November 05, 2013

MISSION MATTERS: Turbulent Waters and Our Mission

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Think back to when you were 5 or 6-years-old. At a holiday dinner, Grandma Betty or Uncle Richard asked you, "What do you want to be when you grow up?" No one has ever answered, "I want to be a sex offender," "I want to be an alcoholic" or "I want to be a murderer." Yet, some children grow up to assume these behaviors. And many of us in the Saint Louis University community serve these people by providing health, legal, mental health and other forms of support. Maintaining a moral center, a charitable spirit and enduring resilience can be challenging.

Sherman was 12-years-old when he confessed to kidnapping, raping and beating a 6-year-old in November 2005. By the time Sherman is eligible for parole, he will be 64-years-old. Sherman was certified as an adult on the day he turned 13 and transferred from the juvenile to the adult facility. I was his physician for the three years.

Children and adolescents are certified as adults when the state determines that the seriousness of the crime, typically along with a record of previous offenses, particularly previous violent offenses, warrants that, in the eyes of the law, they are seen as adults. These offenders are then tried and sentenced as adults - no matter what their age at the time of the crime.

The logic here is tricky to understand. The United States has a strong tradition of defining the line between child and adult. We have had extensive judicial and public debates on topics as widespread as voting ages, reproductive services and child labor laws. We acknowledge that children are not adults. They deserve protection and guidance in the course of their development so that, among other reasons, they can develop an adult sensibility regarding their individual life choices and the ability to contribute to the society.

Trying a child as an adult discounts this tradition. The child is no longer the focus of the justice; rather, the penalty becomes the focus. The child is certified an adult in order to justify the severity of the sentence deemed appropriate. By emphasizing the penalty of the crime over the nature of the criminal youth, we disregard the strides our society has made in distinguishing the child from the adult.

The development of cognitive and moral reasoning has been explored and documented by developmental psychologists such as Piaget and Erikson. All of these theories share stepwise progression of the individual in understanding self and in understanding his role in relation to others and community. Cognitive and moral stages of development must be learned before one can advance to the next step. And successful learning requires a supportive environment.

More recent studies in brain mapping and neurochemistry have now demonstrated the corresponding physical development of the human brain. We now understand that children's and adolescents' brains are still developing in significant ways. Neuroimaging studies, for example, have demonstrated that the brains of the children and adolescents diagnosed with attention deficit disorder develop at a delayed rate - but, in time, they develop as fully as those of individuals without the diagnosis. Such a study begs the question of when (or whether) an adolescent develops his or her own mature moral sensibility. And it certainly begs the question of how fully morally developed a 12-year-old child can be.

Juvenile certification exemplifies a trend away from rehabilitation of children and adolescents. It also represents a trend away from growing scientific evidence concerning biological development of the brain and most likely development of moral sense. And it represents a growing trend in our village to label individuals as evil or insane in order to dismiss them with impunity.

At Saint Louis University, our Mission calls us to wade into turbulent moral waters such as these. Our collective faith, our interprofessional resources and our community of support strengthens my ability to care and advocate for the Shermans in my professional life. May our work diminish the turbulence for our society.

— Fred Rottnek, M. D., SLU Family and Community Medicine

Higher purpose. Greater good.
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