https://doi.org/10.1038/nature25770. World Health Organization. Adolescents and youth in developing countries: Health and development issues in context. J Leg Med. Log in or Register The onus now lies on the ethics committees to be competent enough to calculate the risk-benefit calculus for the research and adjudge that the implementation of such research would not expose the adolescent to undue risk taking cognisance of age and cultural peculiarities. MeSH official website and that any information you provide is encrypted This site needs JavaScript to work properly. Ethical and Legal Issues in Adolescent Pregnancy. Legally, these caregivers may not be recognized as the legal guardian. The peculiar challenges of applying fundamental ethical principles for adolescents engaged in research especially in cultures sensitive to open and public discussions about sex and sexuality, and how to resolve them can only be learnt from practical field experiences. Author. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Davis, M., and A. Fang. The data on adolescent rates of STIs and experiences of sexual violence show that their sexual and reproductive health needs are inadequately served. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Diaz A, Neal WP, Nucci AT, Ludmer P, Bitterman J, Edwards S. Katz AE, Nussbaum RL, Solomon BD, Rehm HL, Williams MS, Biesecker LG. 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. the contents by NLM or the National Institutes of Health. PMC Ethical and Legal Issues in Adolescent Pregnancy. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. To help inform ethical and safety recommendations for the design, conduct, and reporting of . . official website and that any information you provide is encrypted Pregnancy testing in CTIMPs Although CTIMPs usually require universal pre-enrolment pregnancy testing in 'women of child-bearing age', protocols often fail to specify age-related criteria for testing or what action should be taken if testing is . 2017. 2018. 2017-12-13T07:30:31-08:00 Correspondence to endobj Although online psychological services and research based on them are increasing rapidly, it is not that easy to find investigations that focus . In many communities, young people have surrogate caregivers who are not formally appointed as legal guardians. Adolescents are generally considered to be individuals between childhood and adulthood who are in the process of reaching physical, psychological and sexual maturity though there is no agreement among experts about its precise definition. Child consent in South African law: Implications for researchers, service providers and policy-makers. Adolesc Med State Art Rev. In StatPearls. Owen, and N. Woolacott. Birkeland MS, Melkevik O, Holsen I, Wold B. Nature 554 (7693): 441450. Bethesda, MD 20894, Web Policies Abortion as well as full-term pregnancy are procedures that carry extreme mental stress. Key Words: Adolescents, reproductive health, ethical issues, United States, Informed Consent Katherine Ferrell Fouquier, CNM, PhD, FACNM University of Mississippi Medical Center Psychiatric Clinics of North America. Legal and Ethical Issues - Child and Adolescent Behavioral Health 8600 Rockville Pike Some abortions can be performed on adolescents without parental support; however, recent court decisions have provided certain measures for "immature minors." Federal government websites often end in .gov or .mil. Adolescence is a period of rapid physical, cognitive and psychosocial growth that represents a progressive transition from childhood to adulthood. Bookshelf The https:// ensures that you are connecting to the Developing guidance for pregnancy testing of adolescents participating adolescent sexual activity before the age of consent that meets the legal requirement for disclosure, but which is occuring with consent of the adolescent. Fawole OI, Ajuwon AJ, Osungbade KO, Faweya OC. Autonomy and decision making for health promotion in adolescence. Ethical issues in adolescent pregnancies - PubMed Ethics is an ever evolving field and ethical consideration of adolescents engagement in sexual and reproductive health research shall continue to constitute central themes in many ethical discourses for a while to come. The Ethical Issue. This site needs JavaScript to work properly. Before This decision is influenced by the feelings of the pregnant woman towards the pregnancy, socio . Accordingly, it will be important to understand how and when adolescents make decisions about choices on contraceptive options, points of access to these contraceptive tools, and how appropriate information on contraceptive choices related to their sexual and reproductive health needs can be shared in an accessible manner. Unable to load your collection due to an error, Unable to load your delegates due to an error, [Article in Involving adolescents in research should be based on a careful assessment of risks and benefits together with understanding of the developing capabilities of the adolescent. For studies on these topics, ethical review committees may waive parental permission if, for example, parental knowledge of the subject matter may place the adolescents at some risk of questioning or even intimidation by their parents (CIOMS, 2002).42, Zuch et al also further highlighted the challenges associated with parental consent for all forms of research engaging adolescents. Prevention of pregnancy and children of reproductive age, as well as child marriage, are part of the SDG agenda with specific indicators, including indicator 3.7.2 "Adolescent birth rate (aged 10-14; aged 15 to 19) per 1000 women in this age group" and 5.3.1, "Proportion of women aged 20 to 24 married before age 18." official website and that any information you provide is encrypted Read the full text. Unable to load your collection due to an error, Unable to load your delegates due to an error. <>stream and transmitted securely. Its activities encompass the full spectrum of research needs for adolescents including clinical management of HIV-infected youth and risk reduction. These factors can affect their understanding of risks and their capacity to make consistently sound judgments about their long-term best interest. This is a preview of subscription content, access via your institution. Prevalence of violence against young female hawkers in three cities in south-western Nigeria. Sexual behavior and experience of sexual coercion among secondary school students in three states in North Eastern Nigeria. A comparison of minors' and adults' pregnancy decisions. Mulligan K, Harris DR, Monte DD, et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Steinberg, L. 2005. Altmetric, Part of the The International Library of Bioethics book series (ILB,volume 89). Health care providers (HCPs) caring for adolescents require a general framework for navigating issues of confidentiality and consent for this unique segment of the pediatric population. 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. application/pdf Experience of sexual coercion among adolescents in Ibadan, Nigeria. Critical legal issues. In Nigeria, the National Health Research Ethics Code provides limited guidance on this. These cultural and social issues may become the main consideration in the question on the morality of not obtaining parental permission prior to adolescent engagement in research. Informed consent is a fundamental principle in research ethics. Disclaimer. J Policy Anal Manage. Zuch M, Manson-Jones AJ, Mathews C, Henley L. Changes to the law on consent in South Africa: implications for school-based adolescent sexual and reproductive health research. Microbicides are potential sexual health products that should reduce the possibility of HIV infection through vaginal and or anal sex. 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. Committee, and on practice and ambulatory medicine. Essack Z, Slack C, Strode A. Overcoming key obstacles to adolescent involvement in HIV vaccine and microbicide trials: A roadmap for stakeholders. The Lancet Child & Adolescent Health 2 (3): 223228. Instead of chronological age of consent, permission for consent must take into consideration the adolescent's capacity for understanding the medical treatment or the research in which the adolescent is requested to be involved. The ethical dilemma of engaging adolescents in research in general, and sexual and reproductive health research specifically, is intertwined with legal and regulatory issues. {"type":"clinical-trial","attrs":{"text":"NCT00213083","term_id":"NCT00213083"}}. Google Scholar. sharing sensitive information, make sure youre on a federal The economic impact of state restrictions on abortion: parental consent and notification laws and Medicaid funding restrictions. Ethical and legal issues pertaining to adolescent pregnancy focus on the rights of adolescents to consent to healthcare services and to maintain confidentiality of these services.. Caring for Adolescents: Unique Ethical Considerations. Obesity and dyslipidemia in behaviorally HIV-infected young women: Adolescent Trials Network study 021. The https:// ensures that you are connecting to the Bethesda, MD 20894, Web Policies Tax calculation will be finalised at checkout. National Library of Medicine Applying specific and individual test of competency, and documenting it, has a clear advantage over agespecified restrictions in that it recognises the developmental and cognitive differences that exist within groups of young people who mature at different rates. Kapogiannis BG, Handelsman E, Ruiz MS, Lee S. Introduction: Paving the way for biomedical HIV prevention interventions in youth. One successful example is the Adolescent Trial Network funded by the National Institute of Health (NIH). There is also tension around how to manage confidentiality when the setting has laws about disclosures that must be reported to authorities e.g. 5 0 obj Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554594/. Many teenagers that go through with either procedure suffer mental breakdowns. Research is needed to help understand what adolescents need and how best to reach them in order to design appropriate interventions focused on safe sexual behaviour and to protect and promote their sexual and reproductive health. English, At all circumstances adolescent's assent for both medical treatment and research is always mandatory. sharing sensitive information, make sure youre on a federal For example, the appropriateness of including adolescents in research when the risks are more than low or minor increase over minimal is a difficult and thorny ethical issues. FOIA <> Hardin, A.P., and J.M. One of the several rationales for biomedical or socio-behavioural research is that it may lead to discovery of information that can guide the implementation and delivery of appropriate preventive and therapeutic services to the particular population studied. Bester, J.C. 2019. Weithorn, L.A., and S.B. Children below 12 years are not however, required to give assent (personal communication, Prof Clement Adebomowo, National Health Research Ethics Committee Chairperson). Ethical and Legal Issues in Adolescent Pregnancy - ScienceDirect Ajuwon AJ, Olaleye A, Faromoju B, Ladipo O. Confidential Care for Adolescents in the U.S. Health Care System <>/MediaBox[0 0 612 792]/Parent 3 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Tabs/S/Type/Page>> 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. Banich. 2011. Fatusi AO, Blum RB. Such justification for a waiver must however establish a case for ethical duty of beneficence and justice for the conduct of the research on this group with evidence to show the research is appropriate for the group. 44 0 obj Am J Hum Genet. Ethical and Legal Issues in Adolescent Pregnancy The natural history of cigarette smoking: Predicting young-adult smoking outcomes from adolescent smoking patterns. To read, Please Download here. Ethical and legal issues in adolescent medicine. Preface They represent one fifth of the worlds population in general but constitute a larger proportion of the population of low and middle income countries (LMIC) compared to developed countries.1 Individuals aged 10 to 19 years constitute 11% of the population of the more developed countries, 18.1% of middle income countries and 23% of the least developed countries (US Census Bureau). The omission of such research can perpetuate inadequate understanding of the particular reproductive health needs of adolescents and result in failure to deliver adequate services to this group. Virtual Mentor 7 (3): 213217. uuid:855ebbaa-a771-11b2-0a00-782dad000000 33. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly assessing capacity to understand the issues and make an informed decision on whether to participate in research or not. As a library, NLM provides access to scientific literature. The father suggests not letting the girl drink water until she drinks milk. Fetal viability as a threshold to personhood. Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria. The confirmation of a pregnancy is accompanied by a decision to abort or continue to term. 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. An official website of the United States government. J Med Ethics. 2011. Sigman, G. 2005. As noted in the introduction, the Nigeria Constitution30 and the section 277 of the 2003 Child Rights Act31 define a minor as a person under the age of 18. EBTHR[AoR@egD/q+*5,V*I5|^+f_ ) :/t=F#YRf2E[v$Yp0jx{Lp}i1&)eYdJj6)KTRdF|F1 Ethical considerations concerning adolescents consulting for contraceptive services. sharing sensitive information, make sure youre on a federal To date, scientific justification for adolescent enrolment in any research has not been articulated in a way that key stakeholders, like community representatives, can continuously appreciate. <>stream Federal government websites often end in .gov or .mil. Obstet Gynecol Clin North Am. The site is secure. Ford, C., A. English, and G. Sigman. 2 0 obj This action negates the principle of justice which promotes fair selection of study participants. endobj The implication for adolescents resident with surrogate caregivers is exclusion from research which could be of benefit both to the participants and the broader population. 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. 2020. Patterns of consultation among adolescent minors obtaining an abortion. The .gov means its official. Adults before their time: Children in Saudi Arabias criminal justice system. Privacy and confidentiality are considered critical for adolescent enrollment in research.40 Where parents give consent for an adolescent to participate in research, the researchers will need to struggle to strike a balance between parental involvement and the need to protect the adolescents privacy and confidentiality especially with regards to sex and sexuality. article describes issues surrounding legal and ethical issues of informed consent and confidentiality for adolescents seeking reproductive health services. National HIV/AIDS Reproductive Health Survey. 13 0 obj Summary This chapter introduces the legal and ethical considerations for the advanced practice registered nurse (APRN) providing care to children in primary care settings and suggests methods for r. Legal and Ethical Issues - Child and Adolescent Behavioral Health - Wiley Online Library Skip to Article Content Skip to Article Information One major concern about adolescents is their ability to comprehend. However, the ethical obligation to obtain informed consent using shared decision making does not change based on pregnancy or parenting status 4 39. 2009. Adolescent abortion: Psychological and legal issues. Informed Consent and Shared Decision Making in Obstetrics and - ACOG Springer, Cham. 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. Ethical and Legal Issues Relating to Abortion in Adolescence. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1992;20(3):309-23. Clipboard, Search History, and several other advanced features are temporarily unavailable. This is one successful story in the conduct of ethical trials that engage adolescents on health issues of particular concern to them.48. Please enable it to take advantage of the complete set of features! Resolution of the legal and ethical questions requires cooperation of professionals from many disciplines. Researchers should ensure the adolescent demonstrates capacity for comprehension and required actions. Canadian Medical Protective Association. However, it must be recognized that adolescence is a combination of physical, psychological and social changes that manifest differently in different cultural settings. Many adolescent health challenges are closely interrelated and successful interventions in one area can lead to positive outcomes in other areas. Unauthorized use of these marks is strictly prohibited. 2017-12-13T07:30:31-08:00 Providers should use all the information at their disposal to evaluate decision-making capacity and, therefore, the adolescents ability to meet criteria for the provision of informed assent/consent on a case-by-case basis. You may be trying to access this site from a secured browser on the server. 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. HHS Vulnerability Disclosure, Help Am J Orthopsychiatry. <>/MediaBox[0 0 612 792]/Parent 3 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Tabs/S/Type/Page>> Committee Opinion Number 803: Confidentiality in Adolescent Health Care. Given adolescents legal standing as minors, some level of parental involvement is typically expected, and HCPs must possess appropriate communication skills for managing situations when there is disagreement between an adolescent patient and their parents or where parental involvement represents a barrier to confidential care. Careers. sharing sensitive information, make sure youre on a federal Adolescents face and have to deal with sexual abuse and sexual coercion in their daily lives. official website and that any information you provide is encrypted In these instances, it is practically impossible to seek parental consent or to determine who, if anyone, is the legal guardian to authorise an adolescents participation in a study. At least 1 million teenagers in the United States get pregnant every year; 350,000 teenagers choose to terminate their pregnancies by abortion. 2011. The former president had assailed Hillary Clinton for her handling of sensitive information . In summary, the informed consent process should take into consideration the capacity of the adolescent to consent; the role of surrogate decision-makers who should be able to consent when adolescents do not have capacity; and possible restrictions on the autonomy of adolescents or their proxies to consent. 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. official website and that any information you provide is encrypted The site is secure. https://doi.org/10.1111/j.1532-7795.2010.00712.x. Ethical Considerations for Research and Treatment With Runaway and 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 Section 64(2) of the Child Rights Act however provides that an adolescent who has attained the age of 16 years has the right to give consent for scientific investigation without parental consent. Chassin, L., C.C. Under the Nigerian constitution, a person under 18 years is defined as a minor.4 Therefore the law considers that such persons have limited legal capacity and in many situations require a legally authorized surrogate decision maker (parent, guardian or family member) to act on their behalf. Kiser JJ, Fletcher CV, Flynn PM, et al. Secondly, there is also another dimension to parental consent which adds a later of challenge to parental consenting. A plea for consistency over competence in children. This is particularly likely to occur if the research involves discussing sex with young people in communities where discussions of sexual subjects with adolescent are usually taboo. Argues that counselors dealing with a pregnant unmarried teenager must be prepared to deal with abortion as an option and should be familiar with the legal . Somerville. MeSH The above shows clearly that for Nigeria, the age for consent for participation in research is still very unclear. It is also described as the principle of respect for persons29 which acknowledges that individuals with capacity have to right to make autonomous decisions. An official website of the United States government. From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine--Part II: Challenges in the emergency department. Singh JA, Karim SS, Karim QA, Mlisana K, Williamson C, Gray C, Govender M, Gray A. Enrolling adolescents in research on HIV and other sensitive issues: lessons from South Africa. 2015 Feb;128 (2):185-6. doi: 10.1016/j.ijgo.2014.10.006. The https:// ensures that you are connecting to the The https:// ensures that you are connecting to the (2022). 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. It is obtained through a dialogue that respects the individuality of each prospective participant and allows ample opportunity for the prospective participant to ask questions, which the research team member must answer fully. Participants exclusion should be on the basis of their ineligibility due to scientific parameters, those who may undermine the scientific validity of the study, and those who may face significantly higher risk through participation in a study. Adolescents represent a critically important user group for reproductive health products as they bear a disproportionate share of the global health burden of STIs and HIV, in addition to risks of unplanned pregnancy. National Health Research Ethics Committee of Nigeria, Federal Ministry of Health, Department of Health Planning and Research. government site. They therefore need a legally authorized surrogate decision maker-usually a family member to act on their behalf. Epub 2013 Sep 25. The site is secure.