A Global Campaign for Microbicide report notes that the biologic and behavioral differences between young adolescents and older women justify separate safety and effectiveness data on younger adolescents on sexual and reproductive health products.19 The cervixes of younger female adolescents are not fully mature, making them biologically more susceptible to STIs. The https:// ensures that you are connecting to the Based on 2019 data, 55% of unintended pregnancies among adolescent girls aged 15 . Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, de Bruyn G, Nakku-Joloba E, Ngure K, Kiarie J, Coombs RW, Baeten JM for the Partners in Prevention HSV/HIV Transmission Study Team. World Health Organisation. Steinberg, L., E. Cauffman, J. Woolard, S. Graham, and M.T. Secondly, there is also another dimension to parental consent which adds a later of challenge to parental consenting. Informed consent is a fundamental principle in research ethics. [Accessed 17th May 2013]; efficacy study of the vaginal gel Carraguard to prevent HIV transmission. official website and that any information you provide is encrypted Minors access to abortion, the juvenile death penalty, and the alleged APA flip-flop. American Psychologist 64 (7): 583594. The .gov means its official. Accessibility Bethesda, MD 20894, Web Policies Ethical and Legal Issues in Education | Free Essay Example - StudyCorgi The claim that it is reasonable and sufficient to extrapolate safety and effectiveness data derived from those over 18 years to younger adolescents is flawed on two levels the physical and the social. Sawyer, S.M., P.S. AM: STARs: ethical and legal issues in adolescent medicine. A large number of adolescents initiate sex early with the median age of sexual debut being 157. While the parent may have given consent to the adolescents participation in research, the onus is on the researchers to keep all information provided by the adolescent confidential. Such distinctions could become incredibly important when considering how to introduce and promote such products to teens. The best interest standard is the best we have: Why the harm principle and constrained parental autonomy cannot replace the best interest standard in pediatric ethics. The guideline 14 of the Council for the International Organisation of Medical Sciences Guidelines tries to address the potential challenges that may arise with parental consent when adolescents are enrolled in research. <>/MediaBox[0 0 612 792]/Parent 3 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Tabs/S/Type/Page>> Journal of Adolescent Health 35 (2): 160167. <>/MediaBox[0 0 612 792]/Parent 3 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Tabs/S/Type/Page>> There is a growing body of evidence to show that adolescents can be safely engaged in sexual and reproductive health research howbeit these examples are almost exclusively limited to USA. The .gov means its official. endobj Before Also, 12.4% of male and female respondents were married by 15 years, 15.3% of women and 6.2% of men had their first sex experience by 15 years, and 29.7% of female and 6.8% of male 1519 year old respondents had had sex within the last 4 weeks of the survey.21 These data emphasises the need for early engagement of adolescents in sexual and reproductive health research that can help in the development of products and the design of programmes that addresses their sexual and reproductive health needs. Hardin, A.P., and J.M. Eliason et al reported an unintended pregnancy rate of 70% in a Ghanaian hospital-based study, with over 90% of adolescent pregnancies being unintended [ 7 ]. An adolescent with an eating disorder. The Nigerian population is young with well over 55% of the population below 29 yrs.16 There is therefore the need to pay particular attention to the health needs of this population. Ethical and legal issues in adolescent pregnancy. Consultation and engagement of the community prior to research protocol submission to the ethics committee creates the opportunity to discuss the rationale underpinning the inclusion of adolescents in the research, as well as the reasons for not making parental consent for an adolescents participation in a study a requirement where such is the case. Careers, Unable to load your collection due to an error. Presson, S.J. Adolescents and Informed Consent: Ethical and Legal Issues : The Journal of Perinatal & Neonatal Nursing The right of adolescents to consent to various types of healthcare vary widely from state to state. Fetal viability as a threshold to personhood. National Library of Medicine 1 - 4 Health care confidentiality is the "privileged and private nature of information provided during the . These factors can affect their understanding of risks and their capacity to make consistently sound judgments about their long-term best interest. Adolescent Medicine: State of the Art Reviews. 2015;24(3):166-176. doi: 10.1080/1067828X.2013.777380. Prevalence of violence against young female hawkers in three cities in south-western Nigeria. National Library of Medicine The .gov means its official. Unable to load your collection due to an error, Unable to load your delegates due to an error. Kapogiannis BG, Handelsman E, Ruiz MS, Lee S. Introduction: Paving the way for biomedical HIV prevention interventions in youth. Significantly more female adolescents who reported being HIV positive had experiences forced sex when compared to female adolescents who reported being HIV negative (p = 0.008).15. Epub 2014 Oct 7. The site is secure. government site. However, it must be recognized that adolescence is a combination of physical, psychological and social changes that manifest differently in different cultural settings. It explicitly states in the section F(c) that minors should not be excluded from research without explicit reasons for doing so.32 Unfortunately, the code is not explicit about age for consent and assent. The .gov means its official. The https:// ensures that you are connecting to the In addition to legal concerns, serious ethical dilemmas arise, particularly with respect to treatment of special populations of adolescents. https://doi.org/10.1111/j.1532-7795.2010.00712.x, https://doi.org/10.1037//0278-6133.9.6.701, https://www.ncbi.nlm.nih.gov/books/NBK554594/. Somerville. As we shall elaborate later in this paper, data cannot be extrapolated from other populations because adolescent experiences are particular to their societal context, shaped by factors including gender expectations and the socialisation processes at family levels17. First published: 07 October 2014. https://doi.org/10.1016/j.ijgo.2014.10.006. There are several justifications for conducting research on adolescents reproductive and sexual health especially in Nigeria where there is limited data to inform national planning on sexual and reproductive health for adolescents. 1993 Summer;12(3):498-511. PDF. The assurance of data security is likely to promote adolescents engagement in sexual and reproductive health research. 2020a. As medical evidence shows, cognitive development of the adolescents is near that of the adult by 14 years such that decision making and reasoning ability is as good as that seen in adulthood and involves the flaws.44 It may therefore be important to advocate for changes in the law so it can permit adolescents 15 years and above with proven evidence of sufficient maturity, and with the mental capacity to understand the benefits, risks, and social and other implications of the outcome, to participate in research in general and sexual and reproductive health research specifically, without parental consent. Adolescent abortion: Psychological and legal issues. Adolescents and Informed Consent: Ethical and Legal Issues : The - LWW Federal government websites often end in .gov or .mil. National Library of Medicine As noted, a parent may give consent for enrolment, but adolescents may expect confidentiality for some components (such as their risk behaviour). 2018. This review examines confidentiality, consent to health care and research involving adolescents in regard to legal and ethical aspects. The 2008 NDHS showed that 9% of those under the age of 15 years were not living with biological parents.37 A recent analysis of a data collected on adolescent studies showed that 18.9% of adolescents aged 10 19 years reside with guardians.38 Research practice however limits parental consent to recognized legal guardians. Pediatric Ethics: Theory and Practice pp 155169Cite as, 4 World Health Organization. DOI: 10.1016/s0025-7125(16)30504-1 Abstract Treating adolescents in the health care system raises significant legal and ethical issues related to consent for treatment, confidentiality of communications and records, and payment for care. Experience of sexual coercion among adolescents in Ibadan, Nigeria. FOIA The site is secure. Age limit of pediatrics. The former president had assailed Hillary Clinton for her handling of sensitive information . Unfortunately, while the National Childs Act specifically specified the age limits for consenting in research, evolving evidence points to a need to lower the current age for consenting to enable younger adolescents engage in research that can inform programme development and programming apt to address their needs. However, the ethical obligation to obtain informed consent using shared decision making does not change based on pregnancy or parenting status 4 39. Adolescents and Informed Consent: Ethical and Legal Issues - ResearchGate The Ethical Issue. Legal and Ethical Issues in the Provision of Adolescent Reproductive Health in the United States Ethical and Legal Issues in Adolescent Pregnancy. Where ethics committees do not feel confident that the risk associated with the research are acceptably low, parental consent for research participation may be required. Adolescent health: overview and global situation. Duties and responsibilities: Can a child provide consent? sharing sensitive information, make sure youre on a federal This is a preview of subscription content, access via your institution. The prevalence of sexual violence ranges between 15 to 40% in sub-saharan Africa12 with studies showing rates of sexual coercion and abuse among adolescents in Nigeria ranging between 11 to 55%.13 The report of rape ranges between 4% and 6%.14 A recent study conducted amongst 1,601 adolescents in Nigeria shows that 12 (0.05%) male and 69 (31.4%) female adolescents reported forced sex. https://doi.org/10.1016/S2352-4642(18)30022-1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA, UNLV School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA, Barone, S., Unguru, Y. Unauthorized use of these marks is strictly prohibited. Age limits and adolescents. The rights of minors to give consent to medical care is expressed in the mature minor doctrine and has been extended, with some limitations, to the abortion decision. Child consent in South African law: Implications for researchers, service providers and policy-makers. Autonomy and decision making for health promotion in adolescence. Parental consent alongside that of the adolescent is a major concern. Ethical issues in adolescent pregnancies - - 2015 - International Federal government websites often end in .gov or .mil. Singh et al36 noted that mature minors live with surrogate caregivers who are not formally appointed or recognised as the adolescentss legal guardian. Morolake Odetoyingbo, Positive Action for Treatment Access, Lagos, Nigeria. MeSH Nature 554 (7693): 441450. Adolescents are more likely to seek health care if their provider assures confidentiality, but in providing confidential care a balance should be considered between the needs of the adolescent patient, parents, and provider. While the capacity for autonomous decision-making varies considerably across cultures and stages of adolescence it is important to consider that the involvement of parents (and guardians) in an informed consent process may jeopardize the autonomous decision-making of the adolescent, in addition to possibly compromising confidential information about the adolescent. endobj Wheeler R. Gillick or Fraser? %PDF-1.7 % Federal government websites often end in .gov or .mil. Would you like email updates of new search results? A comparison of minors' and adults' pregnancy decisions. <>/MediaBox[0 0 612 792]/Parent 3 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Tabs/S/Type/Page>> National Library of Medicine <>stream Doctors who examine teenagers usually find that their patients come in fairly late, and some teenagers may carry their pregnancy to term while others request abortions as late as the 2nd trimester. What Can Parents Do? One successful example is the Adolescent Trial Network funded by the National Institute of Health (NIH). A review of the health consequences of adolescent pregnancy indicates that pregnancy in adolescents has a higher mortality rate than that of legal abortions. Ethical and legal issues relating to abortion in adolescence Author T J Silber 1 Affiliation 1 Department of Adolescent and Young Adult Medicine, Children's Hospital National Medical Center, Washington, DC. J Pediatr 2021:231;24-30. Confidentiality, consent, and caring for the adolescent patient. Azzopardi, D. Wickremarathne, and G.C. From the obstetrical point of view, abortion is the interruption of pregnancy, spontaneous or provoked, with up to 22 weeks of gestation and/or with the fetus weighing up to 500 g 1.. From a Brazilian legal point of view, abortion is the interruption of pregnancy with the destruction of the product of conception, regardless of gestational age or fetal weight and whether the pregnancy is . 2005 Jan;45(1):60-7. doi: 10.1016/j.annemergmed.2004.08.011. Clinicaltrial.gov. 2016. 2 0 obj Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria. Edwards. Bester, J.C. 2019. https://doi.org/10.1016/j.psc.2009.02.001. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women.
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