306 LETTERS TO EDITOR
psychiatrist's obligation to advocate for the child is anoverriding principle. Hence, issues of commitment ortreatment which are complicated by what the parentswant, what the state desires, what the legal systemdemands and what the child perceives is in his or herinterest are in part dealt with by Principle XIV, whichstates that when: "The child psychiatrist is calledupon to participate in attempts to control or changethe behavior of children or adolescents and in his/heropinion, those efforts ignore individuality or arecounter to the needs of the child or adolescent, orimpede optimum development, or involve effortssolely 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 whichthe Supreme Court established that "most parentswho seek to have their children admitted to a statemental hospital do so in good faith." However, to usthe most significant lesson from this suit is derivedfrom the events surrounding the initial suit Parhamvs. J.R. and J.L. and it reinforces Principle 1.The suitwas brought on behalf of two adolescents committedat parents' discretion without hearing or due process,and it sought to establish a child's right to due processin commitment proceedings. Through judicial procedure, J.L. and J.R. were released from a Georgiahospital pending determination of their rights. Evidently, the parents judgments and professional clinicaljudgments were correct for J.L. thereupon committedsuicide. This issue is referred to only to direct attentionto Principle I of the Code of Ethics. The child diedbecause the legal system was concerned with globallegal issues rather than the needs of the particularpatient.
The Lewis' comments stress the child psychiatrist'sobligation to advocate for protection of the child'sright 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 PrincipleI to do what is best for the child should prevail evenif 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 inpatient consent or family involvement. The child psychiatrist's role in research is specifically addressed inPrinciple XV.
It is unfortunate that this paper indicates no awareness of so important a document as the Academy'sCode 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., ChairmanJoseph D. Noshpitz, M.D., MemberCommittee on Ethics
ReferenceLewis, M. (1981). Comments on some ethical, legal, and clinical
issues affecting consent in treatment, organ transplants, andresearch 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 maywrite to Virginia Q. Bausch, Executive Director, American Academy of Child Psychiatry, Suite 201A, 142416th Street, N.W., Washington, DC 20036.
Corrections
In the Autumn 1981 issue (20:4), in the article "Differences in the Patterning of Affective Expression inInfants" 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 paragraphon p. 21 in the article "Clinical Studies of Methylphenidate Serum Levels in Children and Adults" byC. Thomas Gualtieri et al. should read:
The primary route of metabolism for methylphenidate is deesterification to ritalinicacid, which accounts for 75 to 91% of totalurinary metabolites in man (Bartlett and Egger, 1972). Little or no unchanged methylphenidate can be detected in urine.
The staff regrets the errors.