acting solely as an agent of the parents, guardians or agencies." The article cites Parham vs. J.R as the suit in which the Supreme Court established that "most parents who seek to have their children admitted to a state mental hospital do so in good faith." However, to us the most significant lesson from this suit is derived from the events surrounding the initial suit Parham vs. J.R. and J.L. and it reinforces Principle 1. The suit was brought on behalf of two adolescents committed at parents' discretion without hearing or due process, and it sought to establish a child's right to due process in commitment proceedings. Through judicial procedure, J.L. and J.R. were released from a Georgia hospital pending determination of their rights. Evidently, the parents judgments and professional clinical judgments were correct for J.L. thereupon committed suicide. This issue is referred to only to direct attention to Principle I of the Code of Ethics. The child died because the legal system was concerned with global legal issues rather than the needs of the particular patient. The Lewis' comments stress the child psychiatrist's obligation to advocate for protection of the child's right to "personal privacy." The Code of Ethics addresses these difficult issues in Principles VIII, IX, X, XI, and XII. In any case, the basic thrust of Principle I to do what is best for the child should prevail even if privacy may have to be compromised. Dr. Lewis' comments address several relevant, broad issues about research, not specifically address-
ing the child psychiatrist's responsibilities or role in patient consent or family involvement. The child psychiatrist's role in research is specifically addressed in Principle XV. It is unfortunate that this paper indicates no awareness of so important a document as the Academy's Code of Ethics. In a Journal published by the Academy, it is a serious oversight, since an Academy officer, the editor, ignores a major Academy contribution. Irving N. Berlin, M.D., Chairman Joseph D. Noshpitz, M.D., Member Committee on Ethics
Reference Lewis, M. (1981). Comments on some ethical, legal, and clinical issues affecting consent in treatment, organ transplants, and research in children. This Journal, 20:581-596
Dr. Lewis Responds I am grateful to Drs. Berlin and Noshpitz for drawing attention to the Academy's Code of Ethics. Readers who wish to obtain a copy of this document may write to Virginia Q. Bausch, Executive Director, American Academy of Child Psychiatry, Suite 201A, 1424 16th Street, N.W., Washington, DC 20036.
Corrections In the Autumn 1981 issue (20:4), in the article "Differences in the Patterning of Affective Expression in Infants" by Theodore J. Gaensbauer and David Mrazek, figure 4 (p. 685) and figure 5 (p. 687) were reversed. In the January 1982 (21:1) issue, the first paragraph on p. 21 in the article "Clinical Studies of Methylphenidate Serum Levels in Children and Adults" by C. Thomas Gualtieri et al. should read: The primary route of metabolism for methylphenidate is de esterification to ritalinic acid, which accounts for 75 to 91% of total urinary metabolites in man (Bartlett and Egger, 1972). Little or no unchanged methylphenidate can be detected in urine. The staff regrets the errors.
LETTERS TO EDITOR
psychiatrist's obligation to advocate for the child is an overriding principle. Hence, issues of commitment or treatment which are complicated by what the parents want, what the state desires, what the legal system demands and what the child perceives is in his or her interest are in part dealt with by Principle XIV, which states that when: "The child psychiatrist is called upon to participate in attempts to control or change the behavior of children or adolescents and in his/her opinion, those efforts ignore individuality or are counter to the needs of the child or adolescent, or impede optimum development, or involve efforts solely directed toward conformity, the child psychiatrist will avoid acting solely as an agent of the parents, guardians or agencies." The article cites Parham vs. J.R as the suit in which the Supreme Court established that "most parents who seek to have their children admitted to a state mental hospital do so in good faith." However, to us the most significant lesson from this suit is derived from the events surrounding the initial suit Parham vs. J.R. and J.L. and it reinforces Principle 1. The suit was brought on behalf of two adolescents committed at parents' discretion without hearing or due process, and it sought to establish a child's right to due process in commitment proceedings. Through judicial procedure, J.L. and J.R. were released from a Georgia hospital pending determination of their rights. Evidently, the parents judgments and professional clinical judgments were correct for J.L. thereupon committed suicide. This issue is referred to only to direct attention to Principle I of the Code of Ethics. The child died because the legal system was concerned with global legal issues rather than the needs of the particular patient. The Lewis' comments stress the child psychiatrist's obligation to advocate for protection of the child's right to "personal privacy." The Code of Ethics addresses these difficult issues in Principles VIII, IX, X, XI, and XII. In any case, the basic thrust of Principle I to do what is best for the child should prevail even if privacy may have to be compromised. Dr. Lewis' comments address several relevant, broad issues about research, not specifically address-
ing the child psychiatrist's responsibilities or role in patient consent or family involvement. The child psychiatrist's role in research is specifically addressed in Principle XV. It is unfortunate that this paper indicates no awareness of so important a document as the Academy's Code of Ethics. In a Journal published by the Academy, it is a serious oversight, since an Academy officer, the editor, ignores a major Academy contribution. Irving N. Berlin, M.D., Chairman Joseph D. Noshpitz, M.D., Member Committee on Ethics
Reference Lewis, M. (1981). Comments on some ethical, legal, and clinical issues affecting consent in treatment, organ transplants, and research in children. This Journal, 20:581-596
Dr. Lewis Responds I am grateful to Drs. Berlin and Noshpitz for drawing attention to the Academy's Code of Ethics. Readers who wish to obtain a copy of this document may write to Virginia Q. Bausch, Executive Director, American Academy of Child Psychiatry, Suite 201A, 1424 16th Street, N.W., Washington, DC 20036.
Corrections In the Autumn 1981 issue (20:4), in the article "Differences in the Patterning of Affective Expression in Infants" by Theodore J. Gaensbauer and David Mrazek, figure 4 (p. 685) and figure 5 (p. 687) were reversed. In the January 1982 (21:1) issue, the first paragraph on p. 21 in the article "Clinical Studies of Methylphenidate Serum Levels in Children and Adults" by C. Thomas Gualtieri et al. should read: The primary route of metabolism for methylphenidate is de esterification to ritalinic acid, which accounts for 75 to 91% of total urinary metabolites in man (Bartlett and Egger, 1972). Little or no unchanged methylphenidate can be detected in urine. The staff regrets the errors.