scholarly journals This Wasn’t a Split-Second Decision”: An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy

2021 ◽  
Author(s):  
Beth A. Clark ◽  
Alice Virani
Keyword(s):  
Decision Making ◽  
Hormone Therapy ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Best Interests ◽  
Legal Authority ◽  
Capacity To Consent ◽  
Decision Making Capacity ◽  
The Right ◽  
Trans Youth

AbstractInherent 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.

Narratives of Regret: Resisting Cisnormative and Bionormative Biases in Fertility and Family Creation Counseling for Transgender Youth

2021 ◽  
Vol 14 (2) ◽  
pp. 157-179
Author(s):  
Beth A. Clark
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Hormone Therapy ◽  
Healthcare Providers ◽  
Healthy Development ◽  
Ethical Concerns ◽  
Transgender Youth ◽  
Trans Youth

Gender-affirming hormone therapy is increasingly available to support healthy development of transgender (trans) youth, but ethical concerns have been raised regarding fertility-related implications. In this article, I present data from an exploratory qualitative study of the decision-making experiences of trans youth, parents of trans youth, and healthcare providers serving trans youth related to fertility and family creation. I discuss how cisnormative and bionormative biases can impact care and contribute to ethically problematic narratives of regret. Finally, I offer recommendations to support ethically sound, gender-affirmative fertility and family creation counseling with transgender youth.

scholarly journals Transitions in decision-making authority at the end of life: a problem of law, ethics and practice in deceased donation

2020 ◽  
pp. medethics-2020-106572
Author(s):  
Shih-Ning Then ◽  
Dominique E Martin
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
End Of Life ◽  
Decision Maker ◽  
Legal Authority ◽  
Time Of Death ◽  
Medical Decisions ◽  
Ethical Concerns ◽  
Decision Making Capacity ◽  
Practical Implications

Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person’s life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death (and often preceding death) is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the donation decision (the ‘donation decision-maker’) is different from the person who was granted decision-making authority for medical decisions during the person’s life. To date, little attention has been given in the literature to the ethical concerns and practical problems that arise where this shift in legal authority occurs. Such a change in decision-making authority is particularly problematic where premortem measures are suggested to maximise the chances of a successful organ donation. This paper examines this shift in decision-making authority and discusses the legal, ethical and practical implications of such frameworks.

scholarly journals Consenting to invasive contraceptives: an ethical analysis of adolescent decision-making authority for long-acting reversible contraception

2018 ◽  
Vol 44 (9) ◽  
pp. 585-588 ◽  
Author(s):  
Rosemary Talbot Behmer Hansen ◽  
Kavita Shah Arora
Keyword(s):  
Decision Making ◽  
Pregnancy Termination ◽  
Healthcare Providers ◽  
Parental Consent ◽  
Best Interest ◽  
Adolescent Autonomy ◽  
Long Acting ◽  
The Right ◽  
Satisfaction Rates ◽  
Analogous Reasoning

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception (LARC) methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted.

Outcomes of organ donation in brain-dead patient's families: Ethical perspective

2017 ◽  
Vol 26 (1) ◽  
pp. 256-269 ◽  
Author(s):  
Shamsi Ahmadian ◽  
Abolfazl Rahimi ◽  
Ebrahim Khaleghi
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
Qualitative Content Analysis ◽  
Organ Procurement ◽  
Healthcare Providers ◽  
Traumatic Experience ◽  
Ethical Review ◽  
Ethical Perspective ◽  
Main Category ◽  
Brain Dead

Background: The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. Objective: The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. Methods: This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. Findings: The main category of the data was “Decision to organ donation: a challenge from conflict to transcendence.” This main category consisted of 10 subcategories and 3 general categories. The general categories were “challenging outcomes,” “reassuring outcomes,” and “transcending outcomes.” Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Conclusion: Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.

scholarly journals Validation of the French Version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in a French Sample of Individuals with Schizophrenia: Validation de la version française de l’instrument d’évaluation des compétences MacArthur-traitement (MacCAT-T) dans un échantillon français de personnes souffrant de schizophrénie

2020 ◽  
pp. 070674372096644
Author(s):  
Stéphane Raffard ◽  
Cindy Lebrun ◽  
Yasmine Laraki ◽  
Delphine Capdevielle
Keyword(s):  
Decision Making ◽  
Factor Analysis ◽  
Assessment Tool ◽  
Competence Assessment ◽  
Rater Reliability ◽  
French Version ◽  
Capacity To Consent ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
High Degree

Background: Assessing an individual’s capacity to consent to treatment is a complex and challenging task for psychiatrists and health-care professionals. Diminished capacity to consent to pharmacological treatment is a common concern in individuals with schizophrenia. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is the most common tool used in individuals with schizophrenia to evaluate the decision-making abilities for judgments about competence to consent to treatment. This instrument assesses patients’ competence to make treatment decisions by examining their capacities in 4 areas: understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. Despite its importance, there is no French version of this scale. Furthermore, its factor structure has never been explored, although validated measures are strongly needed to further detect deficits in patients’ decision-making abilities. The goal of this study was thus to empirically validate a French version of the MacCAT-T in a French sample of individuals with schizophrenia. Method: In this cross-sectional study, we included 125 inpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier. The MacCAT-T was administered to patients by a trained psychologist. Patients were also assessed for severity of symptoms, insight into illness, and depressive and anxiety symptoms. Inter-rater reliability and psychometric properties including internal consistency, construct validity, and discriminant and divergent validity were also investigated. Results: The MacCAT-T’s internal consistency was high (Cronbach α of 0.91). A high degree of inter-rater reliability was found for all the areas of the MacCAT-T (intraclass correlation coefficient range, 0.92 to 0.98). Exploratory factor analysis revealed a 2-factor model. The factor analysis explained 50.03% of the total score variation. Component 1 included all subparts of “understanding.” Component 2 included all subparts of “appreciation” and “reasoning” and was therefore labeled “reflexivity.” After Bonferroni corrections, decision-making capacity was positively associated with insight and the severity of psychotic symptoms but not with sociodemographic variables except for education. Conclusions: The MacCAT-T demonstrated a high degree of inter-rater reliability and strong psychometric properties. The French version of the MacCAT-T is a valid instrument to assess the decision-making capacity to consent to treatment in a French sample of individuals with schizophrenia.

scholarly journals Decision Making Capacity or How to Accept Patient’s Refusal for Orthodontic Treatment

2021 ◽  
Vol 2 (4) ◽  
pp. 1-5
Author(s):  
Yulia Bogdanova Peeva
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Orthodontic Treatment ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Treatment Protocol ◽  
Class Iii ◽  
Decision Making Capacity ◽  
Sharing Responsibility ◽  
The Individual

Introduction: Communication in dentistry is bilateral process which usually is based on response (understanding) by the person. That’s why the Oral Healthcare Providers (OHP) should be convinced the consent given by the patient is valid. It means that at the beginning of the treatment the orthodontist will ask a lot of questions and have expectations to receive appropriate answers. There is a specific lack of awareness about the first orthodontic consultation at 7y of age, occurrence and prevention of most of the common tooth jaw discrepancies which affect the oral health, self-confidence and overall development of the child. A variety of socio-demographic, educational, personal and other factors mostly divided into objective and subjective factors influences the perception of facial attractiveness. The orthodontic treatment lays down on the personal desire and attitudes, depends from the motivation but is not without a risk for the patient. The aim of the current research is to present the most objective and subjective factors identifying the patient’s refusal. Material and methods: It’s a case report based on preliminary discussion and orthodontic consultation over the cephalometric analysis and cast models. Orthodontic treatment protocol was followed and given informed consent by the individual was received. Results and discussions: An electronic search was conducted using the Medline database (PubMed), Science Direct, and Scopus. In this case report were described the treatment options for Class III malocclusion with an emphasis on maxillary protraction and existing impacted canine 13. The decision making capacity was evaluated and also what are the objective and subjective factors and how to proceed with patient refusal. Conclusions: Despite the orthodontist’s efforts to improve the management of the dental practice and to attract new patients, these challenges should never been from the first importance. Contemporary dentistry requires that the patient’s right to refuse should be respected and this refusal must be accepted. Because orthodontic treatment is expensive, the process of returning money or sharing responsibility for the treatment depend on the socio-cultural characteristics of both the patient and the doctor. The whole situation requires a very delicate approach, as it affects the image of the dental community in society at whole.

scholarly journals Decision and Gender issue – A correlation study

2020 ◽  
Author(s):  
AMAL SANKAR MUKHERJEE
Keyword(s):  
Decision Making ◽  
Gender Issue ◽  
Correlation Study ◽  
Stress And Strain ◽  
Decision Making Capacity ◽  
Adolescence Period ◽  
The Common ◽  
Behavioral States ◽  
And Gender ◽  
The Right

<p><i>Stress and strain are the common symptoms of the adolescence period. Naturally, their lives are full of emotion and they cannot consider all the possible alternatives to be taken as their decision making. Behavioral states and emotional attitudes always obstruct adolescent learners to take proper decision at the right time. The investigator in this study has analyzed the responses of adolescent learners from rural schools for their irresolution in decision making based on various emotional changes. The study concludes that emotion largely affects the decision-making capacity of adolescent learners’, especially female learners.</i></p>

Emergencies, general medicine, ‘community treatment orders’, and ‘psychiatric advance statements’

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Decision Making ◽  
Psychiatric Treatment ◽  
Good Practice ◽  
General Medicine ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Best Interests ◽  
Important Place ◽  
Decision Making Capacity ◽  
Advance Statements

The implications of the Fusion Law for general medicine, especially inpatient care when non-consensual and involuntary treatment is being considered, are examined in this chapter. The new burdens posed by regulation can be minimized by making requirements essentially parallel ‘good practice’. Involuntary psychiatric treatment in the community under the ‘decision-making capability–best interests (will and preferences)’ principles of the Fusion Law would be substantially different from the way it is commonly instituted today. The Fusion Law offers an important place for ‘advance statements’ and ‘advance directives’, supporting respect for a patient’s beliefs and values (or ‘will and preferences’). Illnesses that impair decision-making capacity, but that are relapsing-remitting—such as the majority of mental illnesses—are good candidates for such advance planning, yet such measures have rarely been employed to date.

Abstract W MP7: Predictors and Implications of Capacity to Provide Informed Consent for Acute Ischemic Stroke Treatment Trials

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Hari Kishan R Indupuru ◽  
Loren Shen ◽  
Amber N Jacobs ◽  
Chunyan Cai ◽  
James C Grotta ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Informed Consent ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Capacity To Consent ◽  
Decision Making Capacity ◽  
The Right ◽  
Study Designs

Background and objectives: Enrollment into AIS trials has always been limited by the ability of the patient to give informed consent or the availability of a Legally Authorized Representative (LAR) in decision making capacity on behalf of the patient. In this analysis we try to identify the factors contributing to an acute ischemic stroke (AIS) patient’s inability to give informed consent. We hypothesized that clinical features and demographics would differ between those patients with and without capacity to consent. Methods: This analysis includes patients who enrolled into the coordinating center of the prospective, randomized ARTSS-2 clinical trial (Argatroban + TPA for acute ischemic stroke) and also screen failures due to inability to consent. Data is collected prospectively in the study screening log. The data collected included age, gender, race, NIHSS, lesion location, ER arrival time and mode of consent (self-consent, LAR-consent and unable to consent). Results: Between 12/11 and 06/13, a total of 33 acute ischemic stroke patients received IV-tPA and were eligible for the ARTSS-2 study. While 19 were enrolled, 14/33 (42.4%) were otherwise eligible, but not enrolled due to inability to self-consent and no LAR present. Patients not enrolled due to lack of capacity to consent and without LAR present tended to have higher median NIHSS scores and greater proportions of drowsiness and aphasia compared to the other groups (see table). Conclusion: Approximately 2 in 5 AIS patients are not eligible for AIS clinical trials based solely on their lack of capacity for informed consent. It is remains ethically imperative that current clinical trials as well as future study designs address this disregarded group of patients who deserve the right to be able to participate in research. Addressing this group of patients through exception from informed consent (EFIC) will both extend research to all stroke patients, but also greatly enhance AIS research.

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