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Bioethical Issues and Secondary Prevention for Nonoffending Individuals with Pedophilia

Published online by Cambridge University Press:  22 May 2019

Abstract:

Child sexual abuse is a global problem with significant emotional, psychological, and financial implications to victims, perpetrators, and society. Most child sexual abuse prevention programs target young children or those who have already engaged in abusive behavior, in order to prevent further offending. There are numerous secondary prevention programs targeting individuals at-risk of various health conditions in an effort to reduce the likelihood they will go on to experience a particular illness or disease. Considerable research exists regarding the risk factors for engaging in child sexual abuse and more specifically the factors contributing to reoffense. We argue that engaging in secondary prevention programs for people with pedophilia, in order to prevent child sexual abuse, is an ethically responsible and necessary practice. Secondary prevention programs with this focus are reviewed, along with the implications of mandatory reporting in doing this work.

Type
Special Section: Health, Morality, and Moralism
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Acknowledgment: We thank Sarah Moss for a review of an earlier version of this paper

References

Notes

1. World Health Organization. Preventing Child Maltreatment: A Guide to Taking Action and Generating Evidence [Internet]. Geneva: World Health Organization; 2006; available at http://apps.who.int/iris/bitstream/handle/10665/43499/9241594365_eng.pdf;jsessionid=55060734A3F698280E7A408E2596E7BE?sequence=1 (last accessed 22 Aug 2018).Google Scholar

2. Barth, J, Bermetz, L, Heim, E, Trelle, S, Tonia, T. The current prevalence of child sexual abuse worldwide: A systematic review and meta-analysis. International Journal of Public Health 2012;58(3):469–83.CrossRefGoogle ScholarPubMed

3. Fergusson, D, McLeod, G, Horwood, L. Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect 2013;37(9):664–74.CrossRefGoogle ScholarPubMed

4. Turner, S, Taillieu, T, Cheung, K, Afifi, T. The relationship between childhood sexual abuse and mental health outcomes among males: Results from a nationally representative United States sample. Child Abuse & Neglect 2017;66:6472.CrossRefGoogle ScholarPubMed

5. Mai C, Subramanian R. Price of prisons 2015: Examining state spending trends, 2010-2015. [Internet]. New York: Vera Institute of Justice; 2017; available at https://storage.googleapis.com/vera-web-assets/downloads/Publications/price-of-prisons-2015-state-spending-trends/legacy_downloads/the-price-of-prisons-2015-state-spending-trends.pdf (last accessed 22 Aug 2018).

6. California’s Annual Cost to Incarcerate an Inmate in Prison [Internet]. Legislative Analyst’s Office. 2017 [cited 15 Aug 2018]; available at https://lao.ca.gov/policyareas/CJ/6_cj_inmatecost (last accessed 22 Aug 2018).

7. Letourneau, E, Brown, D, Fang, X, Hassan, A, Mercy, J. The economic burden of child sexual abuse in the United States. Child Abuse & Neglect 2018;79:413–22.CrossRefGoogle ScholarPubMed

8. See note 1, World Health Organization 2006.

9. Van Horn, J, Eisenberg, M, Nicholls, C, Mulder, J, Webster, S, Paskell, C et al. Stop It Now! A pilot study into the limits and benefits of a free helpline preventing child sexual abuse. Journal of Child Sexual Abuse 2015;24(8):853872.CrossRefGoogle ScholarPubMed

10. Nelson, G, Laurendeau, M, Chamberland, C. A review of programs to promote family wellness and prevent the maltreatment of children. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement 2001;33(1):113.CrossRefGoogle Scholar

11. Martin, E, Silverstone, P. An evidence-based education program for adults about child sexual abuse (“Prevent It!”) that significantly improves attitudes, knowledge, and behavior. Frontiers in Psychology 2016;7.CrossRefGoogle Scholar

12. Chen, J, Dunne, M, Han, P. Prevention of child sexual abuse in China: Knowledge, attitudes, and communication practices of parents of elementary school children. Child Abuse & Neglect 2007;31(7):747–55.CrossRefGoogle ScholarPubMed

13. Walsh, K, Zwi, K, Woolfenden, S, Shlonsky, A. School-Based Education Programmes for the Prevention of Child Sexual Abuse. Cochrane Database of Systematic Reviews. 2015;4.Google Scholar

14. Kemshall, H, Wood, J. Risk and public protection: Responding to involuntary and ‘taboo’ risk. Social Policy & Administration 2008;42(6):611–29.CrossRefGoogle Scholar

15. Smart summary 2016. Global survey of sex offender registration and notification systems [Internet]. U.S. Department of Justice; 2018 [cited 16 Aug 2018]; available at https://smart.gov/pdfs/global-survey-2016-final.pdf (last accessed 22 Aug 2018).

16. Lasher, M, McGrath, R. The impact of community notification on sex offender reintegration. International Journal of Offender Therapy and Comparative Criminology 2010;56(1):628.CrossRefGoogle ScholarPubMed

17. Nobles, M, Levenson, J, Youstin, T. Effectiveness of residence restrictions in preventing sex offense recidivism. Crime & Delinquency 2012;58(4):491513.CrossRefGoogle Scholar

18. Blanchard, R, Lykins, A, Wherrett, D, Kuban, M, Cantor, J, Blak, T et al. Pedophilia, hebephilia, and the DSM-V. Archives of Sexual Behavior 2008;38(3):335–50.CrossRefGoogle ScholarPubMed

19. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.

20. Grundmann, D, Krupp, J, Scherner, G, Amelung, T, Beier, K. Stability of self-reported arousal to sexual fantasies involving children in a clinical sample of pedophiles and hebephiles. Archives of Sexual Behavior 2016;45(5):1153–62.CrossRefGoogle Scholar

21. Levenson, J, Willis, G, Vicencio, C. Obstacles to help-seeking for sexual offenders: Implications for prevention of sexual abuse. Journal of Child Sexual Abuse 2017;26(2):99120.CrossRefGoogle ScholarPubMed

22. Cantor, J, Blanchard, R, Christensen, B, Dickey, R, Klassen, P, Beckstead, A et al. Intelligence, memory, and handedness in pedophilia. Neuropsychology 2004;18(1):314.CrossRefGoogle ScholarPubMed

23. Cantor, J, Blanchard, R. White matter volumes in pedophiles, hebephiles, and teleiophiles. Archives of Sexual Behavior 2012;41(4):749–52.CrossRefGoogle ScholarPubMed

24. Poeppl, T, Nitschke, J, Santtila, P, Schecklmann, M, Langguth, B, Greenlee, M et al. Association between brain structure and phenotypic characteristics in pedophilia. Journal of Psychiatric Research 2013;47(5):678–85.CrossRefGoogle ScholarPubMed

25. Fazio, R, Lykins, A, Cantor, J. Elevated rates of atypical handedness in paedophilia: Theory and implications. Laterality: Asymmetries of Body, Brain and Cognition 2014;19(6):690704.Google Scholar

26. Seto, M. Pedophilia and sexual offenses against children. Annual Review of Sex Research 2018;15(1):321–61.Google Scholar

27. Dombert, B, Schmidt, A, Banse, R, Briken, P, Hoyer, J, Neutze, J et al. How common is men’s self-reported sexual interest in prepubescent children? The Journal of Sex Research 2015;53(2):214–23.CrossRefGoogle ScholarPubMed

28. Joyal, C, Cossette, A, Lapierre, V. What exactly is an unusual sexual fantasy? The Journal of Sexual Medicine 2015;12(2):328–40.CrossRefGoogle ScholarPubMed

29. Mann, R, Hanson, R, Thornton, D. Assessing risk for sexual recidivism: Some proposals on the nature of psychologically meaningful risk factors. Sexual Abuse: A Journal of Research and Treatment 2010;22(2):191217.CrossRefGoogle ScholarPubMed

30. Hanson, R, Morton-Bourgon, K. The characteristics of persistent sexual offenders: A meta-analysis of recidivism studies. Journal of Consulting and Clinical Psychology 2005;73(6):1154–63.CrossRefGoogle ScholarPubMed

31. See note 9, Van Horn et al. 2015.

32. See note 21, Levenson et al. 2017.

33. Sexual Behaviours Clinic [Internet]. CAMH. 2018 [cited 16 Aug 2018]; available at https://www.camh.ca/en/your-care/programs-and-services/sexual-behaviours-clinic (last accessed 22 Aug 2018)

34. Beier, K. Proactive strategies to prevent child sexual abuse and the use of child abuse images: The German Dunkelfeld-Project for Adults (PPD) and Juveniles (PPJ). In: Jeglic, E, Calkins, C, ed. Sexual Violence: Evidence Based Policy and Treatment. New York: Springer; 2016. p. 249272.CrossRefGoogle Scholar

35. More than 9.500 people asked for help [Internet]. Dont-offend.org. 2018 [cited 17 Aug 2018]; available at https://www.dont-offend.org/story/more-than-9-500-people-asked-for-help.html (last accessed 22 Aug 2018).

36. See note 9, Van Horn et al. 2015.

37. Beier, K, Grundmann, D, Kuhle, L, Scherner, G, Konrad, A, Amelung, T. The German Dunkelfeld Project: A pilot study to prevent child sexual abuse and the use of child abusive images. The Journal of Sexual Medicine. 2015;12(2):529–42.CrossRefGoogle ScholarPubMed

38. See note 9, Van Horn et al. 2015.

39. See note 34, Beier 2016.

40. See note 34, Beier 2016.

41. Raz, M. Unintended consequences of expanded mandatory reporting laws. Pediatrics 2017;139(4):e20163511.CrossRefGoogle ScholarPubMed

42. Hendricks, M. Mandatory reporting of child abuse in South Africa: Legislation explored. South African Medical Journal 2014;104(8):550.CrossRefGoogle ScholarPubMed

43. McPhail, I, Stephens, S, Heasman, A. Legal and ethical issues in treating clients with pedohebephilic interests. Canadian Psychology/Psychologie canadienne 2018;59(4):369381.CrossRefGoogle Scholar

44. Levi, B, Crowell, K. Child abuse experts disagree about the threshold for mandated reporting. Clinical Pediatrics 2010;50(4):321–29.CrossRefGoogle ScholarPubMed

45. Lareau, C. Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court. International Journal of Law and Psychiatry 2015;423:43–8.CrossRefGoogle Scholar

46. Ontario.ca. (2018). Child, Youth and Family Services Act, 2017, S.O. 2017, c. 14, Sched. 1; available at https://www.ontario.ca/laws/statute/17c14#BK167 [last accessed 19 Aug. 2018].

47. Smith v. Jones, 1999. S.C.C. 455; available at https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/1689/index.do (last accessed 22 Aug 2018).

48. Lamond D. The impact of mandatory reporting legislation on reporting behavior. Child Abuse & Neglect 1989;13(4):471–80.

49. Mathews, B, Lee, X, Norman, R. Impact of a new mandatory reporting law on reporting and identification of child sexual abuse: A seven year time trend analysis. Child Abuse & Neglect 2016;56:6279.CrossRefGoogle ScholarPubMed

50. McTavish, J, Kimber, M, Devries, K, Colombini, M, MacGregor, J, Wathen, C et al. Mandated reporters’ experiences with reporting child maltreatment: a meta-synthesis of qualitative studies. BMJ Open 2017;7(10):e013942.CrossRefGoogle ScholarPubMed

51. See note 43, McPhail et al. 2018.

52. Fischer, B, Blanken, P, Da Silveira, D, Gallassi, A, Goldner, E, Rehm, J et al. Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies. International Journal of Drug Policy 2015;26(4):352–63.CrossRefGoogle ScholarPubMed

53. Kolodny A, Courtwright D, Hwang C, Kreiner P, Eadie J, Clark T et al. The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health 2015;36(1):559–74.

54. Principles of harm reduction–Harm Reduction Coalition [Internet]. Harmreduction.org. 2018 [cited 17 Aug 2018]; available at http://harmreduction.org/about-us/principles-of-harm-reduction/ (last accessed 22 Aug 2018).

55. Harm reduction | CMHA Ontario [Internet]. Ontario.cmha.ca. 2018 [cited 17 Aug 2018]. available at https://ontario.cmha.ca/harm-reduction/ (last accessed 22 Aug 2018).

56. Critchley, J, Capewell, S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database of Systematic Reviews; 2012.CrossRefGoogle Scholar

57. Thompson A. Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension. JAMA 2011;305(9):913.

58. Kelly J, Kalichman S. Behavioral research in HIV/AIDS primary and secondary prevention: Recent advances and future directions. Journal of Consulting and Clinical Psychology 2002;70(3):626–39.

59. Conley, C, Shapiro, J, Kirsch, A, Durlak, J. A meta-analysis of indicated mental health prevention programs for at-risk higher education students. Journal of Counseling Psychology 2017;64(2):121–40.CrossRefGoogle ScholarPubMed

60. Feldman, D, Crandall, C. Dimensions of mental illness stigma: What about mental illness causes social rejection? Journal of Social and Clinical Psychology 2007;26(2):137–54.CrossRefGoogle Scholar

61. Richards, K. Born this way? A qualitative examination of public perceptions of the causes of pedophilia and sexual offending against children. Deviant Behavior 2017;39(7):835–51.CrossRefGoogle Scholar

62. Jahnke, S, Philipp, K, Hoyer, J. Stigmatizing attitudes towards people with pedophilia and their malleability among psychotherapists in training. Child Abuse & Neglect 2015;40:93102.CrossRefGoogle ScholarPubMed

63. Beauchamp, T, Childress, J. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press; 2012.Google Scholar

64. Müller, S, Walter, H, Christen, M. When benefitting a patient increases the risk for harm for third persons — The case of treating pedophilic Parkinsonian patients with deep brain stimulation. International Journal of Law and Psychiatry 2014;37(3):295303.CrossRefGoogle ScholarPubMed

65. See note 34, Beier 2016, at 258.

66. See note 43, McPhail et al. 2018, at 381.