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On April 21, 1971, The Supreme Court rendered a decision in which the practice of abortion in the District of Columbia was defined legally. Since the District of Columbia is the Capital, and the Supreme Court represents the highest legal authority, I explored the influence of this decision on the judicial and legislative systems and on the practice of medicine with regard to therapeutic abortions in the United States. I interviewed the following people involved with abortions: 31 obstetricians and gynecologists in the District of Columbia; the heads of the Department of Obstetrics and Gynecology at three medical schools and at 11 hospitals; the administrators of the free-standing clinics; an Assistant United States Attorney; an Assistant Corporation Counsel; General Counsel of the Police Department; a City Councilman; and an Assistant Health, Education and Welfare Secretary. Thereafter, in 1971, nearly 19 000 legal therapeutic abortions were performed in the District of Columbia. This has risen steadily and nearly 39000 were performed in 1972. This compares to 2500 each year previously. Incomplete abortions fell from 10000 to 100 per year. Abortions are performed in all equipped hospitals except in two Catholic hospitals. Preoperative consultations and committee review are no longer required. Several hospitals have set up outpatient clinics so that there are ten free-standing clinics, and nine hospital facilities. Abortions in the clinics are restricted to pregnancies of less than ten weeks; hospitals allow up to 20 weeks. District of Columbia residence is not required. The physicians indicated that hospital and clinic requirements of spousal and parental consent were unnecessary. Abortions in the office were unacceptable to all but one physician. Since the decision, criminal investigations and prosecutions of physicians for abortions have ceased. This decision has resulted in a revolution in the practice of abortion in the District of Columbia. Abortion is now essentially available on demand. On January 22, 1973, the Supreme Court rendered two additional decisions interpreting the abortion statutes of Georgia and Texas. In essence the Supreme Court held that, during the first trimester, a woman may secure an abortion from a willing physician or available facility without any restrictions by the state, facility or profesion. During the last six months, the state may, through its police powers, regulate abortions only as to protect the life of the mother. Without deciding when life begins, the Court held that the state may regulate abortions during the last ten weeks of pregnancy when the fetus is “viable”, and its life can be reasonably and successfully maintained outside the mother. The Court did not decide whether spousal or parental consent is required to secure an abortion. Recent cases have now placed these specific issues before the Court. Based on other Court decisions, it also seems reasonable to believe that a facility may not deny an abortion when it is the only facility available, even though it may be contrary to the facility's policy. Although the mandate of the Supreme Court in regard to abortions seems clear, there is still a great deal of diversity among the states as to how to bring their abortion statutes into conformity with the Supreme Court decisions. In those jurisdictions where the Supreme Court decisions have been implemented, the experience with reference to the practice of abortion is similar to that of the District of Columbia. Furthermore, the attitude, approach and management of abortion among physicians has been revolutionary. Although a majority of Americans agree with the liberalization of abortion, there remains a nationwide vocal minority and actual majorities in some states that oppose the new policy. The Supreme Court decisions have had an international impact in that in a number of countries around the world efforts to liberalize abortion laws are underway.

The needs of the child—not the fault of the parents—are the basis for the law's intervention in the welfare of a child. In an emergency, the physician or surgeon has not only the right but also the legal duty to save the life of a child. Even if he cannot locate the parents to obtain their consent, he may act, especially when the patient is a mature juvenile.

(1974). Ethical Issues in School Psychology. School Psychology Review: Vol. 3, No. 1, pp. 4-15.

Extract: Expectations and attitudes of parents of 140 children awaiting admission to a pediatric research center were examined in semistructured preadmission interviews. Parental conceptions of the purpose of hospitalization are summarized in table I. Even after discussion with the physician-investigator, parents of 61 children (Group A) failed to comprehend that hospitalization was for some research purpose. Although the expectations of parents and physicians could not be uniformly compared, it was established that, in many instances, purposes of the research had been explicitly described and that parents had utilized denial and repression in blocking these anxiety-producing communications. Parents of 60 children (Group B) viewed hospitalization as combining therapeutic and research aims. Parents of 9 (Group C) viewed the aim as primarily research. Parents of 6 (Group D) viewed the aim as pure research. Views of parents of 4 were unclassified. A broad spectrum of fears associated with the concept ‘research’ was expressed by parents in Groups, B, C, and D. Children were viewed to be endangered by their disorders, and no alternative source of medical care was considered available. The idea of declining hospitalization seemed to be guilt-laden, and most of these parents thought consent was their only choice. It was concluded from this study that if informed parental consent is sought, there are four questions on which the parents and physicians should concentrate: In what ways do the proposed studies constitute research as distinct from diagnosis and treatment? What is the nature of these studies? What physical and psychological risks are involved? Could alternate methods be developed to meet the child's medical needs? Speculation: Systematic comparison of the motivations and expectations of physicians and parents both prior and subsequent to hospitalization of children for research purposes is proposed. Such a study should clarify the delineations between research and medical care and should elucidate some of the sources of parental misconceptions. In addition, a systematic study of the adaptation of children and their subsequent recovery from the stress experiences associated with research procedures is intended. Such a study should yield guidelines for appraising psychological risk with parents prior to eliciting consent and would also stimulate the development of special nursing techniques to safeguard and perhaps enhance the psychological well-being of the patients.

Refusal of blood transfusion by a Jehovah's Witness is no longer a rare occurrence. What are the physician's responsibilities in caring for such a patient? What is the law in this matter as defined by the courts? These problems cross lines between law, medicine and religion. Moreover, they go to the core of the medical and moral responsibilities of physicians and the constitutional rights of individuals.

Legal developments affecting children and adolescents have been in two directions: the first was and continues to be the development of protective statutes and codes; the second is seen in recent court decisions declaring constitutional rights for minors. Over all, we have seen the beginnings of an evolution of laws and practices which regard adolescents as individuals and which bestow on them graduated adult rights consistent with their increasing maturity.