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Salayev K, Aslanova U, Munir K. Evaluating the Decisional Capacity for Informed Consent of Transition age Children to Adolescents in Human Subject Research. J Empir Res Hum Res Ethics 2024; 19:28-36. [PMID: 38073174 PMCID: PMC10957319 DOI: 10.1177/15562646231219384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This study aimed to evaluate children's capacity for informed consent. We translated into Azerbaijani language and adapted the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). We enrolled four healthy groups: children aged 11, 12, and 13 years and adults. We provided the participants with information about the simulated research proposal and a related informed consent form. Subsequently, they were administered the UBACC. The mean total UBACC scores were 11.9 (11-year-olds), 12.7 (12-year-olds), 14.0 (13-year-olds), and 16.0 (adults). The gradual increase in the mean UBACC scores with age suggests the continuous maturation of the capacity to comprehend the informed consent process. There was no specific cutoff age to decide whether the children were competent enough to provide informed consent.
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Affiliation(s)
- Kamran Salayev
- Department of Neurology, Azerbaijan Medical University, Baku (Azerbaijan)
- Medina Medical Center, Baku (Azerbaijan)
| | | | - Kerim Munir
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts (USA)
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Boston, Massachusetts (USA)
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Vrouenraets LJJJ, de Vries ALC, Arnoldussen M, Hannema SE, Lindauer RJL, de Vries MC, Hein IM. Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians. Eur Child Adolesc Psychiatry 2023; 32:2343-2361. [PMID: 36115898 PMCID: PMC10576681 DOI: 10.1007/s00787-022-02076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents', their parents', and clinicians' perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents' MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC's relevance. The four criteria one needs to fulfill to have MDC-understanding, appreciating, reasoning, communicating a choice-were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents' support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
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Affiliation(s)
- Lieke Josephina Jeanne Johanna Vrouenraets
- Department of Medical Psychology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Emma Children's Hospital, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Marijn Arnoldussen
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
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Michaud PA, Takeuchi YL, Mazur A, Hadjipanayis AA, Ambresin AE. How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics. Front Pediatr 2023; 11:1120324. [PMID: 37351318 PMCID: PMC10282839 DOI: 10.3389/fped.2023.1120324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.
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Affiliation(s)
| | - Yusuke-Leo Takeuchi
- Division for Adolescent Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | | | - Anne-Emmanuelle Ambresin
- Division for Adolescent Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Abstract
Seeking children's assent has been put forward as a way to foster children's involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children's capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children's refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.
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Affiliation(s)
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
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Rea S, Mikesell L, Cuddihy C, Perry M, Allison B. Exploring the Complexity of Telehealth Privacy Through a Lens of Adolescent Development. QUALITATIVE HEALTH RESEARCH 2023; 33:220-235. [PMID: 36655804 DOI: 10.1177/10497323231151596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Many challenges exist related to ensuring adolescent privacy with health care providers (HCPs), and the rapid integration of telehealth visits has created additional complexities in organizing privacy for adolescents. Through interviews with adolescent patients and their parents (n = 34), this qualitative analysis aimed to explore the complicated relationship and balance of adolescent alone time with HCPs, parental presence and support, and organization of privacy in order to consider how privacy during telehealth visits may contribute to adolescents' healthy development. A framework by Blum et al. (2014) proposed four central goals of adolescent development: emotional security, engagement with learning, self-efficacy, and decision-making skills. This conceptual framework was used to outline the ways in which adolescent privacy during telehealth impacts adolescent development. Some adolescents reported that having their parents present during their telehealth visit afforded reassurance and comfort, and many parents explained that they served as a role-model during their adolescent's telehealth visit. However, other adolescents felt higher emotional security when they could establish an independent relationship with their HCP, with many describing how privacy during their telehealth visit enabled them to have more sensitive discussions with their HCP. Adolescents and parents also reported that telehealth allowed increased experiential learning for adolescents, given their proficiency with technology and ability to access their health care visits autonomously. Furthermore, the organization of privacy was complicated by a lack of understanding whose responsibility it was to facilitate alone time between the adolescent and HCP, as well as external factors such as location and quality of technology and the proximity of family members in the home. By ensuring opportunities for private healthcare encounters, both in telehealth and in-person visits, HCPs and parents can help support adolescents in achieving successful and healthy development.
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Affiliation(s)
- Samantha Rea
- 12267Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Martha Perry
- 2332University of North Carolina System, Chapel Hill, NC, USA
| | - Bianca Allison
- 2332University of North Carolina System, Chapel Hill, NC, USA
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Carlson JL, Pageler N, McPherson T, Anoshiravani A. Providing Online Portal Access to Families of Adolescents and Young Adults with Diminished Capacity at an Academic Children's Hospital: A Case Report. Appl Clin Inform 2023; 14:128-133. [PMID: 36792056 PMCID: PMC9931492 DOI: 10.1055/s-0043-1760847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND For caregivers of adolescents and young adults with severe cognitive deficits, or "diminished capacity," access to the medical record can be critical. However, this can be a challenge when utilizing the electronic health record (EHR) as information is often restricted in order to protect adolescent confidentiality. Having enhanced access for these proxies would be expected to improve engagement with the health system for the families of these medically complex adolescents and young adults. OBJECTIVES To describe a process for granting full EHR access to proxies of adolescents with diminished capacity and young adults who are legally conserved while respecting regulations supporting adolescent confidentiality. METHODS The first step in this initiative was to define the "diminished capacity" access class for both adolescents and young adults. Once defined, workflows utilizing best practice alerts were developed to support clinicians in providing the appropriate documentation. In addition, processes were developed to minimize the possibility of erroneously activating the diminished capacity access class for any given patient. To enhance activation, a support tool was developed to identify patients who might meet the criteria for diminished capacity proxy access. Finally, outreach and educations were developed for providers and clinics to make them aware of this initiative. RESULTS Since activating this workflow, proxies of 138 adolescents and young adults have been granted the diminished capacity proxy access class. Approximately 54% are between 12 and 17 years with 46% 18 years and older. Proxies for both age groups have engaged with portal functionality at higher rates when compared to institutional rates of use by proxies of the general pediatric population. CONCLUSION With this quality improvement initiative, we were able to enhance EHR access and engagement of families of some of the most complex adolescent and young adult patients without inadvertently compromising adolescent confidentiality.
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Affiliation(s)
- Jennifer L. Carlson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Natalie Pageler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Tom McPherson
- Information Services, Stanford Medicine Children's Health, Palo Alto, California, United States
| | - Arash Anoshiravani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
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Olick RS, Yang YT, Shaw J. When Adolescents Disagree with Their Vaccine-Hesitant Parents about COVID-19 Vaccination. THE JOURNAL OF CLINICAL ETHICS 2023; 34:158-168. [PMID: 37229735 DOI: 10.1086/724746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AbstractAs we journey into the fourth year of the COVID-19 pandemic, a majority of Americans express relief at a "return to normal," experience pandemic fatigue, or embrace the idea of living with COVID-19 in much the same way we live with the seasonal flu. But transition to a new phase of life with SARS-CoV-2 does not diminish the importance of vaccination. The US Centers for Disease Control and the Food and Drug Administration recently recommended another round of booster dose for persons age 5 and up, or an initial series for those not previously vaccinated, with an updated bivalent formula that protects against both the original virus strain and Omicron subvariants that are now the dominant source of infection. By most accounts most of the population has been or will become infected with SARS-CoV-2. Suboptimal uptake of the COVID-19 vaccines among the approximately 25 million adolescents in the United States is a significant obstacle to population coverage, public health, and the health and well-being of adolescents. A major cause of low adolescent uptake is parental vaccine hesitancy. This article discusses parental vaccine hesitancy and argues that permitting independent adolescent consent to COVID-19 vaccination should be an ethical and policy priority as we continue to confront the threat of Omicron and other variants of the coronavirus. We discuss the central role of the pediatric healthcare team in caring for adolescent patients who disagree with their parents about vaccination.
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Assadi M, Kiani M, Shamsi Gooshki E, Aryanian Z, Afshar ZM, Hatami P. COVID‐19 vaccination in children as a global dilemma through an ethical lens: A retrospective review. Health Sci Rep 2023; 6:e976. [DOI: 10.1002/hsr2.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Masoud Assadi
- Department of Medical Ethics Shahid Beheshti University of Medical Sciences Tehran Iran
- Health Research Institute Babol University of Medical Sciences Babol Iran
| | - Mehrzad Kiani
- Department of Medical Ethics Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Ehsan Shamsi Gooshki
- Department of Medical Ethics, Faculty of Medicine/Medical Ethics and History of Medicine Research Center Tehran University of Medical Sciences Tehran Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences Tehran Iran
- Department of Dermatology Babol University of Medical Sciences Babol Iran
| | - Zeinab M. Afshar
- Clinical Research Development Center, Imam Reza, Hospital, Kermanshah University of Medical Sciences Kermanshah Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences Tehran Iran
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Trends in insurance coverage for adolescent reduction mammaplasty. Am J Surg 2022; 224:1068-1073. [DOI: 10.1016/j.amjsurg.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/31/2022] [Indexed: 11/22/2022]
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Baltag V, Takeuchi Y, Guthold R, Ambresin AE. Assessing and Supporting Adolescents' Capacity for Autonomous Decision-Making in Health-Care Settings: New Guidance From the World Health Organization. J Adolesc Health 2022; 71:10-13. [PMID: 35718387 PMCID: PMC9215696 DOI: 10.1016/j.jadohealth.2022.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Valentina Baltag
- Department of Maternal, Newborn, Child & Adolescent Health & Ageing, World Health Organization, Geneva, Switzerland.
| | - Yusuke Takeuchi
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Regina Guthold
- Department of Maternal, Newborn, Child & Adolescent Health & Ageing, World Health Organization, Geneva, Switzerland
| | - Anne-Emmanuelle Ambresin
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Olick RS, Yang YT, Shaw J. Adolescent Consent to COVID-19 Vaccination: The Need for Law Reform. Public Health Rep 2021; 137:163-167. [PMID: 34546811 PMCID: PMC8721754 DOI: 10.1177/00333549211048784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Robert S. Olick
- Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse, NY, USA,Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA,Robert S. Olick, JD, PhD, Center for Bioethics and Humanities, State University of New York Upstate Medical University, 618 Irving Ave, Syracuse, NY 13210, USA.
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC, USA
| | - Jana Shaw
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA
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Cotrim H, Granja C, Carvalho AS, Cotrim C, Martins R. Children's Understanding of Informed Assents in Research Studies. Healthcare (Basel) 2021; 9:871. [PMID: 34356249 PMCID: PMC8307200 DOI: 10.3390/healthcare9070871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
The assent procedure reflects an effort to enable the minor to understand, to the degree they are capable of, what their participation in the decision making process would involve. AIMS To evaluate the minors' ability to understand the information provided to them when obtaining assent and to evaluate the opinion of the parents regarding the importance of asking the child's assent. METHODS The sample included a total of 52 minors aged between 10 and 17 years who underwent exercise echocardiogram. The Quality of Informed Consent is divided into two parts: Part A was used to measure objective understanding and part B to measure subjective understanding. RESULTS The results show that the minors have a high capacity to understand the information given to them when asking for assent. A positive relationship was found between the two parts of the questionnaire. No statistically significant relationship was found between age and sex and part A and part B or between both age groups (<14 years old and ≥14 years old) and the measure. In the case of the parents, 96.6% of parents consider assent as an advantage for the child's acceptance of health care. The opinion of the parents is not related to the age, sex or level of schooling. CONCLUSION Minors showed a substantial level of understanding regarding the information provided to them. The parents considered the implementation of assent fundamental to the child's acceptance of health care.
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Affiliation(s)
- Hortense Cotrim
- Nursing Department, Universidade Atlântica, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
| | - Cristina Granja
- Anaesthesiology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
| | - Ana Sofia Carvalho
- Associated Teacher with Aggregation, Institute of Bioethics, University of Portugal, 1649-023 Lisboa, Portugal;
| | - Carlos Cotrim
- Cardiology Department, Hospital da Cruz Vermelha, 1549-008 Lisboa, Portugal;
| | - Rui Martins
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, 1549-008 Lisboa, Portugal;
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Burton ET, Mackey ER, Reynolds K, Cadieux A, Gaffka BJ, Shaffer LA. Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations. J Clin Psychol Med Settings 2021; 27:235-246. [PMID: 32333235 DOI: 10.1007/s10880-020-09717-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The rising rates of severe obesity among adolescents in the United States indicate a dire need for more intensive weight management strategies. While current evidence suggests that bariatric surgery is a safe and efficacious intervention for adolescents, the linkages with psychopathology before and after surgery are not well understood. Psychologists are an integral part of the interdisciplinary surgery team and play an important role in preparing youth for bariatric surgery as well as supporting adolescents post-surgery. The present manuscript reviews the literature on psychopathology in the context of adolescent bariatric surgery, discusses consideration of psychopathology as a contraindication for surgery, and provides recommendations on how psychologist members of the bariatric surgery team may balance attention to motivation and adherence to medical recommendations with assessment and treatment of psychopathology. Finally, the importance of continued research to confirm clinical consensus regarding decision-making and expansion of psychological resources within adolescent bariatric surgery programs are discussed.
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Affiliation(s)
- E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Room 452R, Memphis, TN, 38103, USA. .,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Health System, Washington, DC, USA.,Department of Psychiatry and Behavioral Science, The George Washington University School of Medicine, Washington, DC, USA
| | - Kimberly Reynolds
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Adelle Cadieux
- Helen DeVos Children's Hospital, Grand Rapids, MI, USA.,Michigan State University, East Lansing, MI, USA
| | - Bethany J Gaffka
- Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura A Shaffer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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Zimet GD, Silverman RD, Bednarczyk RA, English A. Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations. J Pediatr 2021; 231:24-30. [PMID: 33484694 PMCID: PMC8005441 DOI: 10.1016/j.jpeds.2021.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.
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Affiliation(s)
- Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN,Reprint requests: Gregory D. Zimet, PhD, Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, HS 1001, Indianapolis, IN 46202
| | - Ross D. Silverman
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health and Robert H. McKinney School of Law, Indianapolis, IN
| | - Robert A. Bednarczyk
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, and Emory Vaccine Center, Emory University, Atlanta, GA
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Clark BA, Virani A. This Wasn't a Split-Second Decision": An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:151-164. [PMID: 33502682 PMCID: PMC8043901 DOI: 10.1007/s11673-020-10086-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 06/09/2020] [Indexed: 05/16/2023]
Abstract
Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender (trans) youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to consent to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified.
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Affiliation(s)
- Beth A. Clark
- Women’s, Gender, and Sexuality Studies, Brandeis University, Rabb 108, Waltham, MA 02453 USA
| | - Alice Virani
- Provincial Health Services Authority, British Columbia, 4480 Oak Street, Room V2-233, Vancouver, BC V6H 3V4 Canada
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Caruso Brown AE. Constrained Adolescent Autonomy for Healthcare Should Include Participation in Survey Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:85-87. [PMID: 32945753 DOI: 10.1080/15265161.2020.1806377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Michaud PA, Visser A, Vervoort J, Kocken P, Reijneveld S, Blair M, Alexander D, Rigby M, Weber M, Jansen D. Do European Union countries adequately address the healthcare needs of adolescents in the area of sexual reproductive health and rights? Arch Dis Child 2020; 105:40-46. [PMID: 31270093 PMCID: PMC6951236 DOI: 10.1136/archdischild-2019-317073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Adolescent sexual and reproductive health and rights (SRHR) are of particular relevance given their potential short-term or long-term health consequences. This study evaluates recommendations and policies regarding access to care in this area in 31 European countries (European Union (EU) plus Iceland, Norway and Switzerland). METHODS As part of the EU funded Models of Child Health Appraised project, data were gathered using a 43-item questionnaire sent to experts responsible for collecting information in each country. RESULTS Ten countries have not developed any formal policy or recommendation that guarantee the respect of confidentiality and the possibility of consulting a physician without parents knowing. Nearly half of the countries do not have centres specialised in adolescent healthcare, tackling comprehensive health issues or focusing specifically on SRH. Access to emergency contraception and information regarding pregnancy, including testing, is easy in most countries. However, oral contraception is delivered free of charge in only 10 countries. Twenty-three countries do not meet current standards in terms of providing policy-based pregnancy care, and only 13 have set up special programmes for pregnant adolescents. In only seven countries can adolescents definitely have their pregnancy terminated without their parents knowing (and in another seven countries in selected situations). CONCLUSION The provision and availability of adolescent-friendly SRHR care are far from optimal in around half of the surveyed countries. These results call for the review and implementation of policies, specialised healthcare centres and training initiatives for primary care providers.
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Affiliation(s)
| | - Annemieke Visser
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna Vervoort
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul Kocken
- Department Public Health and Primary Care, TNO, Department Child Health, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Mitch Blair
- Paediatrics, Imperial College London, Harrow, UK
| | | | | | - Martin Weber
- WHO Regional Office for Europe, WHO, Copenhagen, Denmark
| | - Danielle Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Taggart T, Bond KT, Ritchwood TD, Smith JC. Getting youth PrEPared: adolescent consent laws and implications for the availability of PrEP among youth in countries outside of the United States. J Int AIDS Soc 2019; 22:e25363. [PMID: 31369211 PMCID: PMC6672744 DOI: 10.1002/jia2.25363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/09/2019] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Youth under the age of 25 are at high risk for HIV infection. While pre-exposure prophylaxis (PrEP) has the potential to curb new infections within this population, it is unclear how country-specific laws and policies that govern youth access to sexual and reproductive health (SRH) services impact access to PrEP. The purpose of this review was to analyse laws and policies concerning PrEP implementation and SRH services available to youth in countries with a high HIV incidence. To the best of our knowledge this is the first systematic assessment of country-level policies that impact the availability of PrEP to adolescent populations. METHODS We conducted a review of national policies published on or before 12 June 2018 that could impact adolescents' access to PrEP, SRH services and ability to consent to medical intervention. Countries were included if: (1) there was a high incidence of HIV; (2) they had active PrEP trials or PrEP was available for distribution; (3) information regarding PrEP guidelines were publicly available. We also included a selected number of countries with lower adolescent HIV incidence. Internet and legal database searches were used to identify policies relevant to adolescent PrEP (e.g. age of consent to HIV testing). RESULTS AND DISCUSSION Fifteen countries were selected for inclusion in this review. Countries varied considerably in their respective laws and policies governing adolescents' access to PrEP, HIV testing and SRH services. Six countries had specific polices around the provision of PrEP to youth under the age of 18. Five countries required people to be 18 years or older to access HIV testing, and six countries had specific laws addressing adolescent consent for- and access to- contraceptives. CONCLUSIONS Adolescents' access to PrEP without parental consent remains limited or uncertain in many countries where this biomedical intervention is needed. Observational and qualitative studies are needed to determine if and how adolescent consent laws are followed in relation to adolescent PrEP provisions. Intensified efforts to amend laws that limit adolescent access to PrEP and restrict the establishment of national guidelines supporting adolescent PrEP are also needed to address the epidemic in this group.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community HealthGeorge Washington UniversityWashingtonDCUSA
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenCTUSA
| | - Keosha T Bond
- Department of Public HealthNew York Medical CollegeValhallaNYUSA
- Center for Interdisciplinary Research on AIDSYale School of Public HealthNew HavenCTUSA
| | - Tiarney D Ritchwood
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNCUSA
| | - Justin C Smith
- Department of Behavioral Sciences and Health EducationEmory University Rollins School of Public HealthAtlantaGAUSA
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19
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Boskey ER, Johnson JA, Harrison C, Marron JM, Abecassis L, Scobie-Carroll A, Willard J, Diamond DA, Taghinia AH, Ganor O. Ethical Issues Considered When Establishing a Pediatrics Gender Surgery Center. Pediatrics 2019; 143:peds.2018-3053. [PMID: 31085738 DOI: 10.1542/peds.2018-3053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
As part of establishing a gender surgery center at a pediatric academic hospital, we undertook a process of identifying key ethical, legal, and contextual issues through collaboration among clinical providers, review by hospital leadership, discussions with key staff and hospital support services, consultation with the hospital's ethics committee, outreach to other institutions providing transgender health care, and meetings with hospital legal counsel. This process allowed the center to identify key issues, formulate approaches to resolving those issues, and develop policies and procedures addressing stakeholder concerns. Key issues identified during the process included the appropriateness of providing gender-affirming surgeries to adolescents and adults, given the hospital's mission and emphasis on pediatric services; the need for education on the clinical basis for offered procedures; methods for obtaining adequate informed consent and assent; the lower and upper acceptable age limits for various procedures; the role of psychological assessments in determining surgical eligibility; the need for coordinated, multidisciplinary patient care; and the importance of addressing historical access inequities affecting transgender patients. The process also facilitated the development of policies addressing the identified issues, articulation of a guiding mission statement, institution of ongoing educational opportunities for hospital staff, beginning outreach to the community, and guidance as to future avenues of research and policy development. Given the sensitive nature of the center's services and the significant clinical, ethical, and legal issues involved, we recommend such a process when a establishing a program for gender surgery in a pediatric institution.
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Affiliation(s)
- Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | | | | | - Jonathan M Marron
- Ethics Advisory Committee.,Office of Ethics, and.,Division of Hematology/Oncology.,Center for Bioethics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Julian Willard
- Center for Bioethics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - David A Diamond
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | - Amir H Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
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20
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Sisk BA, Canavera K, Sharma A, Baker JN, Johnson LM. Ethical issues in the care of adolescent and young adult oncology patients. Pediatr Blood Cancer 2019; 66:e27608. [PMID: 30623573 DOI: 10.1002/pbc.27608] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 12/12/2022]
Abstract
The diagnosis and treatment of cancer leads to short-term and long-term challenges for every patient. This is especially true for adolescents and young adults (AYAs) with cancer who strive to gain independence, autonomy, confidence, and social status while developing into adulthood. In this article, we review prominent ethical issues in AYA oncology that are related to autonomy, shared decision-making, care refusal or abandonment, end-of-life care, truth telling, and fertility preservation. Clinicians should recognize that AYA patients develop at their own pace; the onus lies with clinicians to determine the patient's interests, values, maturity, and desire to participate in decision-making.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kristin Canavera
- Division of Psychology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Akshay Sharma
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Division of Quality-of-Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Liza-Marie Johnson
- Division of Quality-of-Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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21
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Michaud PA, Weber MW, Namazova-Baranova L, Ambresin AE. Improving the quality of care delivered to adolescents in Europe: a time to invest. Arch Dis Child 2019; 104:214-216. [PMID: 29599165 DOI: 10.1136/archdischild-2017-314429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/10/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Pierre-André Michaud
- Adolescent Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin W Weber
- Child and Adolescent Health, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Leyla Namazova-Baranova
- Department of Pediatrics, Scientific Centre of Children's Health, Russian State Medical University, Moscow, Russia
| | - Anne-Emmanuelle Ambresin
- Interdisciplinary Division for Adolescent Health, Lausanne University Hospital, Lausanne, Switzerland
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22
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Pathak PR, Chou A. Confidential Care for Adolescents in the U.S. Health Care System. J Patient Cent Res Rev 2019; 6:46-50. [PMID: 31414023 DOI: 10.17294/2330-0698.1656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In providing care for adolescents, maintaining confidentiality should be considered a human right and an evidence-based component of quality care. Unfortunately, complexities in the U.S. legal and health care systems have created a setting in which confidential care is inaccessible to many adolescent patients. Federal laws provide a minimum standard for confidentiality protections, but variations in state legislation relating to minor consent, special health care services, and confidentiality exemptions create large variability in adolescent confidentiality rights across the country. In certain contexts, such as consensual sexual activity, legal provisions may not align with professional ethical standards in adolescent care. In addition, contemporary clinical and administrative issues related to the electronic health record and health care financing also threaten to breach confidentiality. Although further research is necessary, providers and institutions are already well positioned to broaden protections by implementing best practices in training and education, workflow, and medical records related to adolescent confidentiality.
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Affiliation(s)
- Priya R Pathak
- Harvard T.H. Chan School of Public Health, Boston, MA.,University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adriana Chou
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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23
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Kirpekar MK, Silvay G, Augoustides JG, Castillo JG, Leong R, Sibbald R, Bainbridge D, Bishop CE, Fernando RJ, Morris B. The Adolescent Minor and Urgent Aortic Surgery: Challenges and Solutions With Capacity and Competence in Informed Consent. J Cardiothorac Vasc Anesth 2018; 33:1139-1145. [PMID: 30181083 DOI: 10.1053/j.jvca.2018.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Meera K Kirpekar
- Cardiac Anesthesiology Division, Department of Anesthesiology, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - George Silvay
- Cardiac Anesthesiology Division, Department of Anesthesiology, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Javier G Castillo
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - Ronald Leong
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert Sibbald
- Department of Ethics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Daniel Bainbridge
- Department of Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Christine E Bishop
- Chair of the Clinical Ethics Consultation Committee, Brenner Children's Hospital, Wake Forest School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Ben Morris
- Cardiothoracic and Critical Care Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
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24
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Brabant B. Adolescents, neurosciences et prise de décisions médicales : devrions-nous revoir certaines dispositions du Code civil du Québec? BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044262ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Au Québec, le mineur de 14 ans et plus peut consentir seul aux soins médicaux requis par son état de santé, sauf exception. Or, les données provenant des neurosciences indiquent que : 1) l’acquisition de la « maturité cérébrale » est un processus continu, pouvant durer jusqu’à la mi-vingtaine, et que 2) certaines habiletés décisionnelles de l’adolescent, comme l’évaluation des risques et bénéfices à court et à long terme, seraient différentes de celles des adultes, surtout dans les situations émotivement chargées. Nous soumettons que, dans une perspective de protection de l’intérêt supérieur de l’enfant, la réalité neurophysiologique de l’adolescent devrait être prise en compte en contexte de soins de santé. Ainsi, nous questionnons le caractère adéquat de la présomption de capacité d’exercer un jugement de façon autonome dès l’âge de 14 ans et soulignons l’aspect paradoxal de la possibilité d’une intervention judiciaire en cas de refus de traitement. Nous questionnons également la pertinence de considérations d’âge dans le cadre de la relation entre le médecin et son patient, dès lors que la détermination de la capacité décisionnelle est une composante essentielle de l’obtention d’un consentement libre et éclairé. Enfin, nous questionnons l’exclusion des parents du processus décisionnel, à la fois en regard de leur responsabilité parentale et des bénéfices que peuvent représenter leurs conseils pour l’adolescent. Par conséquent, nous soumettons qu’une évaluation du bien-fondé de l’octroi d’un pouvoir décisionnel à l’adolescent de 14 ans et plus serait souhaitable et qu’un régime uniformisé tout au long de la minorité, avec de possibles exceptions, reflèterait mieux les connaissances scientifiques actuelles.
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25
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Olszewski AE, Goldkind SF. The Default Position: Optimizing Pediatric Participation in Medical Decision Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:4-9. [PMID: 29466136 DOI: 10.1080/15265161.2017.1418921] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Inclusion of children in medical decision making, to the extent of their ability and interest in doing so, should be the default position, ensuring that children are routinely given a voice. However, optimizing the involvement of children in their health care decisions remains challenging for clinicians. Missing from the literature is a stepwise approach to assessing when and how a child should be included in medical decision making. We propose a systematic approach for doing so, and we apply this approach in a discussion of two challenging clinical cases. The approach is informed by a literature review, and is anchored by case studies of teenagers' refusal of clinical care, regulatory requirements for research assent, and the accepted approach to involving cognitively impaired adults in medical decisions.
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26
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Challa S, Manu A, Morhe E, Dalton VK, Loll D, Dozier J, Zochowski MK, Boakye A, Adanu R, Hall KS. Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana. Women Health 2017; 58:434-450. [PMID: 28296626 DOI: 10.1080/03630242.2017.1306607] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is known about the multilevel social determinants of adolescent sexual and reproductive health (SRH) that shape the use of family planning (FP) among young women in Africa. We conducted in-depth, semi-structured, qualitative interviews with 63 women aged 15-24 years in Accra and Kumasi, Ghana. We used purposive, stratified sampling to recruit women from community-based sites. Interviews were conducted in English or local languages, recorded, and transcribed verbatim. Grounded theory-guided thematic analysis identified salient themes. Three primary levels of influence emerged as shaping young women's SRH experiences, decision-making, and behaviors. Interpersonal influences (peers, partners, and parents) were both supportive and unsupportive influences on sexual debut, contraceptive (non) use, and pregnancy resolution. Community influences included perceived norms about acceptability/unacceptability of adolescent sexual activity and its consequences (pregnancy, childbearing, abortion). Macro-social influences involved religion and abstinence and teachings about premarital sex, lack of comprehensive sex education, and limited access to confidential, quality SRH care. The willingness and ability of young women in our study to use FP methods and services were affected, often negatively, by factors operating within and across each level. These findings have implications for research, programs, and policies to address social determinants of adolescent SRH.
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Affiliation(s)
- Sneha Challa
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , Michigan , USA
| | - Abubakar Manu
- b School of Public Health , University of Ghana , Legon , Ghana
| | - Emmanuel Morhe
- c Department of Obstetrics and Gynecology , Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Vanessa K Dalton
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Dana Loll
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , Michigan , USA
| | - Jessica Dozier
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Melissa K Zochowski
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Andrew Boakye
- c Department of Obstetrics and Gynecology , Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Richard Adanu
- b School of Public Health , University of Ghana , Legon , Ghana
| | - Kelli Stidham Hall
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
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27
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Donders J. Civil capacity in transition-age youth with history of central nervous system compromise: a review. Clin Neuropsychol 2016; 31:501-514. [PMID: 27892809 DOI: 10.1080/13854046.2016.1263362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this paper is to review various aspects of decision-making capacities in children and adolescents with a history of central nervous system compromise over the course of development and into transition to adulthood. METHOD The literature on consent capacity in various domains is reviewed, with reference to state-specific legal definitions and requirements, and illustrated with a case example. CONCLUSIONS Neuropsychologists who use an evidence-based assessment approach, and who can clearly communicate their findings in reference to specific probate court standards, can make a unique contribution to the legal system while serving their clients who are transitioning from adolescence into adulthood.
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Affiliation(s)
- Jacobus Donders
- a Psychology Service , Mary Free Bed Rehabilitation Hospital , Grand Rapids , MI , USA
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28
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Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R, Kennedy E, Mahon J, McGovern T, Mokdad AH, Patel V, Petroni S, Reavley N, Taiwo K, Waldfogel J, Wickremarathne D, Barroso C, Bhutta Z, Fatusi AO, Mattoo A, Diers J, Fang J, Ferguson J, Ssewamala F, Viner RM. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387:2423-78. [PMID: 27174304 PMCID: PMC5832967 DOI: 10.1016/s0140-6736(16)00579-1] [Citation(s) in RCA: 1760] [Impact Index Per Article: 220.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA
| | - John S Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David A Ross
- World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK
| | - Rima Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | - Peter Azzopardi
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
| | | | | | - Ritsuko Kakuma
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Terry McGovern
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ali H Mokdad
- Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Suzanne Petroni
- International Centre for Research on Women, Washington, DC, USA
| | - Nicola Reavley
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | | | | | - Zulfiqar Bhutta
- University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan
| | | | - Amitabh Mattoo
- Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India
| | | | - Jing Fang
- Kunming Medical University, Kunming, China
| | - Jane Ferguson
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Russell M Viner
- Institute of Child Health, University College London, London, UK
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