Encyclopedia of Psychology and Law

physician or hospital administrator. Standing orders

for these techniques are inappropriate; they should be

applied only on an as-needed basis when less restric-

tive alternative possibilities have proven unsuccessful.

The treating physician should be consulted as soon as

practicable if such an order is issued by another staff

member; the physician should review the medical

necessity of such an approach within 1 hour of its impo-

sition; and the duration of the use of these approaches

should be sharply limited. Department of Health and

Human Services regulations impose these and addi-

tional restrictions on the use of seclusion and restraint.

Therapeutic Jurisprudence

Perspectives on a Patient’s Rights

Recognition that patients have various rights within

the institution, including, for example, the right to

refuse treatment, gives the patient a choice of whether

to exercise the right in question or to refrain from

doing so. A patient possessing the right to refuse treat-

ment may decline to exercise it and instead to accept

treatment. If so, this choice in favor of treatment has

psychological value. It constitutes goal setting and

engages positive expectancies that can become self-

fulfilling prophecies that set in motion psychological

forces that help to bring about goal achievement. Choice

provides a measure of intrinsic rather than extrinsic

motivation, an important ingredient in goal achieve-

ment. Coerced treatment, in contrast, can encourage

resentment, anger,and oppositional behavior. According

patients the right to refuse treatment thus can have

important therapeutic value.

Therapeutic jurisprudence considerations also sup-

port the protection of other rights of patients within

the institution. The protection of such rights consti-

tutes an important measure of respect for patients’

dignity and personhood. When these basic rights are

not respected, patients will feel demoralized and

dehumanized and will likely experience a diminished

sense of self-efficacy. Recognizing that patients

within the institution continue to have rights that they

can exercise allows patients to retain an important

measure of self-determination and to exercise a degree

of autonomous decision making that itself is healthy

and can help facilitate their recovery. Denying

patients these rights or failing to take their rights seri-

ously can have the effect of depriving them of these

opportunities for self-determination, impair their

functioning, diminish motivation, and produce

feelings of depression and in some cases a form of

institutional dependency.

Bruce J. Winick

See also Civil Commitment; Forcible Medication; Mental

Health Law; Therapeutic Jurisprudence

Further Readings

Perlin, M. L. (1998). Mental disability law: Civil and

criminal.Albany, NY: LexisNexis.

Winick, B. J. (1997). The right to refuse mental health

treatment.Washington, DC: American Psychological

Association.

Winick, B. J. (2005). Civil commitment: A therapeutic

jurisprudence model.Durham, NC: Carolina

Academic Press.

PEDOPHILIA

Pedophilia, a sexual preference for prepubescent

children, appears early in life, is stable over time, and

directs the person’s sexuality with regard to thoughts,

fantasies, urges, arousal, and behavior. Pedophilia can

be diagnosed on the basis of self-report, sexual his-

tory, and (among men) penile responses. These indi-

cators of pedophilia predict sexual recidivism among

male sex offenders. There is accumulating evidence

that pedophilia is a neurodevelopmental disorder.

Different treatment approaches for pedophilia have

been evaluated but with only mixed success.

Definition

Pedophiliais defined as a sexual preference for prepu-

bescent children, reflected in the person’s sexual

thoughts, fantasies, urges, arousal, and behavior. There

are three key features in this definition: (1) the sexual

interest is persistent, so individuals who have occa-

sionally fantasized about sex with a prepubescent child

or who have engaged in sexual contact with a child are

not necessarily pedophiles; (2) the persons of interest

are prepubescent and thus show few or no signs of sec-

ondary sexual development; and (3) the person would

sexually choose children even when adult partners are

available. Individuals who seek sexual contacts with

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