• The requirement that a subject be competent as a condition of valid consent to participate in research has been accepted by most students of legal and ethical problems of human experimentation. "Competency," however, has lacked a clear and generally agreed on standard. There are four commonly used standards for competency: evidencing a choice in regard to research participation, factual understanding of the issues, rational manipulation of information, and appreciation of the nature of the situation. These standards can be arranged hierarchically such that each represents a stricter test of competency. The decision as to how rigorous a standard for competency is desirable cannot be made on psychiatric grounds. It requires consideration of the policy goals one hopes to attain. Empirical research helps demonstrate the consequences of choosing a particular standard but cannot replace the need for achieving consensus on policy goals.

Competency to Consent to Research: A Psychiatric Overview

In 1944, the year after the Great Bengal Famine, 45.6 per cent of widowers surveyed ranked their health as either “ill” or “indifferent.” Only 2.5 per cent of widows made the same judgement. This subjective ranking belied their actual situations since, as a group, the widows’ basic health and nutrition tended to be particularly abysmal. These women were starving and yet most of them claimed not to be sick. One explanation for this unwarranted stoicism is that, unlike men who were similarly situated, these women reacted to the scarcity of food by coming to believe that what little food there was should not be wasted on them.1 This is (literally) a textbook case of the problem of adaptive preferences; the reason the Bengali women formed these desires while the men did not is that they had already internalized prevalent sexist social mores that granted women’s interests less importance than men’s.2 Because these women did not believe their interests mattered as much as others’, they did not experience their starvation as worth complaining about.

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The Obligation to Resist Oppression

The authors examined retrospectively the prehospitalization behavior of 66 voluntary and involuntary psychiatric patients to determine precipitating factors in each person's hospitalization. Involuntary patients had engaged in dangerous acts directed against others more frequently than had voluntary patients. However, very little significant harm was caused by members of either group.

Behavioral precipitants to civil commitment.

Dix (1976) recently has proposed that a “true experiment” be conducted to assess the validity of predictions of imminent violence. A random sample of persons predicted to be iminently violent would be denied emergency civil commitment in order to test whether they do, in fact, commit a violent act. This article analyzes Dix's proposal and finds that it presents an unacceptable level of risk to the community. Four alternative methodologies by which preliminary data can be gathered on the validity of predictions of violence in emergency civil commitment are described.

Strategies for an empirical analysis of the prediction of violence in emergency civil commitment

The myth of the chivalry factor' in female crime

And out of the ground the Lord God formed every beast of the field, and every fowl of the air; and brought them unto Adam to see what he would call them: and whatsoever Adam called every living creature, that was the name thereof. And Adam gave names to all cattle, and to the fowl of the air, and to every beast of the field; but for Adam there was not found an help meet for him. And the Lord God caused a deep sleep to fall upon Adam, and he slept: and He took one of his ribs, and closed up the flesh thereof; And the rib, which the Lord God had taken from man, made He a woman ....

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Sex-based discrimination in the mental institutionalization of women.

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Into the abyss: psychiatric reliability and emergency commitment statutes.

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Robert T. Roth

Papers

Sex-based discrimination in the mental institutionalization of women.

Into the abyss: psychiatric reliability and emergency commitment statutes.

Informed consent to organic behavior control.