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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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Akrami F, Zali A, Abbasi M. An Islamic Bioethics Framework to Justify the At-risk Adolescents’ Regulations on Access to Key Reproductive Health Services. Asian Bioeth Rev 2022; 14:225-235. [DOI: 10.1007/s41649-021-00200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022] Open
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Salamanca-Buentello F, Seeman MV, Daar AS, Upshur REG. The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world. PLoS One 2020; 15:e0237853. [PMID: 32834012 PMCID: PMC7446846 DOI: 10.1371/journal.pone.0237853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 08/04/2020] [Indexed: 01/14/2023] Open
Abstract
Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi- and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low- and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing long-term funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to reduce the burden of these disorders by encouraging their timely and context-sensitive prevention and management.
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Affiliation(s)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Abdallah S. Daar
- Departments of Clinical Public Health and Surgery, University of Toronto, Toronto, Ontario, Canada
- Stellenbosch Institute for Advanced Study, Stellenbosch, Western Cape, South Africa
| | - Ross E. G. Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld - Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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Gerlach M, Warnke A. [Drug therapy in child and adolescent psychiatry in Germany between ethical as well as social and legal conflicts]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:249-55. [PMID: 27434686 DOI: 10.1024/1422-4917/a000430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Manfred Gerlach
- 1 Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg.,2 Arbeitsgruppe "Kinder- und jugendpsychiatrische Pharmakologie" der AGNP
| | - Andreas Warnke
- 1 Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg
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Jonsson U, Johanson J, Nilsson E, Lindblad F. Adverse effects of psychological therapy: An exploratory study of practitioners' experiences from child and adolescent psychiatry. Clin Child Psychol Psychiatry 2016; 21:432-46. [PMID: 26585069 DOI: 10.1177/1359104515614072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The scientific knowledge about adverse effects of psychological therapies and how such effects should be detected is limited. It is possible that children and adolescents are particularly vulnerable and need specific support in order to express adverse effects. In this exploratory study, we used a qualitative approach to explore practitioners' experiences of this phenomenon. Fourteen practitioners providing psychological therapy within the Child and Adolescent Psychiatric Service were interviewed. Qualitative content analysis was applied to the data. Four overarching categories brought up by the practitioners were identified: vagueness of the concept (reflecting that the concept was novel and hard to define), psychotherapist-client interaction (encompassing aspects of the interaction possibly related to adverse effects), consequences for the young person (including a range of emotional, behavioural and social consequences) and family effects (e.g. professional complications and decreased autonomy for the parent). Professional discussions on these issues could improve psychological therapy for children and adolescents. Based on our findings and previous research, we propose three basic aspects to consider when adverse effects are detected and managed in this context: typology (form, severity and duration), aetiology (hypothesis about the causes) and perspective (adverse effects seen from the points of view of different interested parties).
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Affiliation(s)
- Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden National Board of Health and Welfare, Sweden
| | | | - Elin Nilsson
- National Board of Health and Welfare, Sweden Department of Psychology, Uppsala University, Sweden
| | - Frank Lindblad
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden
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Rothenberger A, Rhode LA, Rothenberger LG. Biomarkers in Child Mental Health: a bio-psycho-social perspective is needed. Behav Brain Funct 2015; 11:31. [PMID: 26420488 PMCID: PMC4589190 DOI: 10.1186/s12993-015-0076-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/15/2015] [Indexed: 02/04/2023] Open
Affiliation(s)
- Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center Goettingen, von-Siebold-Str. 5, 37075, Goettingen, Germany.
| | - Luis Augusto Rhode
- Child and Adolescent Psychiatric Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. .,Institute for Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil.
| | - Lillian Geza Rothenberger
- Kinder- und Jugendpsychiatrischer Dienst Thurgau/Schweiz, Bahnhofplatz 69b, 8500, Frauenfeld, Switzerland.
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Guidance in social and ethical issues related to clinical, diagnostic care and novel therapies for hereditary neuromuscular rare diseases: "translating" the translational. PLOS CURRENTS 2013; 5. [PMID: 23330068 PMCID: PMC3544553 DOI: 10.1371/currents.md.f90b49429fa814bd26c5b22b13d773ec] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Drug trials in children engage with many ethical issues, from drug-related safety concerns to communication with patients and parents, and recruitment and informed consent procedures. This paper addresses the field of neuromuscular disorders where the possibility of genetic, mutation-specific treatments, has added new complexity. Not only must trial design address issues of equity of access, but researchers must also think through the implications of adopting a personalised medicine approach, which requires a precise molecular diagnosis, in addition to other implications of developing orphan drugs. It is against this background of change and complexity that the Project Ethics Council (PEC) was established within the TREAT-NMD EU Network of Excellence. The PEC is a high level advisory group that draws upon the expertise of its interdisciplinary membership which includes clinicians, lawyers, scientists, parents, representatives of patient organisations, social scientists and ethicists. In this paper we describe the establishment and terms of reference of the PEC, give an indication of the range and depth of its work and provide some analysis of the kinds of complex questions encountered. The paper describes how the PEC has responded to substantive ethical issues raised within the TREAT-NMD consortium and how it has provided a wider resource for any concerned parent, patient, or clinician to ask a question of ethical concern. Issues raised range from science related ethical issues, issues related to hereditary neuromuscular diseases and the new therapeutic approaches and questions concerning patients rights in the context of patient registries and bio-banks. We conclude by recommending the PEC as a model for similar research contexts in rare diseases.
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Kölch M, Fegert J, Plener P. Psychopharmakologisches Wissen für die pädiatrische Praxis. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2716-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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March JS, Fegert JM. Drug development in pediatric psychiatry: current status, future trends. Child Adolesc Psychiatry Ment Health 2012; 6:7. [PMID: 22313578 PMCID: PMC3296572 DOI: 10.1186/1753-2000-6-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 02/07/2012] [Indexed: 12/12/2022] Open
Affiliation(s)
- John S March
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Joerg M Fegert
- University Hospital Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Steinhövelstr 5, 89075 Ulm, Germany
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Coverdale J, Roberts LW. Global challenges and ethics in protecting and promoting the interests of psychiatrically ill patients. Int Rev Psychiatry 2010; 22:229-34. [PMID: 20528651 DOI: 10.3109/09540261.2010.486828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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