Minor Minors (under age 18) do not have same constitutional rights as adults: vulnerability of children limited decision-making capacity important role parents plan in making decisions for their children Allowable treatment of minors without parental consent At least 1 million teenagers in the United States get pregnant every year; 350,000 teenagers choose to terminate their pregnancies by abortion. These factors can affect their understanding of risks and their capacity to make consistently sound judgments about their long-term best interest. Obstet Gynecol Clin North Am. 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. Would you like email updates of new search results? This is important as research participants who consent (or whose consent is sought) to participate must be able to understand the implications of information provided about the study. However, the ethical obligation to obtain informed consent using shared decision making does not change based on pregnancy or parenting status 4 39. Obesity and dyslipidemia in behaviorally HIV-infected young women: Adolescent Trials Network study 021. This site needs JavaScript to work properly. Fatusi AO, Blum RB. Adolescents of the same age are also frequently inclined toward risk taking, and are acutely sensitive to peer influence. Published Online:April 01, 1989 https://doi.org/10.3928/0090-4481-19890401-05 Cited by:2. You may be trying to access this site from a secured browser on the server. Careers, Unable to load your collection due to an error. The former president had assailed Hillary Clinton for her handling of sensitive information . PMC EBTHR[AoR@egD/q+*5,V*I5|^+f_ ) :/t=F#YRf2E[v$Yp0jx{Lp}i1&)eYdJj6)KTRdF|F1 FOIA 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). National Library of Medicine Therefore, research on adolescents reproductive health can lead to development of interventions that can maximize adolescents health potentials. Children below 12 years are not however, required to give assent (personal communication, Prof Clement Adebomowo, National Health Research Ethics Committee Chairperson). Management of Secondary Genomic Findings. An official website of the United States government. The World Health Organisation provides comprehensive guidelines on engagement of adolescent in research which could serve as a useful guide for research protocol review.45, While the ethical-legal framework for consent is specified in Nigeria, its understanding and application by ethics reviewers needs to be addressed through trainings. Although online psychological services and research based on them are increasing rapidly, it is not that easy to find investigations that focus . Ethical and Legal Issues in Adolescent Pregnancy. Adolescents also face sexual violence; a recognised growing problem and a leading sexual and reproductive health issue. 14 0 obj <> 2014 Feb;54(2):183-9. doi: 10.1016/j.jadohealth.2013.07.028. A plea for consistency over competence in children. https://doi.org/10.1016/j.tics.2004.12.005. At all circumstances adolescent's assent for both medical treatment and research is always mandatory. National HIV/AIDS Reproductive Health Survey. For sexual and reproductive health research in which the risks are low or have minor increase over minimal, consideration should be given to allowing adolescents to consent unassisted to such research so long as the parents or legal guardians or community at large are unlikely to object to the adolescents participation and the protocol justifies why adolescents should be included as participants.52 Also, ethical guidelines in Nigeria should consider the feasibility of engaging adolescents 14 years and above (rather than the current consideration of 16 years and above) in research without the need for parental consent. Rather, researchers may need to always develop tools and processes to impart information, assess understanding, and enhance the voluntariness of decisions for sexual and reproductive health research conducted in adolescents that require therapeutic interventions. 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. To help inform ethical and safety recommendations for the design, conduct, and reporting of . Intrinsic ones include developmental considerations in physiology, pharmacology, and behaviour. It states that: Some studies involve investigation of adolescents beliefs and behaviour regarding sexuality or use of recreational drugs; other research addresses domestic violence or child abuse. Legally, these caregivers may not be recognized as the legal guardian. In practice, adolescents aged 15 years are regularly engaged in national surveys on HIV prevalence.6 While it is recognized that a constitutional pronouncement supersedes all other ordinances and pronouncements, these disparities in pronouncements and practice all recognize a particular need of older adolescents when it comes to health care research. Impact of three years training on capacity of ethics committees in Nigeria. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Importance of investing in adolescence from a developmental science perspective. Epub 2015 May 20. official website and that any information you provide is encrypted The 2011 (version 7.0) National Health Research Ethics Code also contains provision for soliciting consent from parents or legal guardians and for obtaining assent from minors participating in research. Nigeria Demographic and Health Survey 2008. Unable to load your collection due to an error, Unable to load your delegates due to an error. Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece. Federal government websites often end in .gov or .mil. 8 0 obj Before Open discussions about adolescents and issues that related to them are limited and conservative. Confidentiality concerns can be a critical barrier for young patients in seeking and receiving appropriate medical services, and confidentiality protection represents an important evidence-based practice in adolescent health care. 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. What Can Parents Do? x\mo8 "ERKfMp7cJ{fb7plKgr~drE$Z-wgoc7g 12 0 obj In Nigeria, despite the stipulated legal age of consent of 18 years, a large proportion of adolescents are sexually active. Abigail Harrison, Behavioral and Social Sciences with the Population Studies and Training Centre, Browns University, USA. <>/MediaBox[0 0 612 792]/Parent 3 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Tabs/S/Type/Page>> 1982 Oct-Dec;3(4):307-18. doi: 10.1016/0193-3973(82)90003-x. 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. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. https://doi.org/10.1037//0278-6133.9.6.701. One major concern about adolescents is their ability to comprehend. ISBN: 978-1-58110-6473, The Lighthouse, Children and Families, McGill University, Montreal, QC, Canada, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Childrens Hospital at Sinai and Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD, USA, You can also search for this author in 33. FOIA PIP: J Adolesc Health. In extraordinary circumstances, however, there may be a need to disclose information divulged by a minor during research to the legal caregiver. Morenike Oluwatoyin Folayan, Department of Child Dental Health and the Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Steinberg, L. 2005. PDF Altmetric Case Jennifer, 15, is a sophomore at Middlefield High School who has made an office appointment with Dr. Wilson, an ob-gyn, for the first time. 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. Provided by the Springer Nature SharedIt content-sharing initiative, https://doi.org/10.1007/978-3-030-86182-7_10, https://doi.org/10.1016/j.psc.2009.02.001. Diekema, D.S. 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. Careers. MeSH https://www.who.int/health-topics/adolescent-health#tab=tab_2. Careers. Bridget Haire, Centre for Values, Ethics and the Law in Medicine, University of Sydney, New South Wales, Australia. In Nigeria, ethics committees may have to act based on their informed discretion as the Section F(f13) of the National code provides limited guidance on this subject matter. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The .gov means its official. Owen, and N. Woolacott. Subject. sharing sensitive information, make sure youre on a federal https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2014/can-a-child-provide-consent. Adolescents have unique intrinsic and extrinsic challenges that face them when considering participation in research. Birkeland MS, Melkevik O, Holsen I, Wold B. Without ovulation, adolescents lack progesterone, which may influence the vaginas local immune responses. Confidential health care for adolescents: Position paper of the Society for Adolescent Medicine. 2020b. The Nigeria Adolescent Health policy accepts the adolescent age range as the second decade of life, 1019 years2 in line with the definition by the World Health Organization3. Ringheim K. Ethical and human rights perspectives on providers obligation to ensure adolescents rights to privacy. Unfortunately, there is little clarity on how to manage confidentiality in research involving adolescents. 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. The 2008 NDHS shows that 23% of women age 1519 have begun childbearing, 18% have had a child and 5% are pregnant with their first child. A good starting point may be the conduct of a national youth sexual and reproductive health survey. 13 0 obj 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. Careers. The natural history of cigarette smoking: Predicting young-adult smoking outcomes from adolescent smoking patterns. <>/ProcSet[/PDF/Text]>>/Type/Page>> 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. Careers. 3 0 obj These include the need to understand the determinants of specific patterns of sexual behavior and practices, predictors and age of onset of active sexual life, life-long impact of sexual behavior on adolescents physical and psychological health, and the health and psycho-social needs that results from these issues. Council for International Organizations of Medical Sciences (CIOMS). 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.. and transmitted securely. Legal and ethical issues facing adolescent health care professionals. Braking and accelerating of the adolescent brain. 32: 243257. official website and that any information you provide is encrypted The .gov means its official. Disclaimer. The informed consent process may become more complicated during pregnancy because of the presence of the fetus and the obstetrician-gynecologist's dual concern for maternal and fetal well-being. & GfFq`sC\f~*)(^guO7Rtw!|&*y8%}j:]U;G1v $`Z-g r5bRN{T$7%}UJ6umDQ_vG]Z4%^v~8*'nJ,'0w=x Vc" yB] w0)|1/xqII x5i* M|GO'jknR^@\QB1 Reproductive health. Questioning the significance of the non-identity problem in applied ethics. Silber, T., A. English (eds). Age limits and adolescents. Steinberg, L. 2013. Kiser JJ, Fletcher CV, Flynn PM, et al. The site is secure. It is however possible that ethics review committees waive a requirement for parental permission for adolescent participation when there are compelling reasons warranting this action. Steinberg, L., E. Cauffman, J. Woolard, S. Graham, and M.T. Ethical questions in adolescent contraception. 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 In this paper, we consider the ethical and legal issues posed by pregnancy testing in such individuals and suggest how guidance might be framed. An adolescent with an eating disorder. Background and Objectives: In pregnancies resulting from incest, the adolescent maintains close family and emotional relations with the aggressor, different from what occurs when pregnancy results from sexual violence by strangers. The principles of ethics require that researchers respect study participants autonomy and right to confidentiality. 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. The .gov means its official. Epub 2013 Sep 25. Adolescent pregnancy is a global health issue. <>stream Springer, Cham. 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. <> Dev World Bioeth. Microbicides are potential sexual health products that should reduce the possibility of HIV infection through vaginal and or anal sex. The https:// ensures that you are connecting to the National Health Research Ethics Committee. https://doi.org/10.1001/virtualmentor.2005.7.3.ccas2-0503. Key facts. Researchers should ensure the adolescent demonstrates capacity for comprehension and required actions. Sacks, D., Canadian Pediatric Society Adolescent Health Committee. Adults before their time: Children in Saudi Arabias criminal justice system. It will be necessary and important to discuss any instances where such a requirement might occur with the adolescents prior to such disclosure, even where the law requires disclosure. 2020 Jul 2;107(1):3-14. doi: 10.1016/j.ajhg.2020.05.002. Caring for Adolescents: Unique Ethical Considerations. 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. Please enable it to take advantage of the complete set of features! Requiring adolescents to seek parental consent for their participation in the study may nullify this obligation to assure confidentiality41 and may compromise the quality of generated data. Before and transmitted securely. Adolescents menstrual patterns also differ from adult women, as some 80% of adolescents will have cycles without ovulation within four years after menarche. 1989 Jun;36(3):681-96. doi: 10.1016/s0031-3955(16)36691-3. Constitution of the Federal Republic of Nigeria. 44 0 obj Legal and ethical issues facing adolescent health care professionals. The Ethical Issue. Tools. Ethical and Legal Issues in Adolescent Pregnancy. Adolescent abortion and mandated parental involvement. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Federal government websites often end in .gov or .mil. Ford, C., A. English, and G. Sigman. Ethical issues in adolescent pregnancies Int J Gynaecol Obstet. The Child Rights Act5 however, provides that a child who has attained the age of 16 years has the right to give consent for scientific investigation without parental consent. This paper examines the various potential ethical issues that may impact stakeholders decision making when considering engaging adolescents in research and makes a case for lowering the age for consenting by adolescents. 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. In: Nortj, N., Bester, J.C. (eds) Pediatric Ethics: Theory and Practice . For example, a 12 year old who tests HIV positive and needs to be enrolled for ARVs will need to have information disclosed to the parent in order to provide access to treatment. Unfortunately, there is perception that adolescents participating in research are more likely to be coerced and may not fully comprehend the issues related to the risk they may be taking when engaged with research. There are 2 legal procedures that have to be accomplished before a child can be adopted: termination of the rights of the natural parents and adoption proceedings. Ford, C., A. English, and G. Sigman. 1983. Some abortions can be performed on adolescents without parental support; however, recent court decisions have provided certain measures for "immature minors." sharing sensitive information, make sure youre on a federal American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care. Trajectories of global self-esteem development during adolescence. An official website of the United States government. To read, Please Download here. Does recent research on adolescent brain development inform the mature minor doctrine? Sexual and reproductive health care for adolescents: legal rights and policy challenges. Georgian]. This is underpinned by the work of the New HIV Vaccine and Microbicide Advocacy Society (NHVMAS) which has been engaged for over 5 years in building the capacity of ethics reviewers in the country on the ethics of biomedical HIV prevention research. Ethical considerations concerning adolescents consulting for contraceptive services. 2003. 2016.
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ethical and legal issues in adolescent pregnancy
